What to consider when you have a meniscus injury
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 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: 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: 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.
Is surgery for a rotator cuff tear necessary?
When it comes to a rotator cuff tear, one of the most common questions patients and healthcare providers grapple with is: should we opt for shoulder surgery or stick with conservative care (chiropractic/physiotherapy/massage/osteopathy)? The answer can be more complex and depends on various factors, including the severity of the tear, patient preferences, and long-term goals. Let’s dive into the current recommendations and evidence to help guide this decision. First off, let’s break down what a rotator cuff tear means A rotator cuff tear is damage to the tendons and muscles that stabilise the shoulder joint. These tears can be traumatic (caused by an injury) or degenerative (resulting from wear and tear over time). Symptoms can include pain, weakness, and limited range of motion, however, some individuals may have a tear in their rotator cuff without any significant symptoms. Research suggests the most commonly torn tendon is the supraspinatus tendon 70 – 85% of the time. Do I have to go under the knife? Many people believe that a rotator cuff tear means either undergoing surgery or living a life of pain and disability. Realistically this isn’t true. Rotator cuff tears are common and should be seen as a normal part of aging, like wrinkles and grey hair. Research shows that rotator cuff tears can be present without causing any symptoms, especially in individuals over 50. One study found that if you are over the age of 50, a rotator cuff tear seen on a scan is twice as likely not to cause symptoms, and this increases to four times as likely by the age of 80. Progressions vs. Stability Research suggests that roughly 50% of rotator cuff tears progress in size over 5 years, full thickness tears are more likely to progress in size when compared to partial thickness tears. Partial tears are relatively stable in the short to intermediate term. There is a growing body of evidence to suggest that small full-thickness tears can remain stable and even heal over 3 – 4 years. Tear progression is shown to be negatively impacted by the following things: Another common misconception regarding rotator cuff tears is the way these tears look. Many people believe all tendons are thick rope-like structures at the end of all our muscles, while this is true for some tendons, like those in our forearms and biceps, it is not true for all tendons. In reality, tendons vary in shape and structure, and some are a lot flatter, broader and thicker than others, like those of the rotator cuff. The rotator cuff tendons form a broad, continuous structure around the shoulder joint. This is where a helpful analogy to explain rotator cuff tears plays a role, which is the “hole in a blanket”. Because the tendon is so thick and broad, when a tear occurs, it is like a hole in a large blanket. Just because there is a hole, it doesn’t mean the rest of the blanket is useless. This analogy helps to visualise and understand that the rest of your tendon can still function well, and can be strengthened without creating further damage. Now let’s compare conservative care and surgery Conservative care includes chiropractic care, physiotherapy, osteopathy, exercise physiology, or any other allied health practitioners who can help with your injury without operating on you. At Pittwater Chiro, our treatment would involve a blend of hands-on techniques to assist with pain reduction alongside at-home pain management strategies, exercise prescription to help strengthen the rotator cuff and its surrounding muscles, advice on temporary modifications to work, sports or hobbies which may be aggravating the pain, and advice on how to return to your normal activities in the future. The hands-on treatment we provide can include massage and other soft tissue release techniques, joint mobilisations and manipulations, shockwave therapy, dry needling, and cupping Shoulder surgery is usually considered when conservative care fails to provide adequate relief or when the tear is severe. Surgical options include: Rotator Cuff Tear Summary When considering if surgery can alter the progression of a rotator cuff tear, research has found that surgery does not change the underlying tendon biology which causes the rotator cuff to tear. Therefore, the likelihood of recurrent symptoms and poor functioning of the rotator cuff following surgery can be similar to the likelihood of progression without surgery. Research also suggests that the traumatic onset of a rotator cuff tear is not a sufficient reason to choose surgery over non-operative care. Regardless of whether your tear is non-traumatic or traumatic onset, the first line of care for anyone with partial or full-thickness tears according to the evidence is a period of non-surgical conservative care. For those suffering from a non-traumatic partial or full-thickness tear, individuals benefit from activity modification, chiropractic care, and therapeutic exercise, and if this fails then there is the consideration for a corticosteroid injection. References A B C
