A meniscus tear can be challenging to manage, especially with the diverse options available for treatment. Clinical guidelines now emphasise preserving and repairing the meniscus whenever possible, moving away from traditional meniscectomy practices. This shift reflects our better understanding of the meniscus’s role in knee health and the potential long-term impact of its removal. However, conservative care, including physical therapy, has shown promising results, especially for degenerative meniscal tears. Let’s break down these treatment options to help you decide what might be best for your knee.
The role of the meniscus and why preservation is important
In each knee, we have 2 c-shaped fibrocartilaginous pads on the medial and lateral aspects of the knee joint. These act as a shock absorber in the knee between the femur and tibia, cushioning the joint and reducing stress on the knee. Damage to our meniscus can occur naturally as we age (degenerative tears), from repetitive movements that place stress on the meniscus, or from an acute traumatic incident, e.g. a skiing accident, or playing sports that involves sudden stops and turns. For more information on ACL injuries, read our blog.
Previously when a meniscus tear occurred the consensus was to remove the part that was torn, or all of the meniscus (a procedure called meniscectomy). However, this is no longer recommended as the first line of care as this procedure can lead to increased joint stress, which raises the risk of osteoarthritis over time. Consequently, modern treatment guidelines recommend preservation and repair of the meniscus whenever feasible, and/or conservative care with rehabilitative exercises. Meniscectomy is now only recommended for certain individuals suffering from a meniscus tear. Let’s break down these options.
First up – Surgical interventions…
Meniscus Repair: When Preservation is Preferred
Meniscus repair is most effective for tears located in the “red zone,” the outer part of the meniscus with a good blood supply, making it more likely to heal. If the tear is a vertical tear within this vascular zone, surgical repair may be the best option, allowing the meniscus to heal naturally and retain its function. There are several advanced techniques and devices orthopedic surgeons use to perform meniscus repair, each selected based on the specific characteristics of the tear. Although surgery can be effective, it’s important to correctly follow the recommendations of your surgeon regarding recovery time and post-surgical rehabilitation.
Meniscectomy: When Removal is Necessary
In cases where the meniscus is severely damaged and can’t be repaired, meniscectomy may still be an option. However, this approach carries a greater risk of arthritis and other degenerative changes due to the increased pressure on the knee joint. While it can provide short-term pain relief, patients often experience diminishing benefits over time, with a risk of increased pain and complications as they age.
Now let’s look at the less invasive approaches…
Conservative Treatment for Meniscus Tears
Conservative care, including chiropractic, physical therapy and structured rehabilitation, is a non-surgical option that can be highly effective for many patients, particularly those with degenerative meniscal tears. Studies have shown that conservative management can yield comparable results to surgery in terms of pain reduction and knee function improvement.
Benefits of Conservative Management
- Pain Reduction: Research indicates that conservative treatment, focused on strengthening the muscles around the knee and improving joint stability, can significantly reduce pain levels and improve knee function.
- Low Risk: By avoiding surgery, patients face fewer risks and avoid the potential for post-operative complications, which can sometimes include increased pain in the long run.
- Rehabilitation Program: A tailored rehabilitation program that focuses on muscle strengthening and improving joint mechanics can be particularly beneficial for managing symptoms and enhancing stability, especially for older adults or those with degenerative changes.
When is Surgery Preferred Over Conservative Care for Meniscus Tears?
While conservative care can be highly effective, surgery may still be recommended in cases of:
- Severe Acute Tears: In cases where there’s a clear, repairable tear within the vascularised zone of the meniscus, surgical repair can be advantageous.
- Failed Conservative Treatment: If conservative care fails to provide adequate pain relief or functional improvement, surgery may then become a viable option.
- Patient Preference: Some patients may prefer surgical intervention for immediate relief, particularly if conservative management does not provide results quickly enough for their needs.
Advanced Options for Severe Meniscus Damage
If a large portion of the meniscus is damaged or missing, other options like Meniscal Allograft Transplantation (MAT) or tissue engineering may be considered. These treatments, though still under research, are promising for cases where significant meniscus loss affects quality of life and knee stability.
Choosing the Right Path: Surgery or Conservative Care for Meniscus Tears?
When deciding between surgical or conservative treatment, consider:
- Age and Activity Level: Younger, active individuals may benefit more from repair if the tear is in a repairable location, while conservative care might suit older adults with degenerative tears.
- Pain and Function: If conservative care is effectively managing your symptoms and allowing you to stay active, it may be a sustainable option without the need for surgery.
- Personal Goals: Each person’s priorities and lifestyle are different. If avoiding surgery is a priority and symptoms are manageable, conservative care can be a great choice.
Both surgery and conservative care have their roles in treating meniscus tears. Repair-focused surgery offers the potential for preserving knee health, while conservative care can provide substantial relief and functional improvement without surgery. If you’re confused about which direction to take, book in to chat with one of our chiropractors so we can help you evaluate your specific situation and develop a treatment plan that fits your lifestyle and goals.
If you have questions about managing a meniscus tear or want to learn more about non-surgical rehabilitation options, contact us to discuss the best approach for your knee health.
