Pamela A. Popper, Ph.D., N.D.

Wellness Forum Health

More studies are showing that physical therapy, exercise, diet change, and weight loss  work just as well, and sometimes better than surgery for knee pain. This is important since millions of people have knee pain. Over 9 million people are estimated to have osteoarthritis of the knee, and 35% of people older than 50 have confirmed meniscal tears.

The meniscus is a piece of cartilage that provides a cushion between the shinbone and thighbone. It can tear when the knee is forcefully twisted or rotated, causing pain, swelling, and stiffness

Damage to the meniscus is common in people with osteoarthritis. Most people with meniscal tears are asymptomatic, and studies have shown that people with osteoarthritic knees who have a torn meniscus are not in more pain than people who do not have tears.[1] And 76% of asymptomatic patients have a medial or lateral meniscal tear. It is widely understood that doctors cannot confirm that knee pain is due to these tears, yet over 465,000 people have surgery based on the discovery of meniscal tears each year in the U.S.

The METEOR Trial involved 351 patients who had osteoarthritis and at least one symptom of meniscal tear such as knee clicking or weakness that persisted for longer than a month and after drug treatment, physical therapy or reducing activity.  The patients were randomized to have physical therapy or surgery (arthroscopic meniscectomy) followed by physical therapy. The physical therapy involved both 1-2 sessions per week with the physical therapist and home exercise. Patients advanced to the next intensity level at their own pace. Patients in the surgery group had an average of 7 sessions, while those in the physical therapy only group had an average of 8. The patients were evaluated both 6 months later and 12 months later. 30% of the non-surgery patients later decided to have surgery, but the surgery and non-surgery groups were about the same in terms of function at the end of 6 months.  The 12-month results were similar. In other words, surgery was not superior to physical therapy for resolving knee pain due to osteoarthritis, meniscal tear, or both.[2]

Other studies have shown similar findings – arthroscopic treatment is no better than sham surgical procedures and other non-surgical options.[3]

Tearing of the meniscus and osteoarthritis affects large numbers of people, and the cost of surgery averages $5000 per knee, which means annual expenditures for surgical repair of torn menisci are well over $2 billion. This is a lot of money to spend for a procedure that does not make a positive difference in outcomes. Patients should be given this information before making a decision to have surgery, and surgery should be a last resort after all other attempts to resolve pain have failed.

[1] Bhattacharyya T, Gale D, Dewire P et al. “the clinical importance of meniscal tears demonstrated by magnetic resonance imaging.” J Bone Joint Surg Am 2003 Jan;85-A(1):4-9

[2] Katz J, Brophy R, Chaisson C et al. “Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis.” NEJM 2013 May;368:1675-1684

[3] Moseley J, O’Malley K, Petersen N, et al. “A controlled trial of arthroscopic surgery for osteoarthritis of the knee.” NEJM 2002;347:81-88