Can specific physio for the knee assist after tearing your meniscus?
An injury to the cartilage of the knee can occur suddenly on the sporting field or can occur gradually. A surgeon will typically smooth damaged cartilage and remove fragments in an attempt to address the cause of the patient’s symptoms. This is knee arthroscopic surgery. The most common orthopaedic procedure performed. Often you’ll hear about a football player getting a “clean out” of their knee. Well that’s a knee arthroscope. A knee arthroscopy is often used as the first treatment for meniscal tears. But is this a good idea?
What is the meniscus?
The knee has two thick pieces of fibrocartilage that function as shock absorbers, protecting the cartilage covered surfaces of the knee. This fibrocartilage is known as the meniscus. Just like the shock absorbers of your car, they wear out.
A meniscal tear can be acute, coming on suddenly, or can be degenerative in nature. Degenerative meniscal tears don’t require a specific injury to occur and they tend to develop slowly. They are quite prevalent affecting 25% of 50-59 year olds, 35% of 60-69 year olds and 45% of 70-79 year olds. In fact 75-95% of knee osteoarthritis sufferers have meniscal tears.
Is surgery required for meniscal tears?
So do you need an operation? Like the management of any injury factors must be taken into account such as the patient’s age, the severity of the condition and how long it has been persisting for. A big thing to consider with meniscal injuries is whether pain is accompanied with a locking of the joint. A thorough examination is essential for an accurate diagnosis and the implementation of an effective treatment plan. But what does the evidence say?
Is physio for the knee enough for degenerative meniscal tears?
Evidence is suggesting we try conservative methods first, such as physio for the knee, especially for middle aged (35-65 year old) sufferers. A study in 2016 compared exercise therapy to surgery for degenerative meniscal tears. They found no difference in the outcomes of the two groups except that strength had increased in the exercise group at the 3 month mark.
A 2015 published study split patients with degenerative meniscal tears into two groups that received either keyhole surgery or a sham procedure. The sham procedure group were anaesthetised and incisions were made, but no internal work was undertaken. Therefore the patient was unable to tell if they had received surgical work to their meniscus. At a 12 month follow up, there was no difference between the group that had undergone surgery to their meniscal tears and the group that didn’t.
Conservative approaches that are Evidence based like the GLAD program should be the frontline approach for degenerative knee joints. Here is the link to GLAD Australia if you wish to read more. Alternatively read my post on the GLAD program as I am a qualified instructor.
professional knee assessment is crucial
So what does this mean? Well firstly it’s important to find a physiotherapist suited to your specific injury and have your knee correctly assessed. A thorough assessment, both verbal and physical, is essential and may require scans of the joints.
Some meniscal tears absolutely require surgery. However, in many cases attempting to treat the knee conservatively is the best course of action. Conservative measures such as knee physiotherapy and a graduated exercise program. So if, or when, you have a grumbling knee consider this before running for the knife.
R, Paavola M, Malmivaara A et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013;369(26):2515–24. 36.
Kise NJ, Risberg MA, Stensrud S 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 2016;354:i3740
Salata MJ, Gibbs AE, Sekiya JK. A systematic review of clinical outcomes in patients undergoing meniscectomy. AM J Sports Med. 2010 Sep;38(9):1907-16.