(RxWiki News) Surgery to repair a torn meniscus is one of the most common orthopedic surgeries around the world. But new research questions whether the surgery is needed as much as it is performed.
A recent study review found that arthroscopic knee surgery to repair the meniscus in middle-aged patients did not have better short- or long-term outcomes than nonoperative management of meniscal tears.
The study authors said doctors should weigh the potential pros and cons of surgery for their patients and consider nonsurgical approaches first.
"Discuss treatment plans for a torn meniscus with your orthopedist."
The lead author of this study review was Moin Khan, MD, from the Division of Orthopaedic Surgery at McMaster University in Hamilton, Ontario, Canada.
The review included seven studies that compared arthroscopic surgery with non-operative treatments in patients with degenerative meniscal tears and mild or no osteoarthritis present with the knee pain.
The meniscus is a soft piece of cartilage that sits between the thigh and leg bones in the knee. It helps reduce friction between the bones and aids in movement.
As people age, the meniscus often wears down and becomes less flexible, putting it at risk for tearing. When the meniscus tears, it can cause pain and reduce functionality of the knee.
Joseph Yu, MD, owner and founder of Total Sports Medicine & Orthopedics in Las Vegas, NV, explained to dailyRx News when surgery is and is not recommended for a meniscus tear.
"Usually, patients with meniscus tears fall into three groups. In the first group, a patient might have a small meniscus tear which is not causing significant pain. In my opinion, a non-painful meniscus tears do not need surgery. Mild pain can be treated with non-surgical approaches," Dr. Yu said.
"In the second group, there are other conditions which may also be causing pain in the knee. Arthritis is another common cause of knee pain. When I evaluate a patient, I try to estimate the pain caused by each pathology. For example, I might tell a patient 75 percent of her knee pain is caused by arthritis and 25 percent of the pain is caused by the meniscus. Therefore, an arthroscopic procedure aimed at treating the meniscus might only give her 25 percent pain relief," Dr. Yu explained.
"In the third group, a the meniscus tear is causing pain and disability. Arthroscopic surgery is recommended for a meniscus tear when the pain prevents someone from being active. Most of the times, the tears are removed. In rare cases, the tears are repaired," he said. "In the right circumstance, surgery can definitely improve function and diminish pain. Every treatment regimen is individualized for the patient's specific condition."
According to Dr. Khan and co-authors, more than 4 million people around the world have arthroscopic knee surgery each year. This type of surgery involves making small cuts to remove the damaged part of the meniscus. It is a minimally invasive procedure, but there is often a risk for complications.
The studies were published between 2007 and 2013. They were conducted in Europe, South Korea and the United States.
In all the studies combined, the authors of the study review studied 805 patients with 811 total knee problems. The patients were all between 35 and 65 years old, and the average age was 56.
The authors assessed each study and split pain and functionality outcomes into two categories: short-term outcomes (less than six months) and long-term outcomes (more than two years).
The authors of the previous studies assessed knee functionality and pain through surveys.
The findings showed that arthroscopic surgery for people with degenerative meniscal tears who did not have osteoarthritis (breaking down of the cartilage and bones in a joint) was not more effective in reducing pain than nonsurgical management of meniscal tears.
The authors of the study review found that arthroscopic surgery also had little effect on the patients' knee functionality when compared to nonsurgical management.
Surgery did not reduce pain or improve functionality for either short- or long-term outcomes, the authors found.
This study review was published Aug. 25 in CMAJ.
One study author received consulting fees from medical companies like DePuy and Eli Lilly.