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Can I avoid surgery for a torn knee meniscus?

Physical Therapy in San Jose, Los Gatos, Foster City and Burlingame for Knee

Q: I have a torn meniscus in my knee confirmed by MRI. Can I avoid surgery and just do some kind of knee exercises until it heals on its own?

A: There's a lot of confusion right now about the best treatment for tears of the knee meniscus. For sure, we know that removing this C-shaped cartilage in the knee is a bad idea. That just leads to degeneration of the joint and painful arthritis. Repairing the damage and letting the body heal has proven to be a much better alternative.

But even with a partial meniscectomy (removing the ragged edges) and/or repair (stitching the rest back in place), there are still a fair number of patients who do better than others. Or to turn that around, there's quite a few patients who don't do as well as others.

The natural question is why not? What gives some patients good outcomes while others still end up with knee arthritis? Reports from various studies are all over the place on this one. And what about exercise instead of surgery? You ask a very good question.

There aren't very many studies comparing surgery against exercise without surgery as two separate treatment approaches. There is one study that was included in a recent systematic review of outcomes after meniscectomy. The researchers only looked at patients with degenerative meniscal tears. That research method is good but it leaves out a lot of other types of patients with meniscal injuries.

In the study, one group had surgery with exercise afterwards. The other group just did the exercises. The results (measured in terms of activity level, pain, and motion) were the same between the two groups. Follow-up was limited to six months so there's no report on the long-term results.

Obesity defined as a body mass index of 30 or more was an independent risk factor for both osteoarthritis of the knees and poor outcomes after meniscal surgery. That means being overweight puts people at risk for both knee arthritis (with or without a meniscectomy) and poor function after meniscectomy. We bring that up because in addition to trying exercise, weight loss (if needed) might be helpful, too.

You should really talk with your orthopedic surgeon about your choices. Treatment options may depend on your age, level of activity, gender (male vs. female), and type/severity of your meniscal tear.

Reference: Michael J. Salata, MD, et al. A Systematic Review of Clinical Outcomes in Patients Undergoing Meniscectomy. In The American Journal of Sports Medicine. September 2010. Vol. 38. No. 9. Pp. 1907-1916.

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