Experts Recommend AGAINST Surgery For Meniscus Tears
Arthroscopic surgery for meniscal tears in the middle-age to older population is not effective. That is the conclusion of a panel of experts at BMJ.
The meniscus is the most commonly injured part of the knee. In young people a meniscus tear is usually caused by a traumatic twisting injury. In middle-aged and older people, in addition to traumatic injury, tears are often caused by weakness of the meniscus caused by degenerative changes in the knee joint.
Meniscus tears are often described by:
- Position: anterior or posterior (front or back)
- Which meniscus: medial or lateral (inside or outside)
- Type of tear
Studies show that 25 percent of the population over 50 years of age have what are considered degenerative meniscal tears – those NOT caused by a sudden severe trauma.
Arthroscopic knee surgery for degenerative knee disease is the most common orthopedic procedure in countries with available data and on a global scale is performed more than two million times each year with a price tag of over $3 billion in the US alone.1,2
Traditional Meniscus Tear Treatments
Treatment options have traditionally included:
- Watchful waiting – the natural course of symptoms is known to wax and wane
- Weight loss if overweight
- Activity modification
- Physical therapy
- Orthotics and bracing
- Oral or topical medication
- Intra-articular corticosteroid and other injection
- Arthroscopic knee surgery
- Knee replacement or osteotomy
Corticosteroid injections, especially Celestone, are known to be toxic to the tissue in the joint, do not lead to healing, and provide usually only a temporary reduction in symptoms.3 While meniscus surgery remains one of the most common orthopedic procedures performed in the US, several recent studies have shown that surgery to repair a torn meniscus may not offer any benefit or pain reduction over physical therapy.4 In addition, those who undergo these surgeries have a much higher probability of getting a total knee replacement in their lifetime.5
Outcome studies on degenerative meniscus surgery have shown a less than 15 percent, short-lived reduction in pain and improved function that did not last a year.6 Is that worth the missed work, recovery time, risk and costs?
Compare that to data published on 288 similar patients with degenerative meniscal tears who received an office-based bone marrow injection. They showed 30 to 50 percent improved pain and function that lasted a year or more.7 This procedure has a fraction of the recovery time and risks as surgery.
Why Cellular Therapy May Be Your Best Option
Cellular treatment of meniscus tears offers patients a minimally invasive same-day injection procedure that may help heal the injured tissue and allow the individual to avoid the painful and lengthy recovery that typically follows surgery, as well as the long term impact to the knee as a result of removing sections of meniscus. Carolina Orthobiologics Center uses the healing power of your own bone marrow and platelets to help heal this tissue, rather than remove it.
1. Bohensky MA, Sundararajan V, Andrianopoulos N, et al. Trends in elective knee arthroscopies in a population-based cohort, 2000-2009. Med J Aust2012;197:399-403. doi:10.5694/mja11.11645 pmid:23025737
2. Järvinen TL, Guyatt GH. Arthroscopic surgery for knee pain. BMJ2016;354:i3934. doi:10.1136/bmj.i3934 pm id:27439983.
3. Knee Surg Sports Traumatol Arthrosc. 2012 Sep;20(9):1809-14. doi: 10.1007/s00167-011-1820-6. Epub 2011 Dec 21.The chondrotoxicity of single-dose corticosteroids.Dragoo JL1, Danial CM, Braun HJ, Pouliot MA, Kim HJ.
4. Jeffrey N. Katz, MD. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. 2013. NEJM
5. Osteoarthritis Cartilage. 2017 Jan;25(1):23-29. doi: 10.1016/j.joca.2016.09.013. Epub 2016 Oct 3. Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: a multi-center longitudinal observational study using data from the osteoarthritis initiative.Rongen JJ1, Rovers MM2, van Tienen TG3, Buma P4, Hannink G5.
6. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1982 (Published 10 May 2017) Cite this as: BMJ 2017;357:j1982
7. Regennexx registry data on Knee meniscal outcomes.