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.
- They specifically studied degenerative horizontal tears of the medial meniscus and hypothesized that surgical treatment would produce better outcomes than nonoperative strengthening exercises.
- This study was a randomized controlled trial with the highest level of evidence . The study had 102 patients with medial meniscus tears 81 women and 21 men with an average age of 53.8.
- Fifty patients underwent arthroscopic meniscectomy while 52 participated in nonoperative strengthening exercises. The results did not match up with the researchers hypothesis.
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 removed, 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.
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 offer a very good rationale for why people still have meniscus surgery. Here are some talking points of the research:
- For older patients or those more active patients with developing arthritis, the use of partial meniscectomy to manage degenerative meniscus tears and mechanical symptoms may be beneficial however, its routine use in the degenerative knee over physical therapy alone is not supported. .
- In younger populations , partial meniscectomy may provide an earlier return to play, and a lower revision surgery rate compared with meniscal repair. However, partial meniscectomy may result in the earlier development of osteoarthritis.
Evaluating this data, one could imply that:
- Younger patients get the meniscus partial removal surgery because they need to get back to work or back to the game quicker and surgery, despite its drawbacks, gets them there faster. As we will see in the research below this is not grounded in fact, for many people getting this surgery, the situation becomes worse.
- Younger patients may not find repair surgery appealing because of
- Longer rehabilitation times
- Risk of needing a second surgery because the first surgery did not fix everything
- Long-term development of osteoarthritis is seen as something that will happen eventually, not any time soon.
The Problem Of Pseudotears
A February 2021 study in the medical journal Arthroscopy 30718-0/abstract” rel=”nofollow”> 6) examined why MRI readings were often inaccurate when it came to interpreting whether there was an actual tear or not of the anterior horn of the lateral and medial meniscus. What these researchers examined was the phenomena of pseudotear, the appearance of a meniscus tear that is not there.
Peter R. Kurzweil, M.D. is an orthopedic surgeon. He is an editorial reviewer for the journal Arthroscopy. This is what he wrote in response to this studys observations: 30841-0/fulltext” rel=”nofollow”> 7)
Editorial Commentary: False-Positive Meniscus Pseudotear on Magnetic Resonance Imaging: A False Sign That Rings True
The false-positive finding of anterior horn meniscus tear on magnetic resonance imaging is an important finding of which to be aware. We have recently seen awareness similarly raised regarding root tears of the meniscus, which, if overlooked, could have detrimental consequences. Manifestations of the MRI finding of meniscus pseudotear arise from the variability of the insertion of the transverse geniculate ligament into the anterior horn of the lateral meniscus. Bearing in mind that anterior knee pain is a common reason that patients present for an orthopaedic and sports medicine evaluation, the understanding that this MRI finding does not represent a true meniscus tear may save patients from unnecessary arthroscopic surgery.
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Prevalence And Severity Of Symptoms
Meniscal injury is a common problem in the general population . However, detailed information on the most common self-reported symptoms, functional limitations, and quality-of-life problems, their severity, and improvements after treatment in patients with a meniscal tear is sparse despite its importance to guide the clinical discussion of symptoms, treatments, and patient expectations. A recent cross-sectional study of baseline data from 2 randomized controlled trials of 199 middle-aged patients with a meniscal tear eligible for meniscal surgery found that knee pain in general, pain when twisting/pivoting the knee, when bending the knee fully, and when going up and down stairs, and lack of knee confidence were the 5 most common self-reported symptoms, functional limitations, and quality-of-life problems, all with at least moderate severity . In general, our results confirm these findings in a larger, prospective cohort that typically are more generalizable to the population undergoing meniscal surgery than participants recruited for RCTs with strict eligibility criteria . Furthermore, the clinical symptoms found to be most prevalent in our study are consistent with the meniscal symptoms that clinicians typically query patients about when diagnosing a meniscal tear , highlighting the relevance of asking these questions in clinical practice. However, many of these symptoms are also typical for patients with early knee osteoarthritis .
Expectations / Risks / Recovery:
This surgery has a very high success rate. In almost all cases, your recovery will be smooth and relatively quick, allowing you to resume all activities that you want to participate in within 4 to 6 weeks. However, everyone heals from knee surgery at a different pace a small number of people still experience pain and swelling several months after surgery.
Arthroscopic knee surgery has a very low complication rate . The standard risks of surgery include post-operative infection, blood clots in the leg , nerve or blood vessel injury, or anesthesia complications.
Immediately after surgery, if your pain is minimal when walking, then the use of crutches or a walker is not required. If necessary due to pain, patients may opt to use crutches or a walker for a few days after surgery. Once more comfortable, most people are able to walk with a minimal limp within one or two weeks after surgery. Most patients realize a benefit from arthroscopic knee surgery within 4 to 6 weeks. Reduction of pain and swelling, and improvement in knee strength, motion, and coordination may continue for three to four months after surgery.
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How Long Does The Pain Last After A Meniscus Surgery
Pain is common and expected after arthroscopic meniscus surgery. However, we typically dont expect the pain to last more than 3 months or so. Most people notice the pain goes away around the two-month mark. In some instances, people will continue to have pain up until 6 months post-surgery.
These patients may need more time to build up strength and allow the body to get rid of inflammation in the joint after surgery. This group will have to work longer on their exercises to help get back to normal.
For Most People You Cannot Get A Surgical Recommendation For A Meniscus Tear Without An Mri Justifying A Meniscus Tear Significant Enough To Get A Surgical Recommendation
For most people, you cannot get a surgical recommendation for a meniscus tear without an MRI justifying a meniscus tear significant enough to get a surgical recommendation. It is often said that if you want surgery, get an MRI. What you are going to read below will take this idea one step further, if the MRI cannot tell if you need surgery, you may want to get surgery to see if you needed surgery. We will show you the studies.
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Possible Benefits Of Arthroscopic Meniscus Repair
The meniscus is an important structure for load transmission and shock absorption in the knee. The knee is subjected to up to 5 times body weight during activity, and half this force is transmitted through the meniscus with the knee straight, and 85% of the force goes through the meniscus with the knee bent ninety degrees. Loss of the meniscus increases the pressure on the articular cartilage, which leads to degenerative changes. A successful meniscus repair preserves meniscus tissue and mitigates these changes.
Another Surgery To Confirm That The First Meniscus Surgery Failed
For the person who continues to suffer from knee pain after meniscus surgery, a failed meniscus repair may be seen within days, weeks or months. Their doctors may wait a few months to allow the surgery to heal before diagnosing a failed surgery. At this point you and your doctor will need to map out a plan to fix the surgery. Initially you may be prescribed a more conservative care option to include knee braces, reduced activity or strain on your knee, physical therapy and anti-inflammatory medication. In many cases your doctor will then recommend a second surgery to go inside your knee to see what is going on. In this second surgery the surgeon may look for a re-tear of the repaired meniscus area, a new tear caused by a change in your knee dynamics after the surgery, or if something was missed in the first surgery.
In this second or revision surgery, the treatment goal remains the same as the first surgery. Treat that part of the meniscus that is causing pain. Either repair it or remove it. But what if too much meniscus was removed? There is not much a revision surgery can do to repair that. Meniscus transplant or eventual knee preplacement may be given the patient as their only treatment options.
- Of these failed repairs, 30.95% were of the medial meniscus, and 18.9% were of the lateral meniscus.
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Recovery From A Meniscus Transplant
Like any surgery, complications can occur. Complications after a meniscus transplant are rare, but the risk of complications is never zero.
- Stiffness of the knee
- Part of the meniscus doesnt heal.
- Damage to nerves around the knee.
- Anesthetic complications
- Blood clots in the leg.
- Getting an infection from the new meniscus .
- incomplete or no pain relief.
- need for more surgery
The recovery after a meniscus transplant will be long. Most surgeons will not allow their patients to go back to sports for 8-12 months following surgery. Some surgeons may not allow someone to go back to sports after a transplant. This remains a controversial topic. The reason for the controversy is that the new meniscus is an allograft which means that it is from a cadaver. There are no living cells within the meniscus and we do not know if that will affect how long the new meniscus will last. This is a big operation you do not want to put the new meniscus at risk by returning to intense heavy sport participation.
If the surgery also involved a reconstruction of the ACL or the PCL then the recovery will extend beyond one year before being allowed to return to sports.
Arthroscopic Knee Surgery May Inhibit Quadriceps
The reason for an inhibited thigh after arthroscopic knee surgery can be several different things. As a result, quadriceps restriction may be amplified if the patient is concerned about worsening pain or even numbness as a result of a nerve block that was performed prior to surgery. In most cases, the muscles in the quad tighten and begin to function again within a few weeks. The activation of the quadriceps may not be fully realized for up to six weeks after the surgery to remove a torn ACL.
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Ouch Symptoms Of A Torn Meniscus
And when it tears, it doesnt feel good! When you get a tear in the meniscus you may feel like your knee is giving out because you have lost some of the support structure. You may also feel like you cant move it properly, or you feel persistent pain. Meniscus pain is different for each person, but you may experience:
- Pain in the knee joint
- Feeling like your knee popped
Arthroscopic Knee Surgery Recovery
After a meniscectomy, your surgeon will likely advise physical therapy to put you on the best path toward recovery. The day after your surgery, you will need to see your physical therapist to:
- Change your dressings
- Take initial measurements
- Learn an initial home exercise program
Your physical therapist will also review information about what to expect, how to take care of your incisions and how to manage your pain. Handouts outlining everything you will learn will be provided.
Physical therapy appointments will be scheduled twice a week for approximately 6 to 8 weeks.
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Diagnostic Accuracy Of Magnetic Resonance Imaging In The Detection Of Type And Location Of Meniscus Tears
That is the title of a February 2021 study published in the Journal of Clinical Medicine. How the study ended was with a suggestion that if you really wanted to know how much damage there was to a patients meniscus or their knee capsule, you should go in and see for yourself during an arthroscopic procedure because many times the MRI is not helpful. Lets let the doctors of the study speak for themselves. First, this is why they did the study:
Magnetic resonance imaging has been widely used for the diagnosis of meniscal tears, but its diagnostic accuracy, depending on the type and location, has not been well investigated. We aimed to evaluate the diagnostic accuracy of MRI by comparing MRI and arthroscopic findings.
Next, this is what they found out:
What the researchers here did was to compare MRI findings with arthroscopic findings in the same patient to determine if the MRI detected the presence, type, and location of meniscus tears later revealed in an arthroscopic procedure. They also looked at a group of patients who had ACL injuries with meniscus tears to see if the meniscus tears showed up on MRI in the same manner that they were discovered during the ACL reconstruction surgery.
The researchers also excluded some patients from the study as not being good study candidates. This would include people who had degenerative arthritis. Degenerative arthritis makes it difficult through imaging, to understand the type and extent of the meniscus tear on MRI.
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. Lets start with a New York Times piece in 2016. The summary is below.
- Dr. Gordon H. Guyatt, a professor of medicine and epidemiology at McMaster University in Hamilton, Ontario, wrote editorial in The British Medical Journal, which he called arthroscopic meniscal surgery A highly questionable practice without supporting evidence of even moderate quality.
- Dr. Guyatt was quoted in the Times I personally think the operation should not be mentioned , he says, adding that in his opinion the studies indicate the pain relief after surgery is a placebo effect. But if a doctor says anything, Dr. Guyatt suggests saying this:
- We have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense, and potential complications.
- Hearing that, he says, I cannot imagine that anybody would say, Go ahead. I will go for it.
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The Hard To Find Ramp Lesion In An Acl Deficient Knee
For those of you reading this article, and you had an acute ACL tear or you had previous ACL surgical repair and were diagnosed with a ramp lesion you should understand that ramp lesions are vertical or longitudinal tears of the peripheral capsular attachment of the posterior horn of the medial meniscus at the meniscocapsular junction. . It is often considered a minor injury and is especially suspected in ACL deficient or compromised knees.
This injury is often difficult to detect on MRI.
A July 2021 study in the journal Skeletal Radiology suggests MRIs can only offer moderate accuracy. Here are the summary learning points:
- There were 57 patients in this study, all had surgical repair of the ACL between January and May 2019. None of these patients had previous knee surgery.
- A comparison in identifying the ramp lesion was made between arthroscopic evaluation and two trained radiologists with 5 and 14 years of experience who did a blinded review
This next part sounds like an MRI report. If you had a suspected meniscus tear it may sound like your MRI report.
Here is a point. This MRI report-sounding description appears detailed and in-depth. It is giving a picture of what is happening in the knee. Or is it?
How To Sleep After Meniscus Surgery
Lower leg elevation promotes healthy circulation, which reduces swelling and pain. You will also avoid bumping the incision site if you are seated in this position, which will protect it from bleeding.
You may wake up more than usual at night if you experience knee pain or locking. Memory foam pillows that are specifically designed for your knee will provide you with long-term pain relief and organic benefits. If you continue to engage in high-level activity after a torn knee cap, you may develop symptoms. You may feel like your knee is trapped, or your grip may be tight. A person may find that he or she cannot fully extend or bend his or her knee after a torn meniscus. Rest, ice, compression, and elevation are all terms for ice. Stretching and strengthening exercises can be used as part of a non-surgical treatment plan.
When surgery is required, the surgeon is presented with a wide range of surgical options. Young, healthy, and active patients are typically the most likely candidates for meniscal replacement. Physical therapy is also frequently used to treat patients. Following an injury to the knee, patients frequently require a knee immobilizer brace. With the Memory Foam Half Moon Bolster Pillow, you can sleep on your back after having your cartilage repaired. This pillow can be placed on the ground or under the knee of a person. If you are unable to sleep on your non-surgery side, a pillow can be placed between your knees.
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