The most common orthopedic surgery in the United States is performed on the knee meniscus. A level-1 study done in Finland and published in the February 2016 issue of the Annals of Internal Medicine shows that surgery done to repair a locking meniscus is no better than placebo. A large number of studies have shown knee meniscus surgery for other reasons to be ineffective. So if you’re asking yourself, “Should I have meniscus surgery?” the research on the topic is in. The answer to your question is no.

What is a meniscus tear? The meniscus is a natural shock absorber in the knee that provides some spring in your step and helps to protect cartilage. It can become torn with age or trauma. More than 90 percent of the surgeries performed on the knee meniscus are not repairs, as most patients believe, but are instead excisions, or cutting out, of the torn part of the meniscus.

Meniscus tears in middle age are like wrinkles—everybody has them. The big misconception that has been propagated is that meniscus tears as seen on MRI after a middle-aged patient reports knee pain are significant. They are not. Just as many of middle-aged people who don’t have any knee pain or problems have meniscus tears. That your MRI shows a tear is no more important than a new wrinkle on your forehead.

Research shows meniscus-tear surgery doesn’t work.

In 2002, a study by a Baylor College of Medicine orthopedic surgeon showed debridement (cleaning up of a knee that has arthritis and degenerative meniscus tears) to be no better than a placebo. At first many surgeons published comments that in medical parlance equated to wanting to blow up the poor guy’s car, but over the last 15 years the debridement procedure slowly has slipped into medical oblivion.

The next study came from an unlikely source. Framingham, Massachusetts, the same town that has given us such great heart data through the years, also has a government-sponsored osteoarthritis study. This and other studies concluded that just as many middle-aged people without knee pain had meniscus tears as those with knee pain. Ouch

In 2012, a large high-level research study published in the New England Journal of Medicine showed that on average, patients who had meniscus surgery didn’t do any better than patients who skipped the surgery and just had physical therapy. Many orthopedic surgeons criticized that study by saying that these patients had some arthritis and that there was still a justification for performing the procedure on patients with a meniscus tear without arthritis. That fantasy went bye-bye in 2013 when another high-level study showed that meniscus surgery in patients without arthritis was no better than a fake surgical procedure. There was still one condition left where meniscus surgery might be helpful—a meniscus tear that was causing the knee to lock.

The new study out of Finland just burst that bubble. Researchers looked at 146 patients who had “mechanical symptoms” (locking or catching of the knee thought to be caused by the meniscus). They randomized about one-half of the patients to meniscus surgery, and about half got a sham surgery. They found that the meniscus surgery provided no benefit to relieve knee catching or occasional locking, and the doctors cautioned against patients getting the surgery.

Some surgeons still will argue that there still may be a justification for the surgery in patients with severe and frequent locking of the knee or in patients who are younger and have an acute meniscus tear. In the first instance, they may be right, and in the second, given that studies have shown a rapid onset of osteoarthritis and increased forces on the cartilage after a meniscus surgery, younger patients as well should be wary of such surgery

There is little scientific justification that operating on the torn meniscus in patients 35 and older will do any good, and it’s only a matter of time until insurers and national healthcare systems begin relegating this procedure to the dustbin of medical history. So if you’re asking yourself, “Should I have meniscus surgery?” the answer is a resounding no.

 

“Should I Have Meniscus Surgery” first appeared as a post on the Regenexx blog.

Like all medical procedures, Regenexx procedures have a success and failure rate.
Not all patients will experience the same results.

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