10 Minute Tip #16: Should You Have Meniscus Surgery - Yes or No?

10 Minute Tip 16: Should You Have Meniscus Surgery - Yes or No?

DOCTORS OFTEN RECOMMEND A “SIMPLE” ARTHROSCOPIC KNEE SURGERY TO ADDRESS KNEE PAIN ASSOCIATED WITH MENISCUS TEARS. AND ATHLETES OFTEN BELIEVE THAT BECAUSE THEIR MENISCUS IS TORN, THEY WILL ALWAYS HAVE PAIN AND NEED SURGERY. HOWEVER, IN MOST CASES, WE RECOMMEND YOU DON’T HAVE KNEE SURGERY FOR SIMPLE MENISCAL TEARS FOR A VARIETY OF REASONS.

If you’ve ever wondered if a knee scope is the answer to your knee pain with the diagnosis of a meniscus tear, we urge you to think again. 

MANY PEOPLE DO NOT REALIZE THAT:

  • The majority of people without knee pain have meniscus tears

  • Surgery can actually cause more long term pain, symptoms, and dysfunction

  • The long term outcomes of surgery versus conservative treatment are not typically better

IN THIS EPISODE OF THE PRS PODCAST WE DISCUSS:

→ When and why not to have surgery

→ When surgery can actually make your knee pain worse

→ Signs and symptoms surgery is the better option

It’s entirely possible to overcome a meniscus tear and continue to barbell train or powerlift. While the process seems slower to rehabilitate the knee without surgery, it’s actually not and you’ll be able to train without interruption.

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Dr. Rori Alter, PT, PRSCC, SSC : [00:00:01] Welcome to the Progressive Rehab & Strength Podcast, where your hosts, physical therapist, strength coaches, and PRS clinical coaches Dr. Alyssa Haveson and Dr. Rori Alter, join us on our journey of barbell strength training and rehabilitation. All right. Welcome back to the Progressive Rehab & Strength podcast. I'm your host, Dr. Rori Alter, clinical coach here at Progressive Rehab & Strength, with my lovely co-host Dr. Alyssa Haveson, also a clinical coach here at Progressive Rehab & Strength. And we're back with Dr. John Petrizzo, clinical coach here at Progressive Rehab & Strength, physical therapist, strength coach, amazing human being, my husband, and a professor at Adelphi University. And luckily for us, I was just like, Let's just pull them on for this ten-minute tip because he's home and he's so brilliant that why not bring him on for this ten-minute tip? So in today's ten-minute tip, we're talking about figuring out if meniscus surgery is appropriate for you. And obviously, you need a doctor to help you figure this out. But many times, the term meniscus tear or meniscus injury or damage to the meniscus scares people. They think that they did something when they started to experience pain that caused the tear or change in the structure of their meniscus, which is why they're experiencing symptoms. The doctor tells them they have a meniscus tear, suggests surgery, or says we can scope the knee.

Dr. Rori Alter, PT, PRSCC, SSC : [00:01:41] It's a quick, easy surgery, and you'll be back to training or physical activity in no time. But. We are of the more conservative mindset. Some doctors are kind of old school and just scope knees because they're surgeons, and that's what they do. And I think there are more scenarios nowadays where we would say, don't have surgery. But there are very specific scenarios where we would say, let's have surgery. So what we want to do in today's ten-minute tip, which we will keep to 10 minutes because my husband will get very mad at me and rip his headphones off and come in here and shut the podcast off, and we don't stop at ten minutes. So we're going to talk about scenarios in which surgery is appropriate and then the immense amount of scenarios where we would say, do something conservative before jumping to surgery. So let me get my timer ready. The timer is set for 10 minutes, and 3,2,1. Who wants to start talking about meniscus surgery? John, why don't we talk a little bit about the reason? Any of us can talk about this, so whoever wants to take this conversation, go with it. So tell us a little about what the research says regarding conservative management versus surgical management of meniscus tears. Who wants to talk? John.

DR. John Petrizzo, PT, CSCS, SSC: [00:03:15] No, one of you guys can go. I'm fine with someone else starting. You guys said you were just looking at some articles, right?

Dr. Rori Alter, PT, PRSCC, SSC : [00:03:22] Yeah. So, the research for the last couple of years has shown that there's not much difference between conservative treatment and surgical outcomes when managing meniscus tears. And the reason, in my opinion, or my belief that this is the case, is that meniscus tears probably already exist in your knee, and the tear isn't necessarily why you're experiencing symptoms. But if it is, then it's not; the tear was there before it got inflamed, and for whatever reason, the knee got inflamed, the meniscus got inflamed, and we just got a calm it down so that you're back in this kind of like homeostasis with the tear existing. The research shows that we can do imaging on most parts of the body or all parts of the body, and there's going to be some type of degenerative change or damage. We don't like to use that word. We like to just use degenerative change or change in the joint. That is atypical of a perfectly beautiful joint. And this is found amongst asymptomatic people at a high percentage or a high rate. Right. This shows us that we can change our joints to the internal structures of the joints without having symptoms. And then surgery is an inflammatory incident to the knee, Right? So we have to cut through the skin, all the layers of the skin. We have to cut through the joint capsule. We go in and irritate the joint that doesn't normally have extra-articular things coming into it. And then we have this process of healing that happens after. And the healing process is an inflammatory process, right? So it can be pretty painful after. So we don't often see that the person has significant change with surgery versus without surgery, but there are scenarios where we might need surgery. So John or Alyssa, does that sound consistent with your beliefs or understanding of surgery versus no surgery for meniscus tears?

DR. John Petrizzo, PT, CSCS, SSC: [00:05:41] Yeah. And I would add that there are some scenarios where arthroscopic surgery on a torn meniscus leads to worse outcomes. So there's some research in people, as you get up to middle age and older, a lot of people, a high percentage of people are going to have meniscus tears. And if they also have osteoarthritis in the joint, having a meniscus surgery usually leads to worse outcomes than conservative treatment. So, I would give that as a kind of caveat. I think if you're talking about a younger, healthier population, then yeah, I would agree 100%. But, you know, long-term outcomes, there doesn't seem to be much of a difference between the surgical route and conservative treatment.

Dr. Rori Alter, PT, PRSCC, SSC : [00:06:34] Yeah. And I think that you might see you might experience a quicker your symptoms might subside quicker after surgery because, especially in that younger population, just because there's been some change to the inflammatory situation in the knee joint. But long term, as you said, the outcomes are no different for surgical versus non-surgical. And any surgery or any area of the body has long-term implications anyway. So like you have scar tissue from the incision, there's the whole process of recovery. What does that mean for your life outside of training? You have to take time off work. You might need help with your like if you're a parent, you might need help with your kids for a couple of days or maybe a week or two. So you have to think of what your home environment looks like, what your social and occupational role or obligations are in terms of making that decision for surgery, and looking at the long-term outcome are the short-term things that you have to go through worth it in the long term if the outcome is the same? Does that make sense?

DR. John Petrizzo, PT, CSCS, SSC: [00:07:46] Yeah. I think that should be weighed for all surgical procedures, and that's something that I think we could do a better job of communicating to patients. Many times, people just think, "Oh, surgery is going to fix my problem," not realizing that often it's going to get worse before it gets better. Right? You come out of surgery, everything's inflamed, and you're feeling worse than you did going in, at least for that initial period, which could be several days to several weeks, depending on the type of surgery you're having.

Dr. Rori Alter, PT, PRSCC, SSC : [00:08:17] Yeah. And I think when you are experiencing knee pain, it's hard to think like, "oh, I have to work through this knee pain to start to feel better" versus like, "oh, I can have surgery and feel better." But they don't think about where I am now in terms of my pain level and function and slowly improve versus getting worse and being less functional for six weeks and being the same in 12 weeks to six months. You know, they don't think about that. And I don't think doctors do a good job of educating people. They say, oh, it's a quick surgery. Yeah, it's quick for them. It's arthroscopic, so it's less invasive but still invasive. So, you know, like, I don't think that people think about and doctors do a very poor job. Most doctors, not all doctors. There are some good doctors out there. But we, as physical therapists, we get patients after the surgery, and they're like, "I had no idea. Like, why am I in so much pain? I didn't expect this." They don't; they don't know they're not.

Dr. Alyssa Haveson, PT, PRSCC, CSCS: [00:09:30] surgery generally isn't the quick fix people want.


Dr. Rori Alter, PT, PRSCC, SSC : [00:09:34] Right. Yeah, exactly.

DR. John Petrizzo, PT, CSCS, SSC: [00:09:36] People perceive it as the quick fix. Like when you talk about conservative treatment and going to PT for maybe a couple of months. Right. They're like, "oh, I'll just have surgery." It's like, well, it's going to be. It's going to feel worse. And then you still have to do the PT after for some time. So yeah, I think there's a disconnect between the perception of what surgery is and does for us versus the reality. And I think like Alyssa just touched on, people perceive it as the quick fix, and that's often not the case.


Dr. Rori Alter, PT, PRSCC, SSC : [00:10:09] Yeah. So in what scenarios might we need or strongly recommend a meniscus surgery?