Arthroscopic surgery to treat either a degenerative meniscus or an acute meniscal tear has been topical in the past 10-15 years. It has been said that one sub-group who may benefit are those with symptoms of “catching” and/or “locking” of the knee. If these symptoms are present and corelate to findings on MRI, this provides a strong rationale for meniscal surgery.

 

It is important to note that a study found younger patients under the age of 40 years of age with mechanical symptoms improved more in patient-reported pain and function than those without mechanical symptoms after meniscal surgery (2). One study found mechanical symptoms were relieved in the same extent in the exercise group as the arthroscopic meniscal group (3). Additionally, no differences were observed at 3 years of follow-up time between the exercise group and the surgery group (4). 

So what next, physiotherapy or surgery?

When a patient turns up to the physiotherapist or orthopaedic surgeon, both health professionals will take into account a combination of the MRI that may confirm a meniscal tear but they will be cautious in considering whether the symptoms can be attributed to the meniscal tear.

The relationship between meniscal tears and mechanical symptoms may explain why surgery does not relieve these symptoms better than placebo surgery or result in larger improvements compared to patients without mechanical symptoms and degenerative meniscal tears. 

Overall the Orthopaedic Surgeon and Physiotherapist will always advise physiotherapy as the first line of treatment.

At WiSE we have comprehensive care for your injuries, with a Fracture Clinic run by Othopaedic Surgeons, under Prof Munjed Al Muderis  and physiotherapists from SIM Physio. Our interdisciplinary team works together to provide the best care for our patients.

References:

1. Sihvonen, R., Englund, M., Turkiewicz, A., Jarvinen, T., 2016. Finnish Degenerative Meniscal Lesion Study G. Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial. Ann Intern Med, 164:449-55.

2. Pihl, K., Turkiewicz, A., Englund, M., Lohmander, L., Jorgensen, U., 2018. Change in patient-reported outcomes in patients with and without mechanical symptoms undergoing arthroscopic meniscal surgery: A prospective cohort study. Osteoarthritis Cartilage, 26:1008-16.

3. Kise, N., Risberg, M.,Stensrud, S., Engebretsen, L., Roos, E., 2016 Treningsterapi versus artroskopisk meniskreseksjon; Hva skjer med mekaniske symptomer? In: Høstmøte 2016, Norsk Ortopedisk Forening.vol. 2016. Oslo: Norsk Ortopedisk Forening; 2016:203.

4. Gauffin, H., Sonesson, S., Meunier, A., Magnusson, H., Kvist, J., 2017. Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 3-Year Follow-up of a Prospective, Randomized Study. American Journal of Sports Medicine, 45:2077-84.