Does a meniscal tear require surgery?
The menisci are important structures in the knee that can be injured from trauma or overuse. The surgical management of patients who have a tear in their meniscus has changed a lot, and there is also some research showing that many individuals can actually return to their prior activity level with conservative management vs surgery.
First of all, what is a meniscus? A meniscus is a fibrocartilaginous disk that is located on the tibial plateau, or the bottom part of the knee joint. There is a lateral meniscus and a medial meniscus. The outer 1/3 of the meniscus is called the red zone due to its rich blood supply, which indicates injuries to this portion of the meniscus actually have potential to heal. The middle 1/3 is known as the red-white zone, and the inner 1/3 as the white zone, due to their lack of blood supply. Injuries to this portion of the meniscus do not have good potential for healing. Menisci are important structures in the biomechanics of the knee joint, and also provide cushion and weight bearing support.
When a meniscus is torn, the goal is always to preserve the meniscus, as damage to a meniscus can alter weight bearing forces and increase joint stress. A surgeon may repair the meniscus if the injury is in the red zone, and debridement rather than removal is the goal if the injury is in the red-white or white zone. If the patient is experiencing locking or giving way of the knee joint, surgical intervention is often necessary. But is surgery always necessary when a meniscus tear is present? Results from a 2018 study by van de Graaf VA et al showed that arthroscopic knee surgery was not superior to Physical Therapy for patients with nonobstructive meniscal tears when comparing patient-reported knee function over a 24 month follow up period. Therefore, if you have a meniscus tear without locking or giving way, Physical Therapy may be a better, less invasive, and more cost effective option to manage your symptoms and return to prior activities.
Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS