Knee Pain: Conservative Treatment Versus Surgery

The number of people suffering from knee pain is growing more common each year. At Buffalo Rehab Group, 25% of our patients are rehabbing injuries to their knees. While there are many causes of knee pain, one of the more prominent injuries we see are injuries or tears in the meniscus. The meniscus is the cartilage and cushion of your knee. The main purpose of the meniscus is to provide shock absorption and stability during activities such as running, jumping, walking, and navigating stairs. Depending on the mechanism of injury, tears can either be acute or degenerative, and stable or non-stable. Both of these can effect the management of meniscus injuries.

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Acute Versus Degenerative Tear

Acute meniscus tears are typically the result of a direct trauma or stress to the knee joint. These acute tears typically present with swelling, sharp pain, reported tenderness across the joint line of the knee, and in severe cases, locking or buckling of the knee joint. Acute tears tend to occur in sports involving repetitive contact (football) or repetitive load to the knee (basketball).

Degenerative meniscus tears are more commonly associated with years of “wear and tear” on the knee. In fact, degenerative tears are very common as we age, affecting about 60% of the population over 65 years old (1). When patients are describing these types of tears, there is typically no specific injury to cause pain, but rather a slow progression of a dull ache, stiffness, or noisy knees over a few months, or even a few years.

Stable Versus Non-stable Tear

As mentioned above, acute tears may present with instability or buckling of the knee, while degenerative tears tend to be more stable. It’s instability that may be the most important factor in determining if surgical intervention required. Prolonged instability will cause continued stress to the knee joint as well as limiting the individual functionally. Patients with unstable tears will typically complain of the knee buckling, locking, or catching with activities such as going down stairs, squatting, or even just standing up.

Management of Meniscus Injuries

There are two main treatment options for managing meniscus injuries. Conservative management consists of physical therapy, exercise, and activity modifications while surgical interventions include a meniscus repair or simply trimming the torn piece out (meniscectomy or arthroscopic “clean up.”) In the past, common practice was to perform a meniscectomy to cut out the injured tissue. It was believed that if you cut out the injury, the pain would go away. However, with less than ideal patient outcomes following surgery, doctors turned to recent research for answers.

Some patients had great success following surgical management, while others had no relief. So what gives? To determine the success rate of surgery, there are many factors that come to play. Two of the main factors that determine the long-term success of the surgery include the acuteness of the tear and the stability of the tear.

Turn to the Research

Other important factors which play a role in the long-term success of a meniscus surgery depend on patient age, activity level, and overall health of the joint. If you are under 40 years old, suffering from an acute tear (less than 6 weeks) and have mechanical symptoms of catching or locking, the success rate for surgery can be as high as 85% (2). For those patients who suffer from a degenerative meniscus tear, conservative management should be considered first. Short term success rate following a meniscectomy on a degenerative meniscus tear is only 50% (2). Furthermore, those who underwent conservative management with physical therapy reported better long-term function and less pain when compared to those who underwent surgery alone (3)!

You had to see it coming– the physical therapist supporting conservative treatment. The take home message here is to consider three to six months of conservative management through exercise and activity modification guided by a physical therapist before jumping into surgery for a “quick fix.” Remember, the meniscus is the cushion and shock absorber of the knee. Simply cutting some of it out has been shown to lead to early development of arthritis and also increase the risk for a knee replacement (2,4).

While some meniscus injuries (acute, unstable, and severe) will require surgery, the most common meniscus injury (a degenerative wear and tear) will likely respond to non-surgical intervention. While conservative care is never a quick fix option, patience early on in the injury cycle will lead to healthy, happy knees in the long term.

If you are dealing with knee pain in your daily life, click the link below for your free discovery visit with a physical therapist at Buffalo Rehab Group.

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References

1. N.D.Meniscus Injuries. Meniscus Injuries. Retrieved November 15, 2017
2. Bartolozzi, M.D. Arthur. “Meniscus Tears: When DO I Need Surgery?” Meniscus Tears: When DO I Need Surgery?. N.p., 26 Feb. 2014. Web. 15 Nov. 2017.
3. Englund, M., Roemer, F. W., Hayashi, D., Crema, M. D. & Guermazi, A. “Meniscus pathology, osteoarthritis and the treatment controversy.” Nat. Rev. Rheumatol. 8, 412–419 (2012).
4. “Regular Articles Long-term Outcome of Meniscectomy: Symptoms, Function, and Performance Tests in Patients with or Without Radiographic Osteoarthritis Compared to Matched Controls” Long-term Outcome of Meniscectomy: Symptoms, Function, and Performance Tests in Patients with or Without Radiographic Osteoarthritis Compared to Matched Controls – ScienceDirect. N.p.
5. Stein, Thomas. “Long-Term Outcome After Arthroscopic Meniscal Repair Versus Arthroscopic Partial Meniscectomy for Traumatic Meniscal Tears.” Long-Term Outcome After Arthroscopic Meniscal Repair Versus Arthroscopic Partial Meniscectomy for Traumatic Meniscal Tears The American Journal of Sports Medicine – Thomas Stein, Andreas Peter Mehling, Frederic Welsch, Rüdige Von Eisenhart-Rothe, Alwin Jager, 2010. SAGE Publications Sage CA: Los Angeles, CA, 15 June 2010.

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