Meniscus Tears, Arthroscopic Surgery, and Increasing Your Risk for Total Knee Replacement

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Meniscus tears are common and seen regularly in physical therapy practices around the country. These injuries are seen with direct contact to the knee or with non-contact, cutting movements. Meniscus injuries can also occur over time due to normal, age-related changes in the knee. Osteoarthritis is commonly associated with these types of age-related changes.

There are several different types of meniscus tears (as can be seen in the image to the right). A physical therapist can help diagnose a meniscus tear by asking you several different questions and performing hands-on testing. However, the gold standard for diagnosing a meniscus tear is via magnetic resonance imaging (MRI).

Some common complaints we hear from patients with meniscus tears are catching, clicking, and locking of the knee. Knee pain and swelling at the joint line is also common with these cases. It is important to remember that pain is multi-faceted, and the pain source could be rooted in the degenerated cartilage, ligamentous tissue, or the patellar tendon. That is why special testing is also necessary during our physical therapy evaluation.

It is standard practice for patients to attempt conservative treatment prior to undergoing arthroscopic surgery. Many times, arthroscopic surgery does not relieve the pain, or stop the catching/clicking/locking symptoms that patients experience. Therefore, attempting physical therapy interventions, including manual therapy, stretching, and corrective exercise are best practice to start.

So, what is arthroscopic surgery of the knee anyway? Essentially, an orthopedic surgeon will make small incisions and enter the knee joint with cameras that identify where the meniscus tear is located. The orthopedic surgeon may then decide the fraying tissue that has settled within the knee joint, or he/she will perform a partial meniscectomy (cut out the part of the meniscus that is torn). Rehabilitation after the procedure will be necessary to regain range of motion, strength, proprioception, and the ability to absorb load/impact.

It is recommended that you avoid surgery, unless completely necessary because an arthroscopic meniscectomy increases your risk of developing knee osteoarthritis later in life. This is likely due to the biomechanical changes in how forces are absorbed by the knee. The meniscus supports the knee by absorbing forces. If we have removed part of the meniscus, we have less support, so to speak. In patients who already have been diagnosed with knee osteoarthritis, arthroscopic knee surgery is associated with a three-fold increase in the risk for future knee replacement (Rongen et. al. 2017).

If you, or somebody you know has had (or suspects) a meniscus tear, please call us at 347-560-6920 to schedule a physical therapy evaluation.

 

Paul Nasri, PT, DPT
Doctor of Physical Therapy
Sarrica Physical Therapy & Wellness
Staff Physical Therapist

 

Rongen, J., Rovers, M., Tienen, T. V., Buma, P., & Hannink, G. (2017). Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: A multi-center longitudinal observational study using data from the osteoarthritis initiative. Osteoarthritis and Cartilage, 25(1), 23-29.