Should I have meniscus surgery? Should I have another meniscus surgery? 

Ross A. Hauser, MD., Danielle R. Steilen-Matias, MMS, PA-C.

Many people who contact our office are in a decision-making process. The decision is to get a meniscus surgery, or, get some type of non-surgical treatment. Many times when we initially discuss meniscus surgery options with people interested in treatment, we ask them if they know what type of surgery are they going to get, total meniscectomy, partial meniscectomy, or suture repair? Many times they do not know because the surgeon told them they themselves do not know what they are going to have to do until they “get in there.”

Waiting until the arthroscopic procedure to figure out what type of surgery I am getting. My MRI was not helpful.

An April 2021 paper in the Australian and New Zealand Journal of Surgery (1) suggested while “Magnetic resonance imaging (MRI) is commonly used for diagnosis and as a research tool, but its accuracy is questionable.” They further wrote that the goal of their study was to compare the accuracy of knee MRI with clinical (in surgery) assessment for diagnosing meniscal tears and to determine the accuracy of MRI for grading chondral lesions. What did they find? “MRI has relatively poor correlation with arthroscopic findings for grading the chondral damage and was less accurate than clinical assessment for the diagnosis of lateral meniscal tears.”

We offer a non-surgical option for meniscus repair and that is why people reach out to us. It is probably the reason you arrived at this article now. To see if our non-surgical option may be an option to your meniscus surgery recommendation. We do understand that there are instances where someone will consider that they have no choice but to have surgery. They are active people whose knees lock up and are acutely painful on movements. The meniscus problem is interfering with their ability to work, participate in sports or simply have a decent quality of life. For some people, meniscus surgery will be successful. The point of this article however is what is the long-term cost of meniscus surgery in terms of knee function and pain? Secondly, if non-surgical options can deliver success equal to or better than surgical intervention.

Should I have another meniscus surgery?

Another of the most common calls our office receives involves patients who have had part or all of their meniscus removed and are now suffering from continued pain or arthritis as a consequence of the meniscus or multiple meniscus surgeries they had.

This is reflected in the types of emails that we get from people looking for help. They go something like this:

I have severe osteoarthritis in both knees. I have had meniscus surgery on both knees. Every day I live with severe pain and swelling in both of my knees. I am told only knee replacements will help me now. I do not want any more surgery. I feel that it is the meniscus surgeries that put me in this position.

I have had meniscus surgery on each knee. X-rays and MRIs show major arthritis in each knee. I can’t walk for longer than an hour without my knees swelling and being so painful I can’t walk anymore. I just turned 50, I do not want to even consider knee replacement without trying everything first

Again, some people do benefit from meniscus surgery in the short-term and near future. It is these recent surgical success patients that we do not see in our clinic. Who we see are the people, who already had meniscus surgery and their knee is causing them problems, or people who do not want a meniscus surgery at this time because of upcoming sports seasons, competitions, or simply, they need to work and there is a waiting list to get the surgery.

This article will focus on the research surround meniscus surgery. If you would like to focus on treatment plans please visit our articles

If you have been given the meniscus injury surgical recommendation, you have been told that you will get one of these three procedures.

One of the primary reasons for a meniscal operation is to improve joint stability, yet meniscectomy often appears to have the opposite effect, as it elicits even more instability, crepitation, and degeneration than the meniscus injury produced prior to operation. This is why reoperation rates after meniscectomy can be as high as documented in the research below.

The fourth procedure – knee microfracture surgery and cartilage implant surgery

The notion that replacing dead meniscus tissue, with a dead person’s meniscus (human allograft) or with synthetic meniscus (really meniscus replacement) is going to prevent osteoarthritis, as discussed in our article Alternatives to knee microfracture surgery and cartilage implant surgery  is not realistic. By the time a person has a damaged meniscus, many other tissues in their joint are also affected included ligaments and tendons that provide stability when strong or provide instability when compromised. The whole knee joint  needs to be treated not just the meniscus tear. The human meniscus is mobile, movable, stretchable and made up of fibrocartilage and has many functions including joint stabilization and the manufacturing of specific mediators of healing that go into the synovial fluid. None of these functions can truly be reproduced by any other type of meniscus besides the persons own meniscus.

Although there is some short term improvement after these surgeries in aspects such as pain control, the long term effects of meniscectomy, meniscal repair, and meniscal allograft transplantation reveal that symptoms, such as pain and instability, will persist for years afterward.

What happens when all or part of the meniscus is removed? Joint instability is a common result of meniscectomy

As mentioned above, the patient will be told that they will eventually develop knee problems. The long-term side effect of meniscus surgery is that meniscectomies worsen knee joint instability by negatively influencing other supporting knee structures by increasing contact stress on the cartilage. The knee’s house of cards will crumble thereafter as increasing contact stress on the cartilage, increases the risk and occurrences of chronic knee inflammation and accelerates the degenerative knee conditions that lead to knee joint erosion or irreversible joint damage to the knee.

Joint instability is a common result of meniscectomy, which is not surprising when considering that the meniscus is a primary stabilizing component of the knee. The knee mensicus provide maximum joint contact protection and thus, reduce the contact stresses on the load-bearing surface of the joint, much like a washer does to distribute the pressure of the nut or bolt evenly and to provide a smooth surface or a double rear wheel (four wheel) truck distributes less pressure on each tire than a normal two rear wheeled truck.

Common physical symptoms of instability after meniscectomy are crepitation, such as cracking or popping, and locking in the joint. On radiographic examination, this postoperative deterioration of the knee is evidenced by narrowing of the joint space between the thigh and shin bones or a flattening of the tibiofemoral surfaces.

Biomechanically, the development of osteoarthritis can in part be explained by the increased stress placed on the tibia and femur post meniscectomy. It is a known fact that reducing the size of contact area on a surface increases pressure in the remaining area. Therefore, by removing part of or the entire meniscus from the knee, the area through which weight is transmitted in the joint is reduced, thus increasing the pressure on both the tibia and the femur and their articular cartilage.

But why did these people have the surgery in the first place? Especially if they were told meniscus surgery could accelerate and cause irreversible knee damage?


It is the patient’s belief that the surgical removal of the whole or part of the meniscus will restore function and lessen their pain.

It can be difficult to tell a patient to have patience when their knee hurts. Most of the time when someone comes into our clinic for the first time they will report on the characteristic symptoms of meniscus related knee problems:

It is also difficult to convince an athlete that meniscus surgery may prevent them from returning to sports altogether. At this point, we will introduce the research from surgeons as a second opinion to our statements.

When you remove the meniscus you remove vital knee lubrication

One of the most vital but lessor known roles of the meniscus is to provide lubrication to the knee, which it accomplishes through diffusing (spreading out) synovial fluid across the joint. Synovial fluid provides nutrition and acts as a protective measure for articular cartilages in the knee. The femoral condyle of the thigh bone in the knee is covered in a thin layer of articular cartilage, which serves to reduce motional friction and to withstand weight bearing. This cartilage is very susceptible to injury both because of its lack of proximity to blood supply and the high level of stress placed on it by excessive motion. The meniscus, therefore, is able to provide a much-needed source of nutrition to the femoral and tibial articular cartilage by spreading fluid to that avascular area.

This illustration demonstrates the reasoning often given to patients that meniscus surgery is the only way.

This illustration demonstrates the reasoning often given to patients that meniscus surgery is the only way.  Menisci have two zones. The red zone is the meniscus’ outside zone the white zone is the inside zone. A red zone tear lies within the blood-rich portion of the meniscus. Where there is a blood supply there is healing as blood brings the healing and growth factors needed for wound repair.  The white zone meniscal tear is thought to be non-healing because there is no direct blood supply.  Many doctors do not believe the white zone meniscus tear can be repaired because of this. This is typically the part of the meniscus removed in meniscus surgery.

This illustration demonstrates the reasoning often given to patients that meniscus surgery is the only way.  Menisci have two zones. The red zone is the meniscus’ outside zone the white zone is inside zone. A red zone tear lies within the blood-rich portion of the meniscus. Where there is a blood supply there is healing as blood brings the healing and growth factors needed for wound repair.  The white zone meniscal tear is thought to be non-healing because there is no direct blood supply.  Many doctors do not believe the white zone meniscus tear can be repaired because of this. This is typically the part of the meniscus removed in meniscus surgery.

Surgeons suggest the reasons people come in for meniscus surgery is over expectation of what the surgery can really do for their knee problem

Doctors writing in The Journal of the American Academy of Orthopaedic Surgeons (2) offer a very good rationale for why people still have meniscus surgery. Here are some talking points of the research:

Evaluating this data, one could imply that:

The risks of cortisone use pre-surgery

Most people that contact us already have a good understanding the frequent or long-term cortisone use has its challenges and risks.

In March 2021, research lead by Rush University Medical Center and published in the journal Arthroscopy (4) found that patients who received knee injections within one month prior to knee arthroscopic surgery developed postoperative infections at twice the rate of those who did not receive an injection.

This of course relates to an injection increasing the risk for surgical infection. But what about the overall impact of corticosteroids on the meniscus?

Corticosteroid short-term success and long-term problems.

It is well understood by most medical professionals and their patients that prolonged and long-term corticosteroid injections for knee pain can break down cartilage including the meniscus. In 2017, doctors from Tufts Medical Center in Boston asked, “What are the effects of intra-articular injection of 40 mg of triamcinolone acetonide every 3 months on the progression of cartilage loss and knee pain in patients with osteoarthritis?”

Writing in the Journal of the American Medical Association, (JAMA) (5they published their answer:

“Among patients with symptomatic knee osteoarthritis, 2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain. These findings do not support this treatment for patients with symptomatic knee osteoarthritis.”

In February of 2020 a review study with the title “Medical Reversals in Family Practice: A Review,” (6) published in the journal Current Therapeutic Research, Clinical and Experimental offered these points:

Cortisone can thin out the meniscus.

In August of 2020 in the journal Scientific Reports (7) doctors expressed concerns about damaging the meniscus tissue with cortisone injections. It should be noted that this research’s main findings were that it was okay to get one cortisone injection. For many people, one injection would be considered safe. Here are the learning points of that research:

Patients undergoing arthroscopic meniscus surgery were too optimistic regarding their recovery time

There is a lure to surgery. We see it every day in our offices. The long-standing belief that surgery will fix everything. A recent paper from the University of Southern Denmark (8) wrote:

The surgical realities of meniscus tear surgery – the research

Between 2013 and 2016 – research began appearing questioning not only the value of meniscus surgery but whether or not the surgery caused more harm than good. Let’s start with a New York Times piece in 2016. The summary is below.

Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscus Tear – Surgery does not alleviate knee catching or knee locking after surgery

The research mentioned above and reported by the New York Times was not the first time the meniscus surgery controversy was reported in the international media. On December 24, 2013, the New England Journal of Medicine published an article entitled “Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear.”(9)

Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. Then a scoring system was designed to measure pain, symptom severity, and knee pain after exercise at 12 months after the procedure.

What they found was “In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.”

In other words, avoid the rush to a surgery that may not fix the patient’s reported problems.

Continuing forward, the lead researcher of this study Raine Sihvonen, MD published more papers on the problems of meniscus surgery.

In February 2018, in the Annals of the Rheumatic Diseases. (10) he and his fellow researchers noted that degenerative meniscus tear can be the result of knee osteoarthritis and not vice-versa: “(Our) results support the evolving consensus that degenerative meniscus tear represents an (early) sign of knee osteoarthritis, rather than a clinical entity on its own, and accordingly, caution should be exercised in referring patients with knee pain and suspicion of a degenerative meniscal tear to MRI examination or Arthroscopic partial meniscectomy, even after a failed attempt of conservative treatment.

In other words, the meniscus tear is the result of knee osteoarthritis development. If you remove the meniscus you accelerate the knee osteoarthritis. We will discuss this further below.

In April 2016, Dr. Sihvonen and colleagues wrote in the Annals of Internal Medicine (11) that removing parts of the meniscus did not appear to relieve the symptoms of knee pain and knee locking in surgical patients. “Resection of a torn meniscus (cutting away tissue that cannot be sutured) has no added benefit over sham surgery to relieve knee catching or occasional locking. These findings question whether (these) mechanical symptoms are caused by a degenerative meniscus tear and prompt caution in using patients’ self-report of these symptoms as an indication for Arthroscopic Partial Meniscectomy.” In other words, avoid the rush to a surgery that may not fix the patient’s reported problems.

Many orthopedic surgeries in my opinion have a far worse outcome then patients anticipate primarily because they cannot return to the activities they love, such as running. When people have arthroscopy surgery I try to go over their surgical reports with them because often what they perceived what was done with the surgery was not done and other things were done that were detrimental and they had no idea they were done.  I have never as far as know seen an orthopedic operative report that showed a real meniscus repair, where the meniscus was sewn together and that was it.  The typical report shows partial meniscectomy and no repair yet the patient believes it was a repair. Every arthroscopy report I have ever seen, has findings that reveal osteochondral lesions, chondromalacia, meniscus degeneration, articular cartilage lesions ligament injury and many others. Remember anyone can have decreased pain by doing less, and unfortunately, many people who receive orthopedic surgeries end up doing less.

Results also showed that meniscectomy did not provide better functional improvement than the nonoperative group

Earlier in 2013 research published in the American Journal of Sports Medicine showed what little value meniscectomy has. Researchers compared meniscectomy to nonoperative treatment for meniscus tears. (12)

At the two-year follow-up, there was no difference in pain relief, improved knee function, or patient satisfaction. Results also showed that meniscectomy did not provide better functional improvement than the nonoperative group.

But what was the difference between these two groups? One group of patients underwent invasive surgery, had tissue remove, and will likely experience long-term meniscus degeneration.

In fact, most surgical meniscus treatments have, “all have a high long-term failure rate with the recurrence of symptoms including pain, instability, locking, and re-injury. The most serious of the long-term consequences is an acceleration of joint degeneration.”

In research from May 2016, (13) doctors warned that the role of arthroscopic partial meniscectomy in reducing pain and improving function in patients with meniscal tears continues to remain controversial and that studies show no difference between arthroscopic partial meniscectomy and non-surgical treatment. 

Meniscus surgery outcomes in American soldiers

Army physicians from the William Beaumont Army Medical Center and doctors from Rush University Medical Center published a March 2018 study in the Journal of Knee Surgery. (14)

It reports on how military surgeons dealt with meniscal injury. The report reveals findings on nearly 30,000 meniscus surgeries.

What are we to make of this?

Does meniscus surgery lead to knee replacement?


To save the knee, you must save the meniscus. A shift is occurring in meniscus surgery but it is just starting

In the July/August 2018 edition of the medical journal Sports Health,(15) surgeons at UCLA talked about the younger patient and why taking out meniscus tissue is really not optimal.

Here are the talking points:

Basically, surgeons need to repair and save the meniscus. They also need to figure out how to do it.

Why do we still perform meniscectomy?

The goal of meniscectomy was to reduce pain, restore knee function, and prevent the development of osteoarthritis. As surgeons had long believed that the meniscus was a “remnant” tissue and that it was not needed, it could be removed if damaged without a negative effect.

However, as medical research studied the long-term effects of this procedure, it became apparent in the medical community that meniscectomy was a primary cause of the sudden onset of knee osteoarthritis. The meniscus was, in fact, an important component of the knee.

The meniscus provides several vital functions including mechanical support, localized pressure distribution, and lubrication to the knee joint. They are made of thick fibrous cartilage that allows them to function as a shock absorber between the upper and the lower leg bones.

Doctors in France writing in the medical journal Orthopaedics & Traumatology, Surgery & Research, (16joined the growing list of doctors rallying under the banner “Save the Meniscus!”

This research asks the same question we do, Why do we still perform meniscectomy?

Why do we ignore a mountain of clinical and scientific evidence against meniscectomy?

They, like us, agree that it is high time that the paradigm shifted, in favor of meniscal preservation.

Now, let’s get back to the reasons why you may still be recommended for meniscus surgery. Surgeons strongly argue that there is validity to meniscectomy

Doctors in Germany (17) say that many of the studies critical of arthroscopic meniscus surgery are not 100% reflective of the patients they see. Medical research is broken up into levels of evidence. Level 1 being base evidence which means a researcher took existing research and combined it into a review of the literature. Doctors and researchers grade this the lowest level of accredited research.

The German doctors say too much level 1 evidence is being offered as a generalization of meniscus surgery. The complaint is some surgeries will help some patients and that every meniscus surgery is not a bad surgery and this research is not reflective of that.

“The treatment of degenerative meniscal lesions should start with conservative management.”

The ESSKA guidelines also say the treatment of degenerative meniscal lesions should start with conservative management. In the case of persistent symptoms, surgery should be considered after 3 months. In the case of mechanical symptoms, arthroscopy might be indicated earlier.

They do say arthroscopy in advanced osteoarthritic knees is not indicated due to inferior clinical outcomes.

The complaint surgeons have is that some surgeries will help some patients and that every meniscus surgery is not a bad surgery and research is not reflective of this benefit.

In March 2020, (18) researchers announced a new study to answer this question. They write of their study:

“Arthroscopic partial meniscectomy after degenerative meniscus tears is one of the most frequently performed surgeries in orthopedics. Although several randomized controlled trials have been published that showed no clear benefit compared with sham treatment or non-surgical treatment, the incidence (numbers performed) of Arthroscopic partial meniscectomy remains high. The common perception by most orthopedic surgeons is that there are subgroups of patients that do need Arthroscopic partial meniscectomy to improve, and they argue that each study sample of the existing trials is not representative of the day-to-day patients in the clinic.”

The researchers of this study announced that they will seek to find “whether there are subgroups of patients with degenerative meniscus lesions who benefit from Arthroscopic partial meniscectomy in comparison with non-surgical or sham treatment.”

Short-term follow-up of meniscectomy has generated some positive results

Short-term follow-up of meniscectomy has generated some positive results; for example, a meniscectomy can provide temporary pain relief in early stages following operation, especially when an acute tear had caused excessive pain or popping preoperatively. Another immediate result may be a greater feeling of stability, if the tear had previously been a source of instability or knee locking by catching between the tibia and femur. On long-term follow-up, however, these initial improvements have rarely been shown to last. Complete pain relief from meniscectomy is nearly unheard of after more than ten years and, at that point, more complex issues including limited range of motion, radiographic degeneration, crepitation, and severe functional impairment have usually begun to surface.  In many cases, a simple meniscus tear, if operated on, can become a career-ending injury.

Arthroscopic meniscus surgery leads to a three-fold increase in the need for knee replacement and supper accelerated osteoarthritis.

Here we present a brief review of many of the papers published in recent years suggesting that meniscus surgery causes more harm than good in many patients.

November 2016: Research in the medical journal Orthopedics:(20)

The study’s doctors suggested that this information can help surgeons to counsel patients on the incidence of total knee replacement after knee arthroscopy and identify preoperative risk factors that increase risk.

Meniscus surgery causes super accelerated knee arthritis

Do these findings present anything really new? No, research has been ongoing telling patients and doctors of the risks associated with arthroscopic meniscus repair.

It is remarkable that studies more than a decade and a half old have issued the same warnings. In 2005, doctors in Canada audited the effectiveness of certain medical procedures found very poor quality evidence on the effectiveness of arthroscopic debridement of the knee with partial meniscectomy. (21)

The summary of these studies? If you have a meniscus surgery, chances are you will be disappointed in the outcome and then move onto an eventual knee replacement.

In research appearing in the medical journal Clinical Anatomy, doctors issued their report on a phenomenon of super-accelerated osteoarthritis in knees with meniscus tear damage and a history of surgical meniscus removal.

Coming out of Tufts Medical Center in Boston, the researchers noted that knee osteoarthritis is typically a slow, progressive problem; however, in some patients knees progressed to osteoarthritis with dramatic rapidity. However, clinicians cannot determine which patients may be at risk for accelerated knee osteoarthritis without knowing the incident structural damage that predisposes a knee to accelerated osteoarthritis. The Tuft researchers found that structural damage that is associated with accelerated knee osteoarthritis destabilizes and compromises the function of the meniscus or compromises the subchondral bone. (22) 

In an early study researchers from the Department of Orthopaedic Surgery at Carolinas Medical Center found that a damaged meniscus is the active participant in the development of knee osteoarthritis. In the study above, the relationship to bone damage is discussed, in this cited study the Carolinas Medical team found a strong association between meniscus damage and cartilage loss. (23) The two combined studies help confirm missing meniscal tissue contributes to bone and cartilage degeneration.

Even the American Academy of Orthopedic Surgeons was unable to come up with evidence to support the use of partial meniscectomy.

Meniscus removal throws the whole knee out of balance and damages other structures – the best way to prevent cartilage breakdown and knee osteoarthritis caused by meniscal surgery is to AVOID the surgery.

Doctors at the Hospital of Special Surgery found that meniscus removal, not only impacts the knee at the point of the surgery but throws the whole knee out of balance and leads to several points of cartilage deterioration. (24)

What is really remarkable is that researchers write paper after paper saying that removal of meniscal tissue in surgery causes advanced osteoarthritis and the procedures continue.

Clearly, the best way to prevent cartilage breakdown and knee osteoarthritis caused by meniscus surgery is to AVOID the surgery.

The middle-aged patient and meniscus surgery – surgeons cannot predict which patients will benefit and who will not benefit from meniscus surgery. Flipping a coin would work just as well.

A March 2020 study in the British Journal of Sports Medicine (25) questioned whether experienced orthopedic surgeons could predict who would benefit from surgery for degenerative meniscus tears and who would not.

The researchers set up an experiment. Surgeons participating in this study were given 20 cases to examine. In each case, the surgeon was asked to predict the outcome of treatment for meniscal tears by arthroscopic partial meniscectomy and exercise therapy in middle-aged patients. The surgeons were also asked to predict the beneficial change in knee function in those patients they would recommend to surgery and those patients they would send to physical therapy or an exercise program.

The surgeons combined to examine and predict outcomes in 3880 knees. The results?

Clinical practice is moving away from treating meniscal tears in patients with osteoarthritis

Surgeons at the Glasgow Royal Infirmary, University Hospital Llandough and the University Hospital Wishaw in the United Kingdom published a February 2020 paper (26) in recommending to their fellow surgeons which patients with meniscus damage and osteoarthritis would be considered as good candidates for surgery. Here is what they said:

“Clinical practice is moving away from treating meniscal tears in patients with osteoarthritis unless there are mechanical symptoms. This study assessed the risk of needing further surgery for osteoarthritis in the five years following partial meniscectomy in different age groups and different grades of knee osteoarthritis.”

What these doctors did was to look at partial meniscectomies that were performed by the paper’s senior author during a 31-month period.  Range of follow-up was 3 to 5 years.

Results:

Conclusion: “(This) study shows that patients with no/mild OA should be considered for  Arthroscopic Partial Meniscectomy. Patient’s with meniscal tears and severe osteoarthritis should be counseled on the outcomes and risks of further surgery after an Arthroscopic Partial Meniscectomy.

Here is a positive study on the benefits of meniscus surgery (27) in middle-aged patients: In this study, doctors said that an arthroscopic partial meniscectomy is a good option for a medial meniscal tear in late middle-aged adults. For the best success, you need a proper diagnosis and excellent surgical technique. If you follow these two rules all the patients could get good clinical results, HOWEVER, “there are some patients with motion restrictions in the early stage after the operation.” 

In other words, even if a patient received “a proper diagnosis and excellent surgical technique,” problems with motion restrictions in the knee developed early. Motion restrictions are probably not what a middle-aged patient is expecting as a result of their meniscus surgery.

In the above research we cited from Raine Sihvonen, MD in February 2018, in the Annals of the Rheumatic Diseases (10), it is noted that:

The meniscus can have a 90% tear and it will still figure out how to function

The meniscus has a very difficult time healing its own injuries because of a lack of vascularization to the entire meniscus. That is the blood that carries healing elements do not reach the entire meniscus. Because of this, the meniscus is a composite of different types of cells, superficially, those that can heal, those that can’t.

However, researchers at the University of Pennsylvania examining the meniscus’ complex mesh of fibers that run criss-cross to each other discovered that the two types of meniscus fibers, whose jobs are to absorb knee impact, the circumferential fibers and the radial tie fibers have a unique understanding of maintaining knee integrity in the event of meniscus injury.

They write: The meniscus is comprised of circumferentially aligned fibers (basically a mesh) that resist the tensile forces within the meniscus that develop during loading of the knee. Although these circumferential fibers are severed by radial meniscal tears, tibial contact stresses (the impact on the shin bone) do not increase until the tear reaches about 90% of the meniscus width, suggesting that the severed circumferential fibers still bear the load and maintain the mechanical functionality of the meniscus.

Note: The meniscus can have a 90% tear and it will still figure out how to function.

How it does this, is that the radial tie fibers, the perpendicular mesh network of the meniscus are helping to redistribute the knee load back to the severed but still functioning circumferential fibers.

Note: What does all this mean?

The study conclusion spells it out. “This finding supports the notion that radial tie fibers may similarly promote tear tolerance in the knee meniscus, and will direct changes in clinical practice and provide guidance for tissue engineering strategies.”(28)

Is there recovery time after arthroscopic meniscus surgery?

Some of the questions patients want to be answered when they compare non-surgical to surgical treatment of meniscus tears are:

While these numbers sound reasonable they are not for the patients in the long run. Non-surgical treatments such as comprehensive Prolotherapy typically and for a realistic expectation of treatment success are offered at about 6-week intervals and on average see results at the third treatment – anywhere from 12 – 18 weeks after the first treatment.

The difference is: While meniscus surgery can offer short-term goals the knee is in a downward spiral of joint instability to osteoarthritis to degenerative joint disease.

In Comprehensive Prolotherapy, the knee joint instability is restored by repairing and regenerating tissue

We use non-surgical treatments for meniscus tears. We may use our Prolotherapy treatments and PRP. This is an in-office injection treatment. This video and the summary below is an introduction to our non-surgical treatments. It is presented by Danielle R. Steilen-Matias, MMS, PA-C of Caring Medical Florida.

Platelet Rich Plasma Therapy and Prolotherapy, which stimulates tendons, ligaments, and cartilage to heal, has many advantages over arthroscopy, which include:

 

Do you have a question about meniscus surgery or need help?
Get help and information from our Caring Medical staff

1 Porter M, Shadbolt B. Accuracy of standard magnetic resonance imaging sequences for meniscal and chondral lesions versus knee arthroscopy. A prospective case‐controlled study of 719 cases. ANZ Journal of Surgery. 2021 Apr 27. [Google Scholar].
2 Feeley BT, Lau BC. Biomechanics and Clinical Outcomes of Partial Meniscectomy. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2018 Dec 15;26(24):853-63. [Google Scholar]
3 Katz JN, Brophy RH, Chaisson CE, De Chaves L, Cole BJ, Dahm DL, Donnell-Fink LA, Guermazi A, Haas AK, Jones MH, Levy BA. Surgery versus physical therapy for a meniscal tear and osteoarthritis. New England Journal of Medicine. 2013 May 2;368(18):1675-84. [Google Scholar]
4 Forsythe B, Forlenza EM, Agarwalla A, Cohn MR, Lavoie-Gagne O, Lu Y, Mascarenhas R. Corticosteroid Injections One Month Before Arthroscopic Meniscectomy Increase the Risk of Surgical Site Infection. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021 Mar 31. [Google Scholar]
5 McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, Ward RJ. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee OsteoarthritisA Randomized Clinical TrialJAMA. 2017;317(19):1967-1975. [Google Scholar]
6 Haslam A, Livingston C, Prasad V. Medical reversals in family practice: a review. Current Therapeutic Research. 2020 Feb 22:100579. [Google Scholar]
7 Pelletier JP, Raynauld JP, Abram F, Dorais M, Paiement P, Martel-Pelletier J. Intra-articular corticosteroid knee injection induces a reduction in meniscal thickness with no treatment effect on cartilage volume: a case–control study. Scientific reports. 2020 Aug 14;10(1):1-0.  [Google Scholar]
8 Pihl K, Roos EM, Nissen N, JøRgensen U, Schjerning J, Thorlund JB. Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery: A prospective cohort study of 478 patients. Acta Orthopaedica. 2016;87(6):615-621.  [Google Scholar]
9 Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013 Dec 26;369:2515-24. [Google Scholar]
10 Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Ikonen A, Järvelä T, Järvinen TA, Kanto K. Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial. Annals of the Rheumatic Diseases. 2017 May 18:annrheumdis-2017. [Google Scholar]
11 Sihvonen R, Englund M, Turkiewicz A, Järvinen TL. Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial Mechanical Symptoms and Arthroscopic Partial Meniscectomy. Annals of internal medicine. 2016 Apr 5;164(7):449-55. [Google Scholar]
12 Yim JH, Seon JK, Song EK, Choi JI, Kim MC, Lee KB, Seo HY. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. The American journal of sports medicine. 2013 Jul;41(7):1565-70. [Google Scholar]
13 Ha AY, Shalvoy RM, Voisinet A, Racine J, Aaron RK. Controversial role of arthroscopic meniscectomy of the knee: A review. World Journal of Orthopedics. 2016;7(5):287-292. [Google Scholar]
14 Pekari TB, Wang KC, Cotter EJ, Kusnezov N, Waterman BR. Contemporary Surgical Trends in the Management of Symptomatic Meniscal Tears among United States Military Service members from 2010 to 2015. The journal of knee surgery. 2018 Mar 7. [Google Scholar]
15 Mosich GM, Lieu V, Ebramzadeh E, Beck JJ. Operative Treatment of Isolated Meniscus Injuries in Adolescent Patients: A Meta-Analysis and Review. Sports health. 2018 Apr 1:1941738118768201.
16 Beaufils P, Pujol N. Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus. Orthop Traumatol Surg Res. 2017 Sep 2. pii: S1877-0568(17)30231-1 [Google Scholar]
17 Becker R, Bernard M, Scheffler S, Kopf S. Treatment of degenerative meniscal lesions : From eminence to evidence-based medicine. Orthopade. 2017 Sep 5. doi: 10.1007/s00132-017-3465-8.  [Google Scholar]
18 Wijn SR, Rovers MM, Rongen JJ, Østerås H, Risberg MA, Roos EM, Hare KB, Van De Graaf VA, Poolman RW, Englund M, Hannink G. Arthroscopic meniscectomy versus non-surgical or sham treatment in patients with MRI confirmed degenerative meniscus lesions: a protocol for an individual participant data meta-analysis. BMJ open. 2020 Mar 1;10(3):e031864. [Google Scholar]
19 Rongen JJ, Rovers MM, van Tienen TG, Buma P, Hannink G. 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. Osteoarthritis Cartilage. 2017 Jan;25(1):23-29.  [Google Scholar]
20 Boyd JA, Gradisar IM. Total Knee Arthroplasty After Knee Arthroscopy in Patients Older Than 50 Years. Orthopedics. 2016 Nov 1;39(6):e1041-e1044. doi: 10.3928/01477447-20160719-01. Epub 2016 Jul 27.  [Google Scholar]
21 Health Quality Ontario. Arthroscopic lavage and debridement for osteoarthritis of the knee: an evidence-based analysis. Ontario health technology assessment series. 2005;5(12):1.  [Google Scholar]
22 Driban JB, Ward RJ, Eaton CB, Lo GH Lyn Price, Lu B8, McAlindon TE. Meniscal extrusion or subchondral damage characterize incident accelerated osteoarthritis: Data from the Osteoarthritis Initiative. Clin Anat. 2015 Jul 6. [Google Scholar]
23 Sun Y, Mauerhan DR, Honeycutt PR, Kneisl JS, Norton JH, Hanley EN Jr, Gruber HE. Analysis of meniscal degeneration and meniscal gene expression. BMC Musculoskelet Disord. 2010 Jan 28;11:19. doi: 10.1186/1471-2474-11-19.  [Google Scholar]
24 Maher S, Wang H, Koff MF, Belkin N, Potter HG, Rodeo S. A clinical platform for understanding the relationship between joint contact mechanics & articular cartilage changes after meniscal surgery. J Orthop Res. 2016 Jul 13. [Google Scholar]
25 van de Graaf VA, Bloembergen CH MD, Willigenburg NW PhD, et al. Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey of 194 orthopaedic surgeons who made 3880 predictions. Br J Sports Med. 2020;54(6):354-359. doi:10.1136/bjsports-2019-100567  [Google Scholar]
26 Chitnis SS, Al-Azzani WA, Kakar R. Medium-Term Results of Arthroscopic Partial Meniscectomy from a Single High-Volume Center. Indian journal of orthopaedics. 2020 May;54(3):358-65. [Google Scholar]
27 Liu JS, Li ZY. Arthroscopic partial meniscectomy for medial meniscal tear in late middle-aged adults. Zhongguo gu shang= China journal of orthopaedics and traumatology. 2014 Aug;27(8):631-4. [Google Scholar]
28 Bansal S, Mandalapu S, Aeppli C, Qu F, Szczesny SE, Mauck RL, Zgonis MH. Mechanical function near defects in an aligned nanofiber composite is preserved by inclusion of disorganized layers: Insight into meniscus structure and function. Acta Biomaterialia. 2017 Feb 1.  [Google Scholar]

This article was updated July 15, 2021

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