When you think of a knee injury, particularly a meniscus tear, your mind might jump immediately to surgery. However, growing research consistently shows that surgery specifically for the meniscus has no long term benefits or superiority to conservative treatment options.1
When it comes to conservative treatment, physical therapy is one of the top options. A physical therapist can guide you in initiating proper treatment for your knee injury and provide continued guidance throughout your healing process.
Let a professional that understands the research help you navigate your choices.
If you try to consult the internet to help you decide between physical therapy vs. surgery for a meniscus tear, you may end up very confused. No matter what you choose, conservative treatment should always be tried first.
Plus, having a physical therapist that understands your unique limitations related to your injury (and how to navigate the sea of literature) can help you feel educated and comfortable with your decision.
What the research actually says.
The most common surgery for a meniscus tear is a meniscectomy, a procedure that removes a portion, or sometimes even the entire, injured meniscus. It has now been well established that this type of surgery can lead to complications in as little as five years, including progressive knee degeneration, arthritis, pain, and overall poor lower body mechanics.2 Additionally, the mere act of surgery leads to decreased integrity of the knee joint (again, causing the same health issues just listed even if the meniscus is not removed!)
Unfortunately, surgery is still frequently done to treat pain in the face of minimal functional deficits of the knee. Since surgery comes with its own risks of chronic pain, it should never be the sole reason for surgery
When surgery is required, repairing the meniscus is superior.
When sharp knee pain, knee locking or continuous clicking, loss of muscle strength, flexibility and balance occur from an injury, it quickly affects your quality of life. This is when surgery may be just what you need to regain some normalcy in your life.
A meniscus repair, involving suturing the torn area rather than removing it, has been found to be superior to the traditional meniscectomy when possible. Talk to your doctor about the best option for you to maintain optimal joint mechanics now and in the future.
Always start conservatively.
Physical therapy is always a great place to start with any injury. If your tear is smaller and in the outer third of the meniscus, you have a great chance of healing without surgery.3 Your physical therapist can work with you to create a comprehensive program to optimize knee function and blood flow to promote healing.
The good news is that this type of treatment can be just as effective as surgery in treating low grade tears with minimal loss of function. Plus, physical therapy is significantly cheaper, much less invasive and overall a great treatment option for an uncomplicated torn meniscus.
The different types of tears: degenerative vs. traumatic meniscus tears.
Depending on your activity level and age, meniscus tears can happen for very different reasons. Understanding your specific type of tear can provide some clarification as to which options are best for you.
Degenerative meniscus tears.
Degenerative tears happen from general wear on the body due to overuse, age or other health complications that have you using your knee improperly. It can be one of the first signs of degenerative changes in the knee, the driving force behind osteoarthritis.
These types of tears are most common in the middle aged population when changes in muscle balance, strength, flexibility, activity level, and blood flow start to occur with each additional decade of life. This type of tear does not typically respond to well to surgery and is currently not supported by research.4 In fact, surgery is more likely to further compromise the knee rather than help it.
Traumatic meniscus tears.
Traumatic tears happen from a sudden rapid movement, typically a planting and twisting motion or a blow to the knee. While it can happen at any age, it is most commonly seen in a younger population that is active in high impact sports. Given the typical profile of these individuals, surgery may be a plausible treatment to help them heal quickly and get back to their sport in full force.
As discussed earlier, meniscus repair is the best option for this specific population to minimize the risk of future degenerative changes. It is now well understood that trying to preserve the meniscus is the best option for these types of injuries.
Conservative care is always your first line of defense.
No matter your age, what caused your injury or the symptoms you are experiencing, surgery for meniscus tears should never be the first option. Instead, start with a full assessment of your injury and resulting loss of function. Physical therapists are highly trained in doing this to help you make the best choices possible for an exercise program and potential surgery. From optimizing the healing phase to getting you comfortable on your knee again, restoring mechanics and returning fully to your favorite activities, physical therapy for a meniscus tear is ideal.
Education about proper care for your knee, lifestyle tips and designing a tailored knee strength, stretch and function based program for you will keep you on the road to success, no matter what. From there, if you aren’t making the progress you hoped to and have lingering symptoms you can always consider surgery as needed. The extra benefit is that if you do decide to have surgery, you will also have a quicker recovery from all the hard work you’ve put in with your therapist!
How do you know if conservative care is right for you?
Conservative care will kick start your healing process. It will help you feel confident in your knee’s abilities and gradually progress your knee function as you make gains with your program. You will also gain valuable insight into how to maximize your potential in all your daily activities and sports. You will focus on the knee but you may learn about other imbalances that can help minimize future injuries as well!
Ultimately, you may be able to heal your knee without delay or complications of surgery while maintaining the integrity of your joint capsule. Building good knee (and overall) health will help you with optimizing your quality of life.
When you’re leaning toward surgery.
Sometimes surgery is inevitable if a tear is causing a severe decrease in your quality of life. This is typical with large tears that extend deep in the meniscus where there is limited blood flow. If you just aren’t seeing the results you want with conservative treatment and have residual deficits, surgery may be what you need.
Especially as a young, well-healing athlete, this may be your only way to return to your sport the way you want. If you’re middle-aged and sustain a sudden higher impact injury, you may also benefit as well. Otherwise, degenerative changes are best addressed conservatively. Make sure you put in your best effort with conservative care and understand the risks of surgery.
Surgery will lead to a full new recovery process that you can tackle with your therapist to maximize results. When meniscus tears are affecting your ability to do what you want, surgery is a great option with good outcomes when it is chosen for the right reasons.
When in doubt, preserve the meniscus!
Preserving the meniscus as much as possible is always the top goal when considering your treatment options. More often than not, conservative care is the best option for smaller or degenerative tears. Although, it will require long-term attention and care for your knee, it far outweighs the risk that goes with surgery in the long term.
Surgery is not the “easier” option.
Ultimately, surgery is sometimes viewed as a “quick fix” for an injury. This couldn’t be farther from the truth. Knee surgery comes with risks of chronic pain and swelling, loss of function, long-term degeneration and lost time at work or your sport due to recovery time. When it is truly warranted, it is a great option to get you back on track to reaching whatever life goals you have.
Extensively discuss your options with your orthopedic surgeon and physical therapist. We all have unique needs, but with the right education and attention to your body you can make a sound decision that is right for you.
Remember, when possible, preserve the meniscus! Your body will thank you in the long-term.