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Is Surgery a Good Option for Meniscus Tears?

Meniscal tears are quite common. So much so, that they are one of the most common injuries to the knee. Meniscal injuries are routinely treated with surgery, and many with meniscus injuries end up receiving some form of meniscectomy. Nearly 700,000 arthroscopic partial meniscectomies are performed annually in the US, at an estimated annual cost of $4 billion.[i]  Is surgery of this type an effective way to treat meniscal injuries? Believe it or not, research shows that it is not! Several studies question the effectiveness of this procedure. One study found that almost half of patients who received non-operative treatment with nonsteroidal anti-inflammatory drugs improved well enough to avoid surgery.[ii] Three other studies compared arthroscopic meniscectomies with sham surgeries. (A sham surgery is a faked surgical intervention that omits the step necessary for the surgery to be therapeutic.) What were the results?  They found no significant difference between meniscectomy and sham surgery, and they did not find meniscectomies to be effective.[iii],[iv] Additionally, the most recent study showed the surgery did not reduce the mechanical symptoms of knee catching and locking.[v] As you can see, the effectiveness of meniscectomies is questionable.

If Meniscus Surgeries Are Ineffective, Then Why Are They Done?

Patients usually believe the surgery will help their knee to function better and lessen the pain they are experiencing. When the knee locks and catches randomly, people want that to stop, especially since knee locking can be painful. If the person with these symptoms is an athlete, they want to get back to their sport quickly, and they think surgery is going to make that happen. People generally think that surgery can get them back to work or play sooner than other treatment options. But evidence and research does not back up this way of thinking. In fact, many patients are worse off after the surgery.

If You Want to Keep Your Knee Intact, Then Keep Your Meniscus!

When part of the knee, like the meniscus, is removed, the knee is unable to function normally. Removing the meniscus makes the knee unstable. The instability leads to the development of more knee problems. The joint instability that arises after removal of the meniscus negatively affects the interplay between the other structures of the knee, because extra stress is placed on them. When more stress is placed on the cartilage, degeneration is accelerated, boosting the arthritic process. More stress is also placed on the various ligaments and tendons supporting the knee, eventually damaging them and leading to the breakdown of the knee joint and irreversible joint damage. It has been proven in studies that new onset instability is demonstrated after a partial meniscectomy,[vi],[vii] with significant rates of cartilage loss transpiring after both partial and complete meniscectomy, and that these procedures lead to degenerative arthritis and ligament injury in the knee. [viii],[ix],[x] And this information is not new! Adverse effects associated with meniscectomy have been documented in the literature going as far back as 1923.[xi],[xii],[xiii],[xiv]

Regenerative Orthopedics Effectively Repairs Meniscus Tears Non-Surgically

Given the accumulation of evidence demonstrating not only the overwhelming lack of efficacy and benefit, but also the risk of serious adverse effects of this widely used procedure for meniscus tears, it is important to consider potential safe and effective alternatives. Regenerative Orthopedics is a non-surgical solution, used to effectively treat knee injuries such as meniscus tears, as well as other soft tissue injuries like ligament and tendon injuries.[xv],[xvi] Regenerative Orthopedic treatments work by initiating the inflammatory stage of the healing process, raising the levels of growth factors, and initiating repair. The treatments stimulate new cell growth and rebuild depleted tissue, including the regeneration of cartilage.

In certain cases, Platelet Rich Plasma may be utilized. This involves the injection of your own blood components to facilitate the healing of tissue that has degenerated. Platelets are the storehouses of growth factors, and platelet rich plasma is abundant in growth factors, capable of stimulating healing of the injured tissue.

Regenerative Orthopedic treatments can safely and effectively treat meniscus tears without the need for surgery, returning you quickly to the activities and sports you enjoy.

[i] Lowry F. Real knee surgery no better than sham for meniscal tear. Medscape Medical News. December 27, 2013.

[ii] Rimington T, Mallik K, Evans D, Mroczek K, Reider B. A prospective study of the nonoperative treatment of degenerative meniscus tears. Orthopedics 2009 August; 32(8). DOI: 10.3928/01477447-20090624-06.

[iii] Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013; 369:2515-2524.

[iv] Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M. Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ.2014;186(14):1057-1064.

[v] Sihvonen R, Englund M, Turkiewicz A, Järvinen TLN. Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear: a secondary analysis of a randomized trial. Ann Intern MedPublished online 9 February 2016 doi:10.7326/M15-0899.

[vi] Demange MK, Von Keudell A, Gomoll AH. Iatrogenic instability of the lateral meniscus after partial meniscectomy. Knee 2013; 20(5): 360-363.

[vii] Arno S, Hadley S, Campbell KA, et al. The effect of arthroscopic partial medial meniscectomy on tibiofemoral stability. Am J Sports Med. 2013; 41(1): 73-79.

[viii] Flavia M, Forbes A, Yuanyuan W, Rush G, Stuckey SL .Rate of knee cartilage loss after partial meniscectomy. The Journal of Rheumatology 2002;29(9):1954-1956.

[ix] Englund M, Roos EM, Lohmander LS. Impact of type of meniscal tear on radiographic symptomatic knee osteoarthritis. A sixteen-year follow-up of meniscectomy with matched controls. Arthritis and Rheumatism. 2003;48:2178-2187.

[x] Johnson RJ, Kettelkamp DB, Clark W, Leaverton P. Factors affecting late results after meniscectomy. The Journal of Bone and Joint Surgery1974;56A:719-729.

[xi] Berthiaume MJ, Raynauld JP, Martel-Pelletier J, et al. Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis 2005;64(4):556-563.

[xii] Baratz M. Meniscal tears: the effect of meniscectomy and of repair on intra-articular contact areas and stress in the human knee. American Journal of Sports Medicine 1986;14:270-275.

[xiii] McNeill Love R. Prognosis after removal of semilunar cartilages. Br Med J 1923; 2:324–6.

[xiv] McDermott ID, Amis AA. The consequences of meniscectomy. Journal of Bone & Joint Surgery, British Volume. 2006 Dec 1;88(12):1549-56.

[xv] Hackett GS, Hemwall GA, Montgomery GA. Ligament and Tendon Relaxation Treated by Prolotherapy. 5th ed. Oak Park, IL: Gustav A. Hemwall; 1993.

[xvi] Hauser RA, Blakemore PJ, Wang J, Steilen D. Structural basis of joint instability as cause for chronic musculoskeletal pain and its successful treatment with regenerative injection therapy (prolotherapy). The Open Pain Journal 2014; 7: 9-22.