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.
- This was the work of Finnish researchers who recognized that arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.
- What they did was to conduct a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis.
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.
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, surgeons at UCLA talked about the younger patient and why taking out meniscus tissue is really not optimal.
Here are the talking points:
- With the rise in sports participation and increased athleticism in the adolescent population, there is an ever-growing need to better understand adolescent meniscus pathology and treatment.
- A shift in the management of isolated adolescent meniscal tears is reflected in the literature, with a recent increase in operative repair. This is likely secondary to poor outcomes after meniscectomy reflected in long-term follow-up studies. .
- The current literature highlights the need for an improved description of tear patterns, standardized reporting of outcome measures, and improved study methodologies to help guide orthopedic surgeons on the operative treatment of meniscal tears in adolescent patients.
Basically, surgeons need to repair and save the meniscus. They also need to figure out how to do it.
Waiting Until The Arthroscopic Procedure To Figure Out What Type Of Surgery I Am Getting My Mri Was Not Helpful
Why do your doctors want to get in there and see what is going on? Because your MRI may be leading you down a poor treatment choice path. An April 2021 paper in the Australian and New Zealand Journal of Surgery suggested while Magnetic Resonance Imaging 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 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.
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What Is The Number 1 Injury In Football
THE MOST COMMON INJURIES IN FOOTBALL Players suffer from knee injuries most often, especially those to the anterior or posterior cruciate ligaments and the menisci . In addition to adversely affecting a players long-term involvement in the sport, knee injuries can also cause him or her to lose their ability to play.
Grade I And Ii Meniscus Tear
A grade I or II meniscus tear is a small tear on the outskirts of the meniscus. This type of tear is generally not considered serious and there is no need for surgery, but guiding you through the phases of recovery is essential. There may still be pain, a locking sensation and loss of full range in your knee, but this is quite an easy fix with physiotherapy. We will discuss every stage of treatment shortly and the goals youll achieve.
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The Rush To Mri Is An Mri Really Necessary Whatever Your Mri Says You May Get Surgery Anyway
We probably cannot even count the number of emails we received in the last few years that begin like this:
I had an MRI
This is what my MRI says: Radial tear poster medial meniscus, degeneration fraying medial meniscus, moderate bone contusion medial tibial plateau with degenerative changes, moderate bakers cyst. My doctor says I should get a clean-up on my knee.
I had an MRI I have another tear
I had arthroscopic knee surgery for a torn meniscus. I just had an MRI and I have another tear in my meniscus. Now they tell me I am developing arthritis as well. I need more surgery. I am not sure I want or even need more surgery. Are non-surgical options available to me?
I had an MRI, I had surgery, now I have more pain
I had a meniscus repair surgery about six months ago. Soon after the surgery, I started experiencing terrible pain. I cannot work like this. I had another MRI and I am being told to have more surgery. Are non-surgical options available to me?
Sometimes we simply get a cut and paste of the persons MRI report. MRI reports can be helpful but people with terrible MRIs have little knee pain. People with good MRIs have terrible pain. It is just as important to understand the persons full situation, to know how someone feels today, what type of pain did they have when they woke up, what makes it worse as it is to get an MRI report.
Question 1 Of : Can A Meniscus Tear Heal On Its Own
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Epidemiology Including Risk Factors And Primary Prevention
Knee meniscal injuries are common with an incidence of 61 cases per 100,000 persons and a prevalence of 12% to 14%.7. The ratio of men to women is 2.5:1 to 4:1. Degenerative meniscal tears most often occur in men ages 40 to 60 years old.20
There is an increased incidence of meniscal tears with anterior cruciate ligament injury ranging from 22% to 86%.7 In the US, of the estimated 850,000 cases per year, 10% to 20% of orthopedic surgeries involve surgery of the meniscus with over 50,000 meniscectomies and 3,000 meniscal repairs performed each year7, 51
Meniscus Injuries : Many Do Not Recall The Event
Of the 100 or so patients I see each week, many are complaining of knee pain. Some these patients have suffered meniscus injuries, some have not. Many of the patients presenting with knee pain will prove to have a meniscus tear. How do meniscus injuries occur?
Some of the patients I see are young and have healthy meniscus tissue that tore as a result of trauma . But the vast majority of patients I see with a meniscus tear are over 35-40. While traumatic meniscus injuries and tears can occur in this age group as well, it is a far less common cause of tears in this age group and beyond. By far, the most common type of meniscal tears I see in my office are atraumatic or attritional in nature. Therefore, many can not recall any of their meniscus injuries or there was no injury at all.
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How To Treat Meniscus Tears In Physical Therapy:
Management of the swelling is the first step in any physical therapy program. Aggressive icing , compression and elevation along with rest are prescribed in the days following a meniscus tear and are utilized until swelling subsides. High dose fish oil is also recommended as a way to control inflammation.
We then work on restoring normal motion and strength to the muscles around the knee with meniscus tear. In the photo to the left, the patient is working on full hyperextension of the knee. The full hyperextension is also called full straightening. Hyperextension is essential for normal function of the knee and takes a load off of your healing meniscus. Your physical therapist will also provide hands on stretches to the knee to ensure the shin bone and thigh bone are moving correctly. Once full hyperextension and motion is restored at the knee, your physical therapist will work on muscle building. Quadriceps, calf and hamstring exercises are commonly prescribed to help you heal from a torn meniscus. Typically exercises start in a non-weight bearing position and progress to standing.
Functional retraining is another key part of the physical therapy program to help you heal from a meniscus tear. Your physical therapist will make sure you stand, walk and can do functional activities like stairs, jog, and cutting/twisting motions safely before you complete PT.
Meniscal Tears In Older People And Children
In general, meniscal lesions occur frequently in middle-aged and elderly patients. Tears encountered in patients belonging to this age group usually result from long-term degeneration. Such meniscal lesions lead to joint swelling, joint line pain, and mechanical blocking . The reported prevalence of meniscal lesions in patients with clinical and radiographic findings of osteoarthritis is 68-90% . This high correlation creates a series of diagnostic problems, mainly concerning the identification of the main pathology in a symptomatic knee. Therefore, on some occasions, symptoms that may be due to a pathological cause may be attributed by the physician to the presence of a meniscal tear in MRI, while on other occasions, symptoms which may result from trauma may be attributed to osteoarthritis. This has obvious repercussions on the choice of proper therapy. For example, treatment of meniscal tears with partial meniscectomy is rather unlikely to reduce symptoms caused by osteoarthritis.
An increased incidence in meniscal tearing has recently been observed in skeletally-immature children . The main causative factor behind this increased incidence is the growing participation of children in highly-demanding athletic activities. Simultaneously, the expansion in health services focused on child pathology, and the extensive use of highly specialized imaging techniques such as MRI, have aided in contributing to these diagnoses.
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How The Location And Type Of Tear Affect Healing
Where a meniscus tear occurs is one of the most important things that affects healing. Tears at the outer edge tend to heal well because there is a good blood supply. The inner area lacks a good blood supply and therefore does not heal well.
The type of tear often determines whether a tear can be repaired. Longitudinal tears are often repairable. Radial tears may be repairable depending on where they are located. Oblique tears and another type called horizontal tears are generally not repairable.
Braces Can Promote Healing
After a meniscus operation, braces can be used to stabilise the knee, protect it and support the healing of the meniscus. The meniscus suture requires particular protection, because a severe bending of the knee with simultaneous loading leads to high levels of shear forces, which can endanger the meniscus suture. The loading of the knee is therefore usually recommended only in a stretched position.
Modern orthoses support treatment after a meniscus fixation. The special lock function allows a therapy-appropriate loading of the knee in full extension and early functional exercises under non-weight bearing conditions as required. It is possible to switch between immobilisation and mobilisation within a defined range of movement with just a single click. Early weight bearing and mobilisation can counteract muscle atrophy.
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Why Do We Ignore A Mountain Of Clinical And Scientific Evidence Against Meniscectomy
- The French team says the number of meniscectomies is excessive in the light of scientifically robust studies demonstrating the interest in meniscal repair or of non-operative treatment for traumatic tear and of non-operative treatment for degenerative meniscal lesions.
- Meniscectomy was long considered the treatment of choice. All but 1 of the 8 recent randomized studies reported non-superiority of arthroscopy over non-operative treatment, which should thus be the first-line choice, with arthroscopic meniscectomy reserved for cases of failure, or earlier in case of considerable mechanical symptoms.
They, like us, agree that it is high time that the paradigm shifted, in favor of meniscal preservation.
What Else Can Help
The exercises here are specifically tailored towards meniscus tear treatment. Once these meniscus tear treatment exercises feel easy, you can progress on to more generalintermediateandadvancedstrengthening exercises to help you recover fully from a torn meniscus.
Sometimes after a meniscus injury, the kneecap muscles get weak. This leads to patellar maltracking, a problem with how the kneecap moves, and can lead to longer term knee problems. To find out how to strengthen your kneecap muscles, visit the kneecap strengtheningsection.
If you have problems with persitent locking at the knee , or your symptoms fail to settle, you may well need surgical meniscus tear treatment, usually an arthroscopy. You can find out more about this in the Meniscus Tear section.
Page Last Updated: 11/09/21
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Treatment For A Meniscus Tear
Specific treatment for a meniscus tear will be determined by your doctor based on:
Your overall health and medical history
How bad your injury is
How well you can tolerate specific medications, procedures, and therapies
The length of time it will take to heal
Your opinion or preference
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What Is The Rest Of The Knee Made Up Of
- Bones: Three bones form your knee joint: thigh bone , shinbone , and kneecap .
- Articular cartilage: At the round part of the femur and tibia bones, and behind the patella, there is a cartilage covering, which makes the bones glide easily across each other to ensure smooth bending and straightening of your knee.
- Meniscus: This is also a type of cartilage, more like a disc that distributes forces through your knee. They are wedge shaped and situated on the medial and lateral of your tibia bone. The meniscus is there to help absorb shock through the knee joint, to stabilize and cushion impact through the joint.
- Tendons: Muscles connect to bones via tendons. The quadriceps tendon connects the muscles in the front of your thigh to your patella. The patellar tendon stretches from your patella to your tibia. The hamstring tendons run around the back to bend your knee.
- Muscles: The quads serve as a mobilizing unit to help straighten your knee. Important here is the VMO muscle the most inside one of the four quad muscles, due its stability function in the knee. If the VMO doesnt activate properly, the knee will inevitably be unstable.
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Whats The Treatment For A Meniscus Tear
Treatment for meniscal tears depends on the size and location of the tear. Other factors which influence treatment include age, activity level and related injuries. The outer portion of the meniscus, often referred to as the Ã¢red zone,Ã¢ has a good blood supply and can sometimes heal on its own if the tear is small. In contrast, the inner two thirds of the meniscus, known as the Ã¢white zone,Ã¢ does not have a good blood supply. Tears in this region will not heal on their own as this area lacks blood vessels to bring in healing nutrients.
Happily, not all meniscal tears require surgery. If your knee is not locking up, is stable, and symptoms resolve, nonsurgical treatment may suffice. To speed the recovery, you can:
These conservative treatments, however, arenât always enough. If a tear is large, unstable, or causing locking symptoms surgery may be required to either repair or remove unstable edges. The procedure is usually pretty simple, and you can often go home the same day. You may need a brace afterward for protection if a repair is performed.
For 85% to 90% of people who get the surgery for a meniscus tear, the short-term results are good to excellent. But in the long-term, people who have a large meniscal injury that is unrepairable may be at a higher risk of developing knee arthritis.
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Treating A Meniscus Tear
Initially, you should treat the knee injury with conservative techniques that include rest, ice, compression, and elevation, or the RICE method:
- Rest your knee. Use crutches to avoid any weight bearing on the joint. Avoid any activities that worsen your knee pain.
- Ice your knee every three to four hours for 30 minutes.
- Compress or wrap the knee in an elastic bandage to reduce inflammation.
- Elevate your knee to reduce swelling.
You can also take medication such as ibuprofen , aspirin , or any other nonsteroidal anti-inflammatory drugs to reduce pain and swelling around your knee.
You shouldnt put your full weight on your injured knee if its painful. Your doctor may recommend physical therapy to strengthen the muscles surrounding your knee.
Physical therapy can help reduce pain and increase your knee mobility and stability. Your physical therapist may also use massage techniques to reduce swelling and stiffness.