Sports Injuries

22 July 2016

Surgery not always needed for meniscal tears in the knee

About 2 million people worldwide undergo knee arthroscopies each year – although there's debate over how valuable these procedures are for meniscal tears.

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A meniscal tear is a common and disabling knee injury affecting many Americans at some point in their lives.

Rubbery discs

Now, new research suggests that in many cases, exercise may work just as well as surgery to heal the condition in middle-aged people.

Meniscal tears occur when damage is done to the rubbery discs that cushion the knee joint.

According to the European research team, about 2 million people worldwide undergo surgeries known as knee arthroscopy each year – although there's debate over how valuable these procedures are for meniscal tears.

To help settle the matter, a team led by Nina Jullum Kise, an orthopaedic surgeon at Martina Hansens Hospital in Sandvika, Norway, tracked outcomes for 140 patients.

These patients averaged 50 years of age and had degenerative meniscal tears, largely without any signs of arthritis.

Read: Repeat injuries after knee surgery common in young athletes

Half of the patients performed two to three supervised exercise sessions a week for three months, while the other half underwent arthroscopic (keyhole) surgery, followed by simple daily exercises at home.

Differing views

After three months, thigh strength improved in the exercise group, but not in the surgery group, Kise's team reported. After two years, pain, sports and recreation function, and knee-related quality of life were similar for both groups, the findings showed.

Thirteen (19 percent) of the patients in the exercise group also underwent knee surgery during the study follow-up period, but it did not provide them with any additional benefits, the researchers said.

According to Kise's group, the findings suggest that exercise therapy should be considered for middle-aged patients with meniscal tears.

Two knee specialists in the United States had differing views on the findings.

Read: Dealing with a dislocated knee like a boss!

Dr Matthew Hepinstall is an orthopaedic surgeon at Lenox Hill Hospital in New York City. He said the new study "complements prior research" finding much the same thing, and he believes that "the majority of patients can experience significant improvement over weeks to months without undergoing surgery".

Conservative treatments

He did offer one caveat, however: the size and cause of the tear matters. "The study results are most likely to apply to patients with small degenerative tears that occur without a discrete injury," Hepinstall explained.

Still, "the bottom line for middle-aged patients with meniscus tears is to try conservative treatments [such as exercise] before jumping to surgical intervention," Hepinstall said.

But another orthopaedic surgeon took issue with the study's design.

"Many important factors were not taken into account," said Dr Victor Khabie, who co-directs the Orthopaedic and Spine Institute at Northern Westchester Hospital in Mount Kisco, New York.

Read: New ligament discovered in human knee

"This study did not look at 'injuries', it only looked at patients who did not have a specific traumatic event. Middle-aged, athletic individuals who sustain sports-related injuries causing meniscal tears comprise a significant proportion of individuals evaluated in an orthopaedics office; excluding these patients limits this study," Khabie said.

Unique characteristics

"My sense is that if this population of patients were examined, a significant benefit to knee arthroscopy would be seen," Khabie said.

He also agreed with Hepinstall that the benefits of an exercise regimen without surgery might be limited to smaller meniscal tears. "The study included 'all' meniscal tears," Khabie noted. "Most orthopaedic surgeons will only offer surgery to large tears, which on physical exam correlate with the patient's symptoms."

According to Khabie, "The bottom line is that each meniscal tear has its own unique characteristic. Only a well-trained orthopaedic surgeon with experience in knee surgery can determine the best treatment option for any given patient."

The study was published in the BMJ.

Read more:

What are sports injuries?

Causes of sports injuries

Symptoms of sports injuries

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Sports Injuries Expert

Adrian Rotunno is a medical doctor in the Sports & Exercise Medicine fellowship at the Sports Science Institute of South Africa, and qualified physiotherapist. Team physician for Dimension Data pro-cycling, and Boland Rugby. Special interests include endurance sport, in particular cycling, as well as contact sports.

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