You are 45 years old and the inside of your knee hurts during and after exercise. Recently, just walking is painful. After an X-ray and an MRI, the orthopedist says surgery may be needed, but physical therapy can relieve your symptoms. You choose the option for surgery – are you doing the right thing? According to recent research in the New England Journal of Medicine, you may not be.
The study found that after a year, meniscus fracture patients who had "shameful" surgery followed by physical therapy improved just as much as patients who underwent meniscus surgery. The patient population includes individuals between the ages of 35 and 65 who have degenerative meniscal tears without osteoarthritis of the knee joint. "Sham" surgery refers to a patient who has had an arthroscopic examination of the knee but has not cut or removed the meniscus.
At first glance, it can be concluded that patients are also doing well without surgery, such as those who have undergone surgery. But did the slammer group really not have surgery?
Each patient had a knee-mounted arthroscope and saline solution circulated in and out of the knee joint. Although nothing is done on the meniscus, saline may have removed loose bodies and irritating tissues. Only reddening of the joint can be symptomatic of treatment improvement.
You can also conclude that patients treated with physical therapy as well as those treated with surgery are followed by physical therapy. But how do you know whether to undergo surgery?
The old saying "go to the source" must be followed. Did the information come from valid research? The gold standard in research is a prospective, randomized, blinded study with a population large enough to produce meaningful results. Valid and reliable outcome measures must be used – measures used to quantify the information examined are subject to scientific scrutiny.
The meniscus study was indeed a prospective, randomized, blinded study of 146 individuals who met the relevant criteria – a very good study. They used reliable and valid exit measures to measure pain, symptoms, function, and effect on quality of life. Other secondary outcome measures / questions were used. The source was good.
But to do surgery or not? We need to determine the study population a little better to see if it fits your problem.
Do you have a degenerative meniscus tear or have you experienced symptoms after a traumatic event such as a fall or a knee twist when playing basketball? The study reported only persons who had no trauma and had degenerative tears that appeared over time and with age. So, if a traumatic episode results in knee pain, the conclusion of this article is only partially applicable.
Do You Have Knee Osteoarthritis? Again, the article only deals with patients with degenerative meniscal tears without osteoarthritis of the knee joint.
We should also look at other literature similar to the recent article. Never make a decision based on a single literature, even if it is well done. The conclusions of good research should always be respected, but one must wait for others to carry out such research and determine whether the conclusions are similar.
So, what other literature is there to help us determine if you need to have surgery? Plenty of good mash:
A July 2013 study by the American Journal of Sports Medicine used an almost identical population of patients and compared those treated with physical therapy to those undergoing partial meniscectomy and physical therapy. The author found that at 2 years after the intervention there was no significant difference between the two pain and function groups.
Another study, published in the May 2013 New England Journal of Medicine, found no difference in results in patients with meniscus tears and osteoarthritis if treated with physical therapy compared to arthroscopic surgery and physical therapy.
A third study was published in 2013 using a similar population of patients and came to the same conclusions. These three studies are of the highest quality.
So the answer to the question "should you get arthroscopic menisectomy if you have degenerative (non-traumatic) meniscus tears without or even with some level of osteoarthritis" is only after you have tried a short course (6-8 weeks) of appropriate physical therapy and not improving. This was the conclusion of each of the studies mentioned. Before jumping on the operating table, try physical therapy!
For more information, or to find your nearest Pen Therapy and Fitness outpatient location, call 877-969-7342 or visit online at www.pennpartners.org.