Your Torn Meniscus: Will Surgery Help?
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Surgery to repair a torn meniscus is very popular today.

Did you know that this surgery might not only fail to help your knee pain, but that people who have sham (or fake) surgery often do as well as people who have actual operations?

The Meniscus

The meniscus in your knee is a thin layer of cartilage that serves as a cushion between the bones of the thigh and shin. The meniscus makes knee movement smooth and helps keep the joint stable. Cartilage wears down as we get older.

Trauma can result in a tear of the cartilage that might require surgery called meniscectomy or resection. The surgery is usually done with an arthroscope, in which the surgeon makes several very small incisions and uses small tools to repair the tear. The surgeon trims the damaged tissue away. This should reduce pain and restore function.

meniscus
Meniscus Tears

Meniscal tears can cause swelling and pain. The symptoms of a meniscus tear come and go, and they may even get better over time, usually within six weeks. Non-impact exercises that strengthen the muscles that control and support the knee (such as your thigh and calf muscles) can be a very helpful way to manage a small tear without surgery.

This important study showed that getting sham surgery works as well as actual surgery —meaning that the surgery is not helpful. (As background, sham surgery is considered the best way to study surgical procedures. Patients are told they may or may not be getting a real operation. But for half of them, the surgeons only make small incisions that will make the patient think they actually had the operation. When the patient believe he or she had the actual repair, because they have incisions and bandages and a bit of discomfort. Sham surgery typically is not done on people with acute meniscal tears, such as a sports injury.)

Meniscus Economics

Meniscus repair is the largest income source for many “sports medicine” doctors (and the more they do, the more they make), so it’s no surprise that your surgery could cost $5000. You will need to pay a portion of this through copayments and deductibles.

These estimates do not include the costs of prescriptions for pain or infection, which may complicate the cost of time lost from work.

And whether or not you have surgery, you will likely benefit from -- and have to pay a portion of -- physical therapy.

How to Choose Wisely

Surgery is potentially most helpful in people whose symptoms include difficulty bending or straightening the knee because of the tear (e.g., their knee locks), or people for whom movement and stability are much worse after the tear or are very painful.

For people with milder symptoms (and whose knees do not "lock"), surgery is far less appealing. They may do just fine with very conservative care, such as exercise and pain management.

How your tear is treated depends on the kind of tear, how it happened, where it is, and how big it is. Surgery should be a last resort because it is costly, painful, and has the possibility of complications after the repair, including much more pain than you might expect.

Essential Info

These articles will help you understand whether you should risk a surgery for your torn meniscus or give exercise and oral pain meds time to work.

New York Times, December 25, 2013, Common knee surgery does very little for some, study suggests.

Tech Times, December 27, 2013, Benefits of Partial Meniscectomy Questioned, points out how the operation isn't of much value and that compared with a sham treatment, there's little difference. "Those who do research have been gradually showing that this popular operation is not of very much value," said Dr. David Felson, a professor of medicine and epidemiology at Boston University.

American Academy of Orthopedic Surgeons, March 2014, Meniscal Tears, describes what happens in a meniscus tear, and some of treatment options available to patients. The article notes that: "if your tear is small and on the outer edge of the meniscus, it may not require surgical repair. As long as your symptoms do not persist and your knee is stable, nonsurgical treatment may be all you need."

By the Numbers

50: Percent of all knee arthroscopic procedures (minimally invasive procedures with very small incisions) are performed for tears in the meniscus cartilage.

80+: Percent of patients who could wait to see if the damage repairs on its own if the meniscal tear is not caused by trauma.

300,000: Annual number of people whose surgeries didn't help them get better faster

2x: The higher rate (double) at which Americans have knee arthroscopy for torn meniscus compared with Great Britain or Canada.

12 months: Number of months of exercise and physical therapy that people with a torn meniscus need to do just as well as patients who had surgery (with none of the post-operative pain or risk)

$4 billion: The amount of money Americans spend every year on this knee surgery, a great deal of which may be unnecessary.

Quiz

This quiz will help to reinforce some of the key points in the material. Your answers won’t affect your coverage or reimbursement. (No one other than you will see the results.) You just need to confirm that you read the information and took the quiz, to be cleared for coverage...

Click the right arrow to continue.

If you have knee pain the first thing you should do is:

Set up an appointment with the surgeon right away, because the longer you wait the worse it could get.

Ask your doctor if there are things you need to change in your diet to help your knee heal.

Ask your doctor which drugs you should start taking right away.

Start good self-care with rest, followed by exercise and pain management guided by your doctor or a physical therapist.

Questions for Your Doctor

Here are five questions to discuss with your physician or other healthcare provider about whether or not to have surgery on your torn meniscus.

  1. How many meniscectomies have you performed in the last 12 months?
  2. What about my meniscal tear make me a good candidate for a surgical repair?
  3. If I defer the surgery, what other steps do you recommend I take to reduce pain, promote healing, and restore full function?
  4. How much do you and the hospital or surgery center charge for the procedure? Do these fees include post-surgical follow-up visits? Is anesthesia included in these charges, or is it billed separately?
  5. If I opt for the surgery, what complications am I most likely to have?
Video View NBC video here.
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Surgery to repair a torn meniscus is very popular today.

Did you know that this surgery might not only fail to help your knee pain, but that people who have sham (or fake) surgery often do as well as people who have actual operations?

Click the on the right arrow to learn more.

»