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Physical Therapy vs. Surgery To Treat Torn Meniscus

A meniscus tear in the knee joint, sometimes referred to as a cartilage tear, is the second most common athletic injury, next to ACL rupture. In some cases, the two injuries happen concurrently, and the risk of a meniscus tear later on is higher after an ACL injury. Many athletes are unable to return to play after a meniscus tear, or are unable to play at pre-injury levels, even after surgery.

In middle aged and older adults, a torn meniscus often occurs in conjunction with osteoarthritis of the knee. Knee cartilage thins and weakens over time, making the tissue more prone to tears. An awkward foot placement or sudden twisting movement may be enough to cause a torn meniscus in someone with degenerative osteoarthritis.

In either case, the injured party will have to decide whether surgery followed by physical therapy is a better treatment choice than physical therapy alone.

Meniscus Anatomy and Function

Your knee joint is formed by three bones, the femur (thigh bone), the tibia (shinbone) and the patella (knee cap). The knee is held together and stabilized by a network of ligaments, muscles and cartilage that enable it to move and function under immense force loads during running, jumping, pivoting and making rapid directional changes.

Each knee has two tough rubbery wedge-shaped shock absorbers, located between the femur and the tibia, one on the inner knee (medial) and one on the outer (lateral).

These cartilaginous structures are called menisci. The menisci are prone to tearing, and sometimes they just wear out.

  • An acute meniscus tear frequently involves rotational force during load bearing activities, such as cutting during a soccer match.  Athletes with a torn meniscus will have swelling, and will feel pain with rotation.  They may complain of their knee “locking” and find it difficult to fully extend the knee.
  • Degenerative meniscus tears may gradually worsen over time, and the patient may not be able to identify an acute onset of symptoms. Sometimes they do not experience any symptoms at all.
  • A torn meniscus can undermine the stability of the knee joint, making the patient more vulnerable to other types of injury.

What the Research Tells Us About Exercise vs Surgery

In 2016 study by Kise et al. published in the British Medical Journal, the authors conducted a randomized controlled trial to “determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears.”

Participants and Methods:

  • 140 middle-aged adults with confirmed degenerative meniscus tears
  • Interventions were either 12 weeks of supervised exercise therapy alone or arthroscopic partial meniscectomy alone
  • Outcome measures were pain, function in sports and recreation, knee-related quality of life and thigh muscle strength
  • Outcome measures were done at baseline and at a two-year follow up

Conclusions:

  • There was no clinically relevant difference between the two groups after two years
  • Exercise therapy showed positive effects over surgery in improving thigh muscle strength

Diagnosis is Key

Accurate diagnosis of the location and nature of a meniscus tear is key. While clinical examination may effectively identify a torn meniscus, imaging can confirm the findings and detect specific details about the injury. Ultrasonography is an excellent diagnostic tool for knee injuries because it enables both the clinician and patient to view the site of injury in real time, and while in motion.

Factors to Consider for Treatment

The location and type of meniscus tear are important factors in determining the best course of treatment. The outer third of the meniscus has a rich blood supply, and a tear in this “red” zone may heal on its own. The inner two-thirds of the meniscus have no blood supply and therefore cannot receive nutrients from blood, making healing nearly impossible. Tears in this “white” zone are often surgically trimmed away.

Besides the nature of your tear, other factors will be taken into consideration when deciding on a treatment protocol, including:

  • Your age
  • Your physical activity level
  • Old or related injuries you have sustained
  • Whether the tear is acute or degenerative
  • Intentions to return to play

One conservative option is to try physical therapy first, and consider surgery only if therapy does not successfully restore function.

Knee Injury Treatment at Back to Health

If you are suffering from chronic knee pain, or if you have an acute knee injury, the knee specialists at Back to Health can help. We use the latest diagnostic strategies to accurately identify the nature and location of your injury. Our team of professional therapists then design a personalized treatment strategy to restore function and help you get back to your busy life, pain-free.

Source

Kise, Nina Jullum, et al. “Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up.” bmj 354 (2016): i3740.

27/12/2017