You’ve developed some knee pain, and you are having difficulty walking and climbing stairs without pain. You visit your healthcare provider, and an MRI is done which shows a knee meniscus tear. Surgery is recommended. It seems reasonable, but is it absolutely necessary? Are there other alternatives to surgery for a knee meniscus tear?
Recent research indicates that a course of physical therapy can yield the same outcome as surgery for a torn meniscus in your knee.
The meniscus—or meniscii when speaking of them in plural—is a small cartilaginous structure in your knee. You have two in each knee, one on the inner aspect of the joint and one on the outer aspect. These meniscii act as miniature shock absorbers in your knee; they help to absorb impact through your knee joint. The meniscus also helps to allow your knee to glide and slide properly as it bends a straightens.
Sometimes jumping and landing in an awkward position or twisting over your knee with your foot planted on the ground can irritate your meniscus. The meniscus can become frayed or torn. Occasionally, wear and tear from degenerative conditions like arthritis can cause a meniscus tear in your knee. When this happens, pain in your knee may result. Your knee joint may also become swollen, and it may catch or lock when moving in certain positions. This can cause significant loss of mobility.
Symptoms of a meniscus tear in your knee may include:
- Knee pain
- Knee swelling
- Locking of your knee joint
- Loss of knee range of motion (ROM)
- Decreased strength in your quadriceps or hamstrings and the muscles around your knee
- Difficulty rising from sitting, walking and running, or climbing and descending stairs
If you have any of these symptoms, check in with your healthcare provider right away. Your healthcare provider may order special tests for your knee, and he or she may recommend you see a physical therapist for your torn meniscus.
Physical Therapy and a Torn Meniscus
If you have a torn meniscus, your healthcare provider may refer you to physical therapy. You may also be able to see a PT via direct access without a healthcare provider’s referral. Your physical therapy experience should be personalized for your specific needs, although there are some goals that are common when rehabbing a meniscus tear.
The goals of physical therapy for a torn meniscus typically include:
- Improve knee ROM
- Improve strength of your muscles around your knee
- Decrease knee swelling
- Decrease knee pain
- Improve functional mobility of your knee and entire lower extremity
- Learn strategies to prevent future knee problems
Doesn’t Everyone With a Torn Meniscus Need Surgery?
Here’s a funny thing about meniscus tears in your knee: many people have them and have no pain. Research shows that many people with no knee pain and no functional loss in their knee still have a meniscus tear on MRI images. Do these patients need surgery? Probably not. Your healthcare provider wouldn’t, or shouldn’t, perform surgery on a patient with no loss of function, no pain, and no loss of strength or motion.
Images on MRI can be difficult to see, and sometimes these images don’t tell the whole story. Sure, MRI results can be helpful in guiding your decision making after a knee injury, but the MRI should be only one small component of your care. Your clinical examination and your knee pain and function are also important variables to take into consideration when choosing to have surgery or not for your torn meniscus.
If you have a torn meniscus, your knee may not be moving properly, and it may be painful and swollen. But these symptoms may be temporary, and they may get better with a course of physical therapy.
The Research: Physical Therapy Vs. Surgery for a Torn Meniscus
Is surgery absolutely necessary for a torn meniscus in your knee? Maybe not, and here’s why: research shows that the long-term outcome of surgery versus physical therapy for a meniscus tear can yield the same result for some patients.
A study published in the New England Journal of Medicine examined the outcome of a physical therapy program versus surgery and post-operative PT for people with knee osteoarthritis (OA) with a meniscus tear. The study included 351 patients with knee OA and meniscus tear. Each patient was randomly selected to have knee meniscus surgery followed by rehab or to simply attend physical therapy without having surgery. The surgery performed was a knee partial meniscectomy, a common surgical procedure used to repair a torn meniscus.
The main outcomes measure of the study was scored on the Western Ontario and McMasters University Osteoarthritis Index (WOMAC), a test of knee function. Higher scores on the WOMAC equate to more severe knee symptoms. The scores were obtained at the start of the study and after 3, 6, and 12 months. This was done to obtain long-term information about the patients’ knee function.
The results of the study show that there was no significant difference in knee function 6 months after randomization into either the surgery group or the physical therapy group. One death occurred in each group—one patient in the surgical group had a pulmonary embolism which was fatal, and one patient in the PT group had a fatal stroke.
It should be noted that 30 percent of the patients originally assigned to the physical therapy group crossed over to the surgery group, while 5 percent of those scheduled to have surgery decided to move to the therapy group. This is consistent with a natural continuum of care—if you start physical therapy for a torn meniscus and your knee pain continues, you can always elect to have surgery. It’s a one-way street, though; you can’t undo your knee surgery once it is done.
More recent research has shown similar results. A 2018 analysis of 321 patients with meniscus tears found that PT is non-inferior to arthroscopic partial meniscectomy surgery. The 24-month functional improvement for PT intervention versus meniscus surgery is virtually the same. People who had meniscus surgery had slightly improved knee function scores, but they also had slightly more adverse events as a result of surgery.
Bottom line: the research shows that you can have a positive outcome with physical therapy for a torn meniscus, and surgery can still be beneficial if it is required once PT has proven unsuccessful.
Work With Your PT and Healthcare Provider to Make the Right Choice for Your Knees
So how do you know if you need surgery for your torn meniscus or if you’ll benefit from physical therapy? It can be a tough decision to make, so if you have knee pain from OA and a torn meniscus, work closely with your healthcare provider to make the best decision on whether or not to have surgery. It can be helpful to understand that many people with meniscus tears have a successful outcome avoiding surgery and working with a physical therapist. If things are not progressing properly with therapy, you can always elect to have knee surgery if recommended by your healthcare provider.
How do you know when it is time to stop physical therapy and consider surgery? There are some signs and symptoms that may indicate the need for surgery, including:
- Persistent knee pain that remains after 3 to 4 weeks of rehab
- Loss of knee mobility that is not restored with PT
- Difficulty walking, rising from sitting, or climbing stairs
- Persistent knee swelling
The best way to know if you need surgery is by working closely with your surgeon and physical therapist for your knee meniscus tear.
Knee pain due to OA and a meniscus tear can limit your ability to perform your normal daily work and recreational activities. If you have knee pain from a meniscus tear, your healthcare provider may recommend you see a surgeon for your condition, or he or she may refer you to a physical therapist. Research shows that you may regain normal, pain-free mobility with physical therapy and without the need for surgery. If the PT is unsuccessful at helping you recover, you can always choose to follow the surgical path for your knee.
Physical therapy should be the first choice when managing the pain and functional limitation that may come with a knee meniscus tear. Your therapist can help you regain normal motion and strength and help you return to your previous level of activity.