A torn meniscus is one of the most common knee injuries, but surgery may not be the best option.
Each knee has two menisci, C-shaped pieces of cartilage that acts as a cushion between your tibia (lower leg) and femur (thigh). The meniscus can be injured traumatically when your knee twists, or gradually over time. A torn meniscus can cause pain, swelling, and stiffness. Some people’s knees “lock up” and have trouble bending or straightening.
For years, surgery was the common solution for meniscus tears, with almost a million meniscectomies performed every year in the US at one point. The problem? Most of the time meniscus surgeries are unnecessary, and the outcomes are no better (and sometimes worse!) than physical therapy.
In 2013 a group of Finnish researchers did a randomized controlled trial comparing meniscectomy with a fake meniscectomy or sham surgery. After 12 months of follow up, the sham surgery group and the meniscectomy group had the same results. After a few years, the sham surgery group had less pain and better function than the group who had the real surgery.
Since that study in 2013, numerous other studies have shown that for most types of meniscus tears, physical therapy outperforms surgery (which usually also includes PT!).
Treatment in the clinic usually involves manual therapy, often to help improve range of motion and muscle activation in your hips and ankles as well as your knee. Mostly, though, meniscus rehabilitation consists of prescribed exercises to improve swelling, range of motion, pain, and strength.
References
Holzer LA, Leithner A, Holzer G. Surgery versus physical therapy for meniscal tear and osteoarthritis. N Engl J Med. 2013;369(7):677. doi:10.1056/NEJMc1307177
Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis [published correction appears in N Engl J Med. 2013 Aug 15;369(7):683]. N Engl J Med. 2013;368(18):1675-1684. doi:10.1056/NEJMoa1301408 van de Graaf, V. A., Noorduyn, J., Willigenburg, N. W., Butter, I. K., de Gast, A., Mol, B. W., Saris, D., Twisk, J., Poolman, R. W., & ESCAPE Research Group (2018). Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears: The ESCAPE Randomized Clinical Trial. JAMA, 320(13), 1328–1337. https://doi.org/10.1001/jama.2018.13308
