Meniscal Injuries: Surgery or Physical Therapy?
Patients with meniscal injuries (such as a meniscal tear) face an interesting choice: surgery or physical therapy. The goal, of course, is to restore functional movement of the knee joint and to reduce pain after an injury to the meniscus. Before getting to what the research says, let’s first take a closer look at the injury.
The menisci are two crescent moon-shaped cartilages that lie between the femur (thigh bone) and the tibia (shin bone). It is often torn by twisting and/or putting pressure on the knee joint. Many types of tears can occur with a meniscus injury including a horizontal, longitudinal, radial, an oblique, a degenerative, or a discoid tear. Tears in the outer 1/3 of the menisci are more likely to heal because the blood supply is greater in that area. Tears closer to the center of the knee (deeper) are less likely to get the blood supply and nutrients it needs to effectively heal.
Research About Meniscal Injuries
Scientific studies have looked at the difference in function and pain between patients who underwent surgery and others who opted for physical therapy. Studies use both “Lysholm” and visual analog scores to measure the different treatment methods. Lysholm is a patient-reported outcome measure that consists of eight questions that deal with the categories of limping, support, locking, instability, pain, swelling, stair climbing, squatting and knee locking. A visual analog score allows a patient to rate their pain from 0-10 usually using faces from “happy” to “sad”. In a study by Yim et al. (2013), they found that there was no difference in Lysholm and visual analog scores between the two groups. In another study by Herrlin et al. (2013), it was also indicated that conservative therapy (physical therapy without surgery) was just as effective as arthroscopic partial meniscectomy (the surgery to repair or “clean out” the knee joint) in symptomatic and functional improvement. When looking at cost-effectiveness, receiving physical treatment is the better option for the patient with a cost savings of between $1,000 – $6,000. After analyzing the literature and reviewing the data, these studies concluded that there were no significant differences between the outcomes of surgery and conservative physical therapy treatment.
As physical therapists, we notice that patients can often be discouraged by a lack of perceived results during their physical therapy sessions. Even though the more conservative approach of slow, steady results can take longer, it’s important to remember all the benefits of conservative treatment versus surgery. This includes, but is not limited to: the cost-effectiveness, the benefits of strengthening (especially pre-operatively in circumstances of definite surgical intervention), and that the literature found no differences in conservative treatment versus surgery in choosing one treatment over the other.
What to Do if you Have a Meniscal Injury
If you’ve recently experienced an injury to your meniscus, be sure that you’re fully educated before making a decision about whether to go under the knife or to get treated by a physical therapist.