It seems like meniscus surgery has become a modern rite of passage for active people. A middle-aged person gets knee pain while doing something active, and sometimes a pop or shift is felt. The knee swells and becomes painful, and activity is difficult. An MRI shows a meniscus tear, and surgery ensues. Is the problem fixed, or are the real problems just beginning? For many patients a meniscus surgery failure is common, and the next step is often knee replacement. Is this all the standard of care or the biggest medical misadventure since snake oil? A new study adds evidence that this rite of passage is not helping patients, but is actually making them more likely to get arthritis.
The knee has cartilage that covers the end of the bones. This biologic cushion is tough, but also vulnerable under the wrong circumstances. The meniscus is an added shock absorber that helps to protect the cartilage. At first blush it would seem that a tear in this structure would be a real problem, reducing the ability of the meniscus to guard against cartilage loss. There is some truth in the assertion that a torn meniscus is less able to do its job. However, there’s one problem with operating on the meniscus—removing parts of it makes the wear-and-tear forces worse.
Before we get into what surgery does to the knee joint, let’s spend some time reviewing whether meniscus tears are important at all. That meniscus tear seen on MRI in a middle-aged man or woman is a story that happens hundreds of thousands of times a year in the U.S. What if the tear seen on MRI was mostly a red herring?
It’s hard for patients to get their heads around the fact that a meniscus tear seen on MRI may have been there long before their knee began hurting and that their buddies who don’t have knee pain also likely have meniscus tears on their MRIs. However, this is true based on a number of big studies. So that meniscus tear that the surgeon convinced you was the cause of your knee pain and swelling likely isn’t. The bottom line: meniscus tears are as common as wrinkles and likely just as meaningful.
Many patients believe that meniscus surgery involves a repair of the torn structure. Nope. More than 9 times out of 10, what’s really being done is that the torn meniscus piece is removed. So while the torn meniscus may be less efficient in helping protect the cartilage, removing a part of the meniscus makes matters even worse!
Many prior studies have shown that meniscus surgery increases the loads on the cartilage, leading to more wear and tear. Now a new study continues to add to that body of literature that this common surgery is bad news for most patients.
The new research looked at patients before and after a partial meniscectomy surgery—the most common elective orthopedic surgery in America. What was unique about this study was that it wasn’t just another cadaver study looking at what happens in simulated surgeries, it was an actual 3D gait analysis of real patients.
What did they find? Just as predicted by other studies, the forces on the knee cartilage went up after surgery. Given that these patients had a meniscus tear that needed surgery at the first gait-analysis measurement and then had the same knee measured after the surgery, the increase in forces is very concerning. The whole point of the surgery is to get rid of the pain and make the knee function better. Given that other studies have shown that meniscus surgery is no better than a placebo procedure in relieving pain, the fact that it made the function of the knee worse is a double whammy!The upshot? Outside of a knee that locks frequently and is nonfunctional, the research shows that knee meniscus surgery is a really bad idea. This hasn’t stopped hundreds of thousands of these procedures a year, but as the evidence continues to mount that the procedure is hurting patients, at what point do insurance companies decide to no longer cover this expensive boondoggle? In the meantime, rather than cutting our torn pieces, we’ll continue to use precise injections of the patient’s own stem cells and platelets to help the problem.
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…