Do you always need surgery for a meniscal tear?
So, you’ve twisted your knee, or you may even have just crouched down the wrong way and you’ve woken up with a painful and swollen knee joint. It hasn’t settled down after a couple of weeks. You’ve tried the simple things like painkillers ice packs and rest, but now as things are not getting better you make an appointment to see your GP. Your GP arranges for you to have an MRI scan, and now the results are in.
You read the report and it says you have torn your cartilage, “a degenerative meniscal tear”. So, you think to yourself “I must need surgery to sort this out, surely a torn cartilage needs to be taken out and then all my symptoms will get better.”
A degenerative meniscal tear can’t be normal, right?
Many people who come to see me in the clinic will sit anxiously in the waiting room thinking that they will come out of the clinic with a date for their surgery. But for most of those patient’s surgery isn’t usually needed. This is often a relief for many.
When your meniscus is healthy, and not degenerative or worn out, it serves an important role as a shock absorber. But the two menisci in your knee change and lose some of their functionality as you get older. It’s natural to think that surgery is necessary. I’ll try to explain why an operation might not be your first choice to help with your knee problems.
Our joints change as we get older.
Many of you reading this like my patients are probably over 45 years old. And, like many of my patients, many of you may not recall a specific injury that led to the onset of your symptoms. Often something as simple as kneeling down to pick something up or crouching to unload the washing machine or put something in the freezer is enough to put pressure on your meniscus and cause it to tear.
But my MRI scan shows a tear surely this needs surgery to treat it?
Many patients who I see will have already had an MRI scan and will have been told that they have a torn cartilage in their knee. It’s only natural for people to think that this needs to be treated with an operation.
Most meniscus tears in middle age and beyond are “complex degenerative tears.” Think of an old pair of denim jeans. It’s likely you didn’t rip the front of the knee of your jeans. The denim just started to fray; an ageing meniscus is similar. It just begins to fray and that usually means no loose pieces are floating around and nothing is getting caught.
So, what is a degenerative meniscal tear?
It isn’t necessarily “normal” to have these tears. But these types of tears should not worry you too much. We accept grey hair, wrinkles, reading glasses and sagging in various places as a normal part of ageing. But we expect our joints to be free of damage as we get older.
After the age of 40 most of us will NOT have an MRI of the knee that says “Normal.” An MRI is a powerful technology and will show many changes within our knee as we mature. Commonly seen changes include arthritic changes, chondromalacia (softening of the cartilage), meniscus tears, bone marrow oedema (inflammation within the bone itself) and fluid within the knee.
What does the research say about treating degenerative meniscus tears?
The current research on this topic is clear. Most people with knee pain and degenerative meniscus tears have a great chance of responding to Physiotherapy alone. Most of you will not require surgery. It might take a few weeks for the pain from a meniscus tear to improve. So be sure to give it enough time before rushing if for surgery.
Can I exercise with a degenerative meniscal tear?
Many people can’t imagine how moving or exercising a knee with a tear and arthritis is the right thing to do. Many patients come to my clinic because they want to be sure that they carry on with their active lifestyle, most are afraid they might make things worse. Looking at the science in this area and my 20 years of experience I can assure you that keeping active is the right thing to do.
IS MENISCUS SURGERY AN OPTION?
Yes, some people respond very well to meniscus surgery. While most of your knee pain might improve with time, physiotherapy, exercise, and over the counter medications, some people have severe persistent pain. If you do not have any significant arthritic changes, then surgery might be a good option.
Also, if your main symptoms are mechanical, such as locking, giving way or feeling something catching within your joint then surgery may be the right option for you.
This is usually day case procedure called knee arthroscopy where the torn piece of cartilage that may be causing the mechanical problem is trimmed. Think of it like a broken nail sometimes it catches on your clothes, you push it down its fine for a period but if it keeps catching you end up trimming the nail. Unfortunately, your cartilage won’t grow back like your fingernail so it’s important to consider your treatment options carefully.
About the author:
Mr. Gareth Stables MB ChB, FRCS (Ed) T&O
Cheshire Orthopaedic surgeon, Mr Gareth Stables, is a fully UK trained Consultant Orthopaedic Surgeon specialising in knee surgery. Gareth has the highest qualifications possible for an orthopaedic surgeon in the UK, FRCS (T&O), and is on the GMC specialist register for Trauma and Orthopaedic surgery.