APPROPRIATENESS OF MENISCUS TEAR SURGERY

Recently, a Finnish study published in the New England Journal of Medicine has suggested that meniscus tear surgery only helps certain patients, and in some cases doing nothing at all is as effective as surgery. At 700,000 operations per year, meniscus tear surgery is the most common orthopedic procedure performed in the United States. The meniscus is a c-shaped piece of cartilage that sits in between the femur, or thighbone, and tibia, or shinbone. It provides cushion to the joint and protects the bones from rubbing on each other. Sometimes, due to an injury or wear and tear over time, the meniscus can tear and cause pain, swelling, and joint instability. Because the meniscus has a poor blood supply, it cannot heal, and many times the only way to relieve pain is to cut the torn piece out using arthroscopic surgery.

The Finnish study, which was also recently highlighted in the New York Times, involved 135 patients ages 35-65 with meniscus tears. All patients were taken to the operating room, placed under anesthesia, and small arthroscopic incisions were made. However, only a randomized half of the patients received an actual menisectomy. A year later, both groups reported similar improvements to their knees. While doctors have noted that the placebo effect has a role, it alone cannot explain why the majority of non-surgical patients reported improvement.

This study represents an important first step in defining when meniscus tear surgery is needed and when it is not. Future studies will be needed to assess what types of patients and meniscus tears are best treated with surgery. The study highlights the need for doctors to distinguish if a patient’s pain is actually coming from the meniscus, or if it is coming from a painful degenerative condition such as osteoarthritis.

Dr. Millstein is very selective in recommending surgery and takes into account each patient’s unique body and lifestyle. If you have a meniscus tear and would like to discuss what type of treatment—surgical or non-surgical—will give you the best results, schedule a consultation with Los Angeles orthopedic surgeon Dr. Millstein today at 310-595-1030.