Knee surgery vs exercise: a new study evaluates the benefits of meniscus surgery

With an incidence rate of 61 people out of every 100,000 suffering an acute meniscus tear every year, according to the British Orthopaedic Sports Trauma and Arthroscopy Association, this is one of the most common knee injuries.

The meniscus are basically nature’s shock absorbers. They are the crescent-shaped pieces of cartilage that sit between the femur and tibia, one on the inner side of the knee and one on the outer side, they also distribute load in the knee and help spread lubricating fluid around the joint. Most trauma to the meniscus is caused during sporting activities, particularly any movement that involves twisting and bending the knee. However, the meniscus can also become worn over time, so many older patients can suffer a tear, despite there being no perceptible traumatic episode.

One option for treating a meniscus tear is surgical repair, but a new study, recently published in the British Medical Journal, indicates that exercise could be just as beneficial as surgery.

How will I know if I’ve torn my meniscus?

Typically, there will be a specific incident that involves twisting the knee, usually when changing direction suddenly during sport. You may hear a popping sensation when the trauma occurs.

In the immediate period, the knee swells up, but this usually dissipates. Afterwards, patients will commonly feel pain on either the inside or outside of the knee, depending on which meniscus is torn. They may also feel that the knee is unstable and ‘gives way’. Alternatively, the knee can ‘lock’ and the patient is unable to fully straighten the knee joint.

Consultant orthopaedic surgeon and knee specialist, Mr Jonathan Webb will typically be able to diagnose a tear of the meniscus based on patient history and clinical examination, but this diagnosis can be confirmed with an MRI scan.

Why is surgery offered after a meniscus tear?

Part of your evaluation at Mr Webb’s London or Bristol knee clinics is to assess your knee’s function. One consideration is that you will have an increased risk of developing osteoarthritis in the knee joint in the future. A conservative, non-surgical approach may be advised in the first instance and this recently published study from a combined team of Norwegian and Danish scientists highlights the importance of exercise to strengthen the supporting structures of the knee.

However, if symptoms are severe and affecting the patient’s quality of life and non-surgical methods have failed to provide relief, then an arthroscopic procedure may be preferred. Small incisions are made at the front of the knee and an arthroscopic camera is inserted along with specially designed surgical instruments that can either repair the meniscus or trim the cartilage, leaving only healthy tissue.

Mensical repair can achieve a success rate in excess of 80%, but patient selection is key, in terms of the age of the patient, the amount of existing wear and tear and the position and extent of the tear.

However, in the study of 140 patients in Norway and Denmark, with an average of 50 and suffering from a degenerative meniscus tear, it seems that exercise route could be as beneficial as surgery. The patients were split into two groups, one who opted for surgery and the other that embraced physical therapy to manage the symptoms.

In the exercise group, each patient received a personalised training programme that encompassed careful warm-ups and strength training, all under the supervision of a trained physiotherapist.

Orthorthopaedic surgeon and member of the team Dr Jullum Kise commented, “Two years later, both groups of patients had fewer symptoms and improved functioning. There was no difference between the two groups.”

It is important to note that the study focused on middle-aged patients – younger patients that have suffered a tear in the meniscus as a result of sudden trauma can respond very well to surgery. Mr Webb can offer expert, impartial advice on the best option for you, whether surgical or non-surgical. To arrange a consultation at his Bristol or London knee clinic, call 08450 60 44 99.