Evidence Does Not Support Knee Surgery for Meniscal Tears
Tears in the meniscus, cartilage within our knees, can occur due to injury or degeneration attributed to the aging process. The latter is a much more frequent scenario and often these tears are found on MRIs of patients without knee pain. These false positive results cast doubt on the direct correlation between a picture of your knee and the symptoms you are experiencing. Thus, meniscal tears are found in patients without pain and those with pain can have a negative image. Unfortunately, arthroscopic surgery for these age related tears is on the rise with 700,000 procedures performed in the United States each year (Cullen et al. 2009). Interestingly, a previous randomized controlled trial in the New England Journal of Medicine found no difference in patient outcomes between this meniscal surgery and a sham surgery (Sihvonen et al. 2013).
In the study, 70 patients were randomized to a partial menisectomy (removal of the meniscus) and 76 were randomized to a sham surgery (Sihvonen et al. 2016). In the article published in the Annals of Internal Medicine the authors reported close to half of the patients in either group reported mechanical symptoms such as locking or catching prior to surgery. Surprisingly, no differences were noted between the surgery and sham surgery for relief of pain or mechanical symptoms. The authors concluded, "resection of a torn meniscus has no added benefit over sham surgery to relieve knee catching or occasional locking".
Patients with meniscal tears are advised to work with a local Physical Therapist on an cost and clinically effective treatment plan before considering any surgical procedure.