Torn meniscus - surgery vs. physical therapy

A new study finds comparable outcomes for treating a torn meniscus whether repaired by surgery or with only physical therapy by itself.  This opens the door for providing options for patients trying to decide the best treatment method for them.

The signs of a torn meniscus are usually very apparent for most people – knee pain, swelling, popping and giving way.  The largest joint in the body, the knee, is vulnerable to the stresses we place on it from walking, running, climbing, forceful twisting or hyper-flexing of the joint. People age 50 and older who suffer from the debilitating pain and limited function of osteoarthritis (OA) are also suspect to developing a torn meniscus.

The dilemma has been which is better for treating a torn meniscus -surgery or physical therapy. 

The knee is made up of the femur (thigh bone), the tibia (leg bone) and the patella (knee cap).  Between the femur and positioned on top of the tibia are two C-shaped cartilages or pads, one on the medial (inner) side of the knee and one on the lateral (outer) side of the knee.  Each of these pads is called a meniscus.

The meniscus is made up of cartilage giving it a rubbery texture along with fibers of collagen helping maintain the shape of the meniscus.  At the outer attachments to the meniscus is a blood supply but 4/5 of the meniscus has no blood supply and if that area is torn, cannot heal on its own.

Researchers at Brigham and Women’s Hospital in Boston and at six other clinical centers around the nation, wanted to evaluate patients who had a torn meniscus repaired with surgery along with receiving physical therapy and to compare their results to patients who only received physical therapy. Did one method of treatment have a distinct advantage over the other with better outcomes?

A total of 351 men and women ages 45 and older with mild to moderate knee OA and a meniscal tear were recruited for the study.  Half were randomly assigned to receive surgery with post-operative physical therapy while the other half were assigned to receive only physical therapy. The patients assigned to physical therapy could choose to undergo surgery later in the trial if they wanted. 

For a year researchers tracked the participant’s progress by assessing improvements in functional status and pain levels at six months and again at 12 months.

The findings showed that at the six month mark, participants in both groups had similar and noticeably improved levels in both function and pain levels. In the group receiving just physical therapy, 30 percent of the patients did elect to undergo surgery within six months due to their symptoms not improving or even worsening.   Those who remained in the physical therapy group for the full year had continued improvements equal to the group that underwent surgery with physical therapy.

Some considerations to keep in mind in regards to the results of this study is that the age of the patients were 45 years and older – torn meniscuses at this age and older are often due to wear and tear with the main problem being osteoarthritis.  The cartilage at the end of the bone is wearing off and eventually these patients will need a knee replacement.

In the short term, surgery or physical therapy are options but cortisone shots and taking anti-inflammatory medications can also bring temporary pain relief.

Another consideration everyone should make a priority throughout their adult life is to keep themselves active as exercise and maintaining good range of motion nourishes the cartilage of the knee.  Excessive wear and tear on the knee from being overly active, as in running numerous miles a day is more likely to lead to problems with a torn meniscus.  Rather adequate but not overdoing it of physical activity – walking, bicycling, appropriate running – is good for keeping the knees and joints healthy. 

Regular, consistent physical activity will also aid in maintaining an appropriate body weight.  Carrying excess fat or adipose tissue throughout the body can release a number of bioactive substances, known as adipocytokines which trigger chronic low-grade inflammation in the knee joint, among other places throughout the body.  It is believed adipocytokines can break down the cartilage or make the cartilage soft in the knee leading to osteoarthritis.