Meniscal Tears: Conservative treatment vs. Surgical intervention

More than 35 percent of the population over 50 years of age has a meniscal tear. Some do not have symptoms, but for those living with pain, there is new evidence to support conservative measures, including Physical Therapy, before considering surgery.

The meniscus aides in the stability of the knee, which takes on excess force during exercise. 

Meniscal tears often occur after weight-bearing or twisting activities; however, they can also be deteriorating in nature. Meniscal injury often occurs in the active population with sudden acceleration/deceleration. 

Surgery vs. Conservative Treatment Recommendations:

Surgery is typically recommended for healthy individuals who are active. There have been a number of systematic reviews and meta-analysis on the effectiveness of surgery (meniscectomy) versus conservative treatment. The overwhelming conclusion to date is that the long term outcomes including pain and function are the same. Research suggests Physical Therapy prior to surgical intervention is beneficial. The primary risk of undergoing meniscectomy is primarily progressive osteoarthritis (wearing down of the cartilage). Osteoarthritis can result in patients undergoing total knee arthroplasty at a younger age than those who did not undergo surgical intervention. Many surgeons are now opting to preserve as much cartilage as possible in order to avoid ‘point loading’ after altered biomechanics post operatively. 

Rehabilitation & the Meniscus

Rehabilitation after partial meniscectomy can vary depending upon many factors including procedure performed, presence of additional pre-existing conditions, BMI, motivation, and activity level. Studies suggest an accelerated rehab program including mobilization, and full weight bearing, which led to better outcomes and improved mobility, strength and return to prior activity. Another factor to consider is the mechanism of injury (traumatic vs. gradual), as well as a valgus deformity (when the joint or bone angles outward), the approach to exercise post-operatively may need to be more conservative in nature. When a full complex meniscal suture or meniscal transplant is performed, the length of time to return to normal activity can be up to 1 year.

Acupuncture/Needling

A number of articles support the use of needling techniques with respect to deterioration in the knee as well as meniscal injury. Dry needling and acupuncture may be advantageous in the healing of meniscal injury and promote an increase in blood flow as well as improve inflammation and pain. Acupuncture and needling appear to aid in pain relief and improved functional scores both pre and post-operatively.

Conclusions

Meniscal injury is a common condition encountered in outpatient orthopedic clinics. Surgical intervention was commonly thought of as the most successful course of treatment; however, it appears other conservative measures are emerging as a less invasive and clinically relevant course of treatment, especially when treating deteriorating tears.  

Written by: Amber Walker, MSc PT, Cert. SMT, Cert. DN, DIP. Osteopractic