Knee Pain: Conservative Treatment vs. Surgery

Knee pain is becoming more common every year, and at BRG, nearly 25% of our patients are rehabbing knee-related injuries.

One of the most frequent issues we see? Meniscus injuries or tears.

The meniscus acts as the cartilage and cushion of your knee, absorbing shock and providing stability during activities like walking, running, jumping, and climbing stairs. Depending on the injury, tears can be classified as acute or degenerative, and stable or unstable. Understanding these distinctions is key to determining the best treatment plan.

Acute vs. Degenerative Tears

Acute meniscus tears often result from direct trauma or stress to the knee. Think sports like football or basketball that involve high impact or repetitive knee loading. Acute tears typically come with sharp pain, swelling, joint tenderness, and in some cases, knee locking or buckling.

Degenerative meniscus tears, on the other hand, are the result of years of “wear and tear” on the knee and are very common as we age. In fact, degenerative tears affect about 60% of people over age 65. With these tears, there’s often no specific injury—just a gradual onset of dull aching, stiffness, or noisy knees over months or even years.

Stable vs. Unstable Tears

Tears can also be stable or unstable.

Stable tears, more common with degenerative injuries, are typically manageable without surgery. Unstable tears, often seen with acute injuries, can cause knee buckling, locking, or catching during daily activities like going down stairs, standing up, or squatting. Prolonged instability not only limits function but also increases stress on the joint, which can accelerate further damage.

Management of Meniscus Injuries

When it comes to meniscus injuries, there are two main approaches to treatment: conservative care and surgical intervention. Conservative treatment includes Physical Therapy, targeted exercise, and activity modifications. Surgical options include meniscus repair or trimming the torn portion through a meniscectomy, often referred to as an arthroscopic “clean-up.”

In the past, meniscectomies were the go-to solution, under the belief that removing the torn tissue would eliminate the pain. However, research has shown that results are mixed, and outcomes can depend heavily on factors like the type of tear, patient age, and overall joint health.

For patients under 40 with an acute tear (less than six weeks old) and symptoms like catching or locking, surgical success rates can be as high as 85% (2). But for those with degenerative tears, conservative care should be the first line of defense. Why? Short-term success rates for surgery on degenerative tears hover around 50% (2). In the long run, studies show that patients who pursue conservative treatment with Physical Therapy report better function and less pain compared to those who go straight to surgery (3).

In addition, removing parts of the meniscus can increase the risk of arthritis and even lead to the need for a knee replacement down the road (2,4).

Turn to the Research

We get it – you might be tempted to jump into surgery for a quick fix. But consider this: giving conservative care three to six months can save you from long-term complications and keep your meniscus intact.

Remember, the meniscus is your knee’s natural shock absorber. Once it’s trimmed, it doesn’t grow back, which could leave your knee more vulnerable to future problems.

While some severe tears (acute, unstable, or causing major limitations) may require surgery, the most common type – degenerative tears – often respond well to non-surgical intervention. And while Physical Therapy isn’t an overnight fix, it’s an investment in healthier, stronger knees for the future.

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, Von Eisenhart-Rothe, Alwin Jager, 2010. SAGE Publications Sage CA: Los Angeles, CA, 15 June 2010.

If you’re dealing with knee pain or have been diagnosed with a meniscus injury, we can help.

Let our skilled Physical Therapists customize an exercise plan to help get you back to the activities you love — without invasive procedures.

Treatment is covered by insurance, no referral is needed, and with multiple locations across Western New York and virtual care, you can find a place and time that work for you.

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