Surgery vs Physical Therapy for MENISCUS TEARS Which One Wins?

By dpope2020

November 8, 2024

all about meniscus surgery, dan pope, dr. david middaugh, el paso manual physical therapy, fitness pain free, fitnesspainfree, knee injury, knee meniscus surgery, knee pain, knee surgery, meniscus, meniscus exercises, meniscus injury, meniscus rehab exercises, meniscus repair, meniscus surgery, meniscus surgery decoded, meniscus tear, meniscus tear exercises, meniscus tear rehab, new meniscus surgery, orthopedics, physical therapy, torn meniscus, torn meniscus exercises

Diagnosing Meniscus Tears for Physical Therapists

To go along with today's episode I have a nice infographic to share...

Sign up to receive FREE: Meniscus Pathology Evidence Based "Cheat Sheet"

Click HERE to Download FREE

Grab the rest of the Mini Course and Sign up for the Certification Pre-sale list:

In today's video we go over Diagnosing Meniscus Tears for Physical Therapists: FPF Show Episode 150

  • 0:00 Introduction
  • 0:48 What are the surgical options for meniscus surgery? (repair, meniscectomy, transplant)
  • 2:05 BJSM clinical practice guideline recommendations for meniscus surgery in degenerative meniscus tears
  • 5:42 Is meniscectomy surgery superior to physical therapy treatment for degenerative meniscus tears?
  • 10:10 Do all patients with degenerative meniscus tears have success with physical therapy or do some go on to have surgery?
  • 14:43 How does a SHAM (fake) meniscectomy surgery compare to a real surgery (meniscectomy)?
  • 19:39 Does meniscectomy outperform physical therapy in ACUTE TRAUMATIC meniscus tears?
  • 23:29 Does meniscectomy OR repair outperform physical therapy in traumatic meniscus tears? (1-2 year outcomes)
  • 31:59 Do meniscus tears heal on their own? (Spontaneous healing rates - Non-operatively)
  • 40:57 Do mechanical symptoms improve more with physical therapy or surgery in degenerative meniscal tears?
  • 44:44 Do mechanical symptoms improve more with physical therapy or surgery in acute traumatic tears?
  • 49:51 Which patients are the best candidates for physical therapy management?
  • 50:58 Which patients are best candidates for meniscus surgery (Acute Tears)?
  • 53:46 Which patients are best candidates for meniscus surgery (Degenerative Tears)?
  • 54:00 How long should patients perform physical therapy and wait before considering surgery?

Surgery!  No, wait, Physical Therapy!,

- Dan Pope DPT,OCS,CSCS

Show Notes / Relevant Articles:

Want to support me and decide topics for future episodes?  Click HERE to sign up for FPF "Insiders" for just a dollar. You'll gain access to 100+ webinars, e-books and complete guides.  Plus, you'll get private access to the "Insiders" Facebook group where you can have all of your questions answered by me.  

Looking for other ways to support me that are 100% free?

  • Like, comment and share on youtube, facebook and instagram 
  • Leave a 5-star review on apple podcasts

Thank you!

Dan Pope DPT, OCS, CSCS

References: 

  1. Damsted C, Skou ST, Hölmich P, Lind M, Varnum C, Jensen HP, Hansen MS, Thorlund JB. Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults-An Exploratory Analysis From the DREAM Trial. J Orthop Sports Phys Ther. 2024 May;54(5):340-349. doi: 10.2519/jospt.2024.12245. PMID: 38385220.

  2. Sedgwick MJ, Saunders C, Getgood AMJ. Systematic Review and Meta-analysis of Clinical Outcomes Following Meniscus Repair in Patients 40 Years and Older. Orthop J Sports Med. 2024 Aug 8;12(8):23259671241258974. doi: 10.1177/23259671241258974. PMID: 39131093; PMCID: PMC11311169.

  3. Chirichella, P. S., Jow, S., Iacono, S., Wey, H. E., & Malanga, G. A. (2018). Treatment of Knee Meniscus Pathology: Rehabilitation, Surgery, and Orthobiologics. PM&R. doi:10.1016/j.pmrj.2018.08.384

  4. Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: A clinical practice guideline. BMJ 2017;357:j1982

  5. ESSKA Meniscus Consensus Project: Degenerative meniscus lesions

  6. Beaufils P, Becker R, Kopf S, Matthieu O, Pujol N. The knee meniscus: management of traumatic tears and degenerative lesions. EFORT Open Rev. 2017;2(5):195‐203. Published 2017 May 11. doi:10.1302/2058-5241.2.160056

  7. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL, Donnell-Fink LA, Guermazi A, Haas AK, Jones MH, Levy BA, Mandl LA, Martin SD, Marx RG, Miniaci A, Matava MJ, Palmisano J, Reinke EK, Richardson BE, Rome BN, Safran-Norton CE, Skoniecki DJ, Solomon DH, Smith MV, Spindler KP, Stuart MJ, Wright J, Wright RW, Losina E. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013 May 2;368(18):1675-84. doi: 10.1056/NEJMoa1301408. Epub 2013 Mar 18. Erratum in: N Engl J Med. 2013 Aug 15;369(7):683. PMID: 23506518; PMCID: PMC3690119.

  8. Sihvonen R, Paavola M, Malmivaara A, Järvinen TL. Finnish Degenerative Meniscal Lesion Study (FIDELITY): a protocol for a randomised, placebo surgery controlled trial on the efficacy of arthroscopic partial meniscectomy for patients with degenerative meniscus injury with a novel 'RCT within-a-cohort' study design. BMJ Open. 2013 Mar 9;3(3):e002510. doi: 10.1136/bmjopen-2012-002510. PMID: 23474796; PMCID: PMC3612785.

  9. Sihvonen R, Englund M, Turkiewicz A, Järvinen TL; Finnish Degenerative Meniscal Lesion Study Group. Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial. Ann Intern Med. 2016 Apr 5;164(7):449-55. doi: 10.7326/M15-0899. Epub 2016 Feb 9. PMID: 26856620.

  10. Damsted C, Skou ST, Hölmich P, Lind M, Varnum C, Jensen HP, Hansen MS, Thorlund JB. Early Surgery Versus Exercise Therapy and Patient Education for Traumatic and Nontraumatic Meniscal Tears in Young Adults-An Exploratory Analysis From the DREAM Trial. J Orthop Sports Phys Ther. 2024 May;54(5):340-349. doi: 10.2519/jospt.2024.12245. PMID: 38385220.

  11. Yagishita K, Muneta T, Ogiuchi T, Sekiya I, Shinomiya K. Healing potential of meniscal tears without repair in knees with anterior cruciate ligament reconstruction. Am J Sports Med. 2004 Dec;32(8):1953-61. doi: 10.1177/0363546504263702. PMID: 15572327.

  12. Marigi EM, Davies MR, Marx RG, Rodeo SA, Williams RJ 3rd. Meniscus Tears in Elite Athletes: Treatment Considerations, Clinical Outcomes, and Return to Play. Curr Rev Musculoskelet Med. 2024 Aug;17(8):313-320. doi: 10.1007/s12178-024-09907-w. Epub 2024 Jun 4. PMID: 38833135; PMCID: PMC11219605.

  13. Arnold S, Spalding T, Parsons H, Beard D, Bradley H, Crisford P, Ellard DR, Ferreira M, Getgood A, Guck J, Haque A, Khan I, Mason J, Milroy B, Myers P, Parker D, Price AJ, Smith A, Smith NA, Smith T, Stewart K, Underwood M, Verdonk P, Metcalfe A. Meniscal Transplant surgery or Optimised Rehabilitation full randomised trial (MeTeOR2): a study protocol. BMJ Open. 2024 Jun 3;14(6):e085125. doi: 10.1136/bmjopen-2024-085125. PMID: 38830746; PMCID: PMC11149128.

  14. Beaufils P, Becker R, Kopf S, Matthieu O, Pujol N. The knee meniscus: management of traumatic tears and degenerative lesions. EFORT Open Rev. 2017;2(5):195‐203. Published 2017 May 11. doi:10.1302/2058-5241.2.160056

  15. van der Graaff SJA, Eijgenraam SM, Meuffels DE, et alArthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trialBritish Journal of Sports Medicine 2022;56:870-876

  16. Damsted C, Thorlund JB, Hölmich P, et alEffect of exercise therapy versus surgery on mechanical symptoms in young patients with a meniscal tear: a secondary analysis of the DREAM trialBritish Journal of Sports Medicine 2023;57:521-527.

  17. Solsona-Carcas D, Trenado-Molina J, Buesa-Estéllez A, López-Royo MP, Bellosta-López P. Physical Therapist Interventions Versus or Combined With Surgical Treatment in Nontraumatic Degenerative Meniscal Pathology: A Systematic Review and Network Meta-Analysis. Phys Ther. 2024 May 1;104(5):pzae007. doi: 10.1093/ptj/pzae007. PMID: 38243408.

  18. Meng J, Tang H, Xiao Y, Liu W, Wu Y, Xiong Y, Gao S. Long-term effects of exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear: A meta-analysis of randomized controlled trials. Asian J Surg. 2024 Jun;47(6):2566-2573. doi: 10.1016/j.asjsur.2024.03.091. Epub 2024 Mar 25. PMID: 38531745.

Images:

  1. Medial Meniscus Source: https://commons.wikimedia.org/wiki/File:Medial_Meniscus_Injury.png Attribution: BruceBlaus / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0) Edited by fitness pain free LLC