Meniscus Surgery: A Costly Decision Without Clear Benefits
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Chapter 1: The Reality of Meniscus Surgery
Meniscus surgery often proves to be a misallocation of resources, both time and money. The growing body of research raises serious doubts about the efficacy of meniscectomies.
Healthcare systems can be frustratingly inefficient. As a physical therapist with nearly ten years of experience, I have witnessed firsthand how many medical procedures fail to deliver meaningful results. Among the most questionable interventions are arthroscopic surgeries for the knee.
It's important to clarify that I am not a surgeon, nor is this text intended as medical advice. I am a board-certified orthopedic physical therapy specialist, and my goal is to share a comprehensive review of years of research. If you are experiencing knee issues, please consult a healthcare professional.
Section 1.1: Comparing Surgical and Non-Surgical Options
A Cochrane review analyzed the outcomes of arthroscopic surgery, including debridement and partial meniscectomy, against sham surgery and non-surgical treatments in patients with degenerative knee conditions such as osteoarthritis and meniscal tears.
This review encompassed 16 trials with a total of 2,105 participants, aged between 46 and 65. The comparisons were diverse: four trials compared arthroscopic surgery to placebo surgery, eight trials included exercise regimens, and others evaluated various injections and medications.
The findings were discouraging. The authors reported:
> High-certainty evidence suggests that arthroscopic surgery offers little to no improvement in pain or functionality three months post-operation. Moderate-certainty evidence indicates negligible enhancements in knee-specific quality of life at the same interval, and low-certainty evidence suggests minimal differences in self-reported success up to five years later, compared to sham procedures.
Interestingly, the surgery groups did not show significant advantages over the placebo procedures. In fact, 74 out of 100 participants reported success with sham surgery, while 82 out of 100 felt the same about arthroscopic surgery, with no meaningful differences in pain or functionality.
Subsection 1.1.1: Long-Term Outcomes of Surgery
Let’s delve into the long-term results, particularly at the two-year follow-up. A recent study evaluated data from four trials (involving 605 patients) comparing arthroscopic partial meniscectomies with non-surgical treatments or sham surgeries. Non-surgical approaches included pain management, exercise, and watchful waiting.
All four studies tracked outcomes over 24 months, focusing on knee pain, overall function, and quality of life, alongside mental health assessments and adverse events.
At the two-year mark, results between the surgical and non-surgical groups were nearly indistinguishable. The surgical group reported slightly lower pain scores, but the difference was merely 2 points on a 10-point scale. This improvement was largely due to patients with severe initial pain and functional limitations.
Even those who opted for surgery after starting with exercise therapy saw no better outcomes compared to their non-surgical counterparts. Thus, the only group that might derive some benefit from surgery—those with severe knee pain—achieved only minimal pain relief with no improvement in functionality.
Section 1.2: The Five-Year Follow-Up Insights
In another pivotal study, patients with MRI-confirmed medial meniscus tears were divided into two groups: one undergoing arthroscopic partial meniscectomy (APM) and the other receiving sham surgery. They monitored outcomes for five years.
Despite expectations, the results remained consistent. At the five-year follow-up, 72% of the APM group and 60% of the placebo group exhibited at least one-grade progression in knee osteoarthritis. Both groups reported sustained improvements in symptoms and function, with no significant differences between them.
However, there's more to consider. Surgical patients faced faster progression of osteoarthritis, compounded by the inherent risks of surgical procedures, further undermining the argument for surgery.
A separate five-year study indicated that those assigned to APM were five times more likely to require total knee replacement compared to those in physical therapy. These findings strongly advocate for exercise and rehabilitation, even in the absence of standardized non-operative and post-operative care.
Chapter 2: Understanding Why Surgery Falls Short
Why doesn’t surgery yield the same benefits as exercise?
Firstly, pain is a complex phenomenon that cannot be solely attributed to biomechanical issues. Research consistently shows that imaging results poorly correlate with pain levels.
Secondly, surgical interventions do not enhance muscle, strength, or cardiovascular fitness; in fact, they tend to diminish all three. Muscle strength is closely linked to muscle mass, which directly impacts a person's overall function. Regardless of the surgical procedure performed, inadequate rehabilitation leads to poor outcomes.
Conversely, if someone opts for non-operative treatment but adheres to a subpar exercise regimen, the poor results do not indicate a failure of non-operative care; rather, they highlight the inadequacy of the specific exercise program undertaken.
Given the comprehensive evidence, it's challenging to justify meniscectomies as a wise investment.
What Should You Do if You Tear Your Meniscus?
The key is to focus on building strength. Enhancing your functional capacity primarily involves improving your strength. While mobility is also crucial, strength should be prioritized throughout your range of motion.
Resistance training is essential for achieving both strength and mobility. Start by targeting the quadriceps. Research, including the Quad-x trials, suggests that the knee extension exercise alone can significantly reduce the need for knee replacements. All you need is a resistance band.
The quadriceps are vital for knee extension and are the primary muscles used in activities like standing from a seated position and climbing stairs. While knee extensions are important, it's essential to diversify your exercise routine to include squatting movements. Options include back squats, lunges, step-ups, leg presses, split squats, goblet squats, front squats, zercher squats, and reverse Nordics.
Take a gradual approach to activity. Begin with a pain-free range of motion and progressively increase intensity and frequency as you grow stronger. Mild discomfort is acceptable; it does not necessarily indicate damage.
Even individuals with significant meniscus tears can rehabilitate their knees through exercise. Imaging studies often reveal tears and other issues that do not correlate with pain or functionality. Many individuals remain symptom-free despite notable findings on imaging scans.
Conditions like meniscus tears, rotator cuff injuries, disc herniations, and arthritis do not automatically necessitate surgery. Arthritis, in particular, does not preclude muscle building or strength enhancement, nor does it guarantee chronic pain.
Is surgery never advisable? Not necessarily. In severe cases, surgery may indeed be the best option. However, it's generally wiser to attempt a comprehensive exercise rehabilitation program first. Aim for a trial period of at least three months, ideally extending to a year. Focus on building strength and improving mobility. If you need assistance, seek a knowledgeable physical therapist who can tailor a program to your specific needs.
Always consult multiple healthcare professionals before deciding on surgery.
For more health and fitness insights, tune into the Clinical Gap Podcast, where I release new episodes weekly. Additionally, for concise health and fitness research summaries, subscribe here.
The first video, "Why You Don't Need Surgery For Your Meniscus Tear," discusses alternatives to surgical interventions and emphasizes the effectiveness of non-surgical treatments.
The second video, "The DANGERS of Meniscus Surgery!" highlights the risks associated with surgical procedures and promotes exercise as a safer option.