Torn meniscus surgery or not?
Should you get surgery for your torn meniscus? Well, you may have a good experience with surgery. Some people do. But there’s a good chance that it’s not necessary and that it won’t “fix” your problem.
In fact it could make it worse.
In this article I’ll share with you some of the research that I have done from when I tore my meniscus. Most of the following links to studies come from my original post here.
The two surgical procedures often done are called a partial meniscectomy (removal of the torn piece) and repair.
PARTIAL MENISCECTOMY (PM) OFTEN LEADS TO ARTHRITIS…
(00:45)
This is the quick “fix”.
Or is it?
It does tend to have better short term effects meaning your symptoms may improve within a few weeks and you can often walk after the surgery. The “recovery” time tends to be shorter. But over the long term the side effects don’t look so good.
Here’s a study that says 63% of those people who received a partial meniscectomy developed arthritis within 8 years compared to 28% in the non-operated knee.
“Osteoarthritis” is believed to be partly caused by mechanical stress on the joint.
And guess what increases joint stress?
Your meniscus acts as a shock absorber and stabilizer for your knee. So removing even a little changes the bio-mechanical function. Of course your surgeon may say that if you don’t remove it or fix it then it will not heal or it will cause arthritis.
But…
What they don’t usually tell you is that surgery is also likely to cause it.
Here are some more studies on partial meniscectomy.
- This study says PM is strong risk factor for arthritis.
- This video says cutting out as little as 10% can increase the joint stress by 70%.
- This one says PM disrupts the mechanical function of the knee.
- This one said partial meniscectomy compared to SHAM surgery didn’t offer very different results.
How about you? Are you an athlete?
“Although patients may be able to return to high-level sports after meniscectomy, long-term results suggest that meniscectomy significantly reduces the longevity of an athlete’s career.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714576/
Some surgeons will say, “Do you like running? Jumping? Well, after the operation you better not.”
Or one said to me if you want to “continue to sport” (in Japan^^) then you should repair it.
MENISCAL REPAIR (stitches) IS THE BETTER “SURGICAL” OPTION.
(01:09)
This tends to have better long term effects than a partial meniscectomy does. Although repairs have a higher re-operation rate than meniscectomy. Probably because it’s more complicated to do.
https://www.ncbi.nlm.nih.gov/pubmed/21820843
You also have to be on crutches and in a brace for 4–6 weeks and then recovery can be another 3–6 months or so.
Studies on the failure rate:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559536/
https://www.ncbi.nlm.nih.gov/pubmed/16878827
https://eorthopod.com/news/high-failure-rate-for-repair-of-meniscal-tears/
https://www.ncbi.nlm.nih.gov/pubmed/20551284/
https://sogacot.org/current-concepts-in-the-techniques-indications-and-outcomes-of-meniscal-repairs/
And the weird thing is that some doctors may only try the repair surgery if you’re of a certain age or if it’s in the “red zone”. Which is ironic as some say that tears in the red zone can heal.
You’re going to find many contradictions.
Also…
Many surgeons do not know for sure what they will do until they go into the joint with an arthroscopic camera. Repair is the more difficult procedure to do and if it’s in a difficult region or the tear is complex then they will likely remove the torn piece.
I personally didn’t like that uncertainty.
Repair is the better surgical option in the long run, but the side effect is that it could fail and you may need another operation.
Chances are…
YOU’RE PROBABLY NOT GOING TO GET THE BEST SURGEON AND HE’S PROBABLY NOT GOING TO BE DOING THE LATEST TECHNIQUES AND WELL, HE IS A SURGEON…
There’s a time lag between evidence and practice. Medicine is a slow changing institution.
For example, the first meniscectomies were done in the late 1800’s. Then they started arthroscopy in the 1950’s and then it wasn’t until the 1960’s when they started realizing that those full meniscectomies were causing arthritis.
It’s been over 100 years.
And some surgeons still remove the whole meniscus.
Chances are you will get “conventional” medicine and not very “advanced” medicine. Well, compared to a 100 years ago you will get advanced medicine, but know that your “average” orthopedic surgeon isn’t practicing the most up to date techniques.
On average the time lag is…
17 YEARS.
According to these studies.
https://implementationscience.biomedcentral.com/articles/10.1186/s13012-017-0555-2
https://journals.sagepub.com/doi/10.1258/jrsm.2011.110180
SO, WHAT DOES THAT MEAN TO YOU?
That there’s better practices, better ways to repair or encourage healing (which are backed by studies), BUT your “average” ortho isn’t practicing those yet because they are bound by convention, what they have always done and bureaucracy.
ALSO…
If you ask a surgeon how to solve your problem he’s likely going to offer what?
A surgical solution.
Most orthopedic surgeons see the body as a machine. And part of that is true. We are made of various parts like a car say, but what’s different?
If the axle on a car breaks is there any chance it will repair itself? We on the other hand are alive and we do have some capacity to regenerate. For example…
If you cut your hair what happens?
If you cut your skin what happens?
If you break a bone what happens? Even if it’s a very bad break the bone will grow together the best that it can.
Is cartilage totally different?
How did your injuries in the past heal?
Sometimes they heal good and others they don’t so they need a little prompt.
One thing to keep in mind is that an injury to your meniscus is an injury to the joint itself. The whole joint is affected which means the surrounding tissues and muscles are affected and the pain in your knee (depending on what stage you are in) may not be from your meniscus, but from the surrounding tissues.
The Google study…
Hehehe..
I coined this one. Search queries contain a wealth of information.
Here’s an informal “study” (02:17) on what happens to some people after surgery courtesy of Google search results. I did the same keyword search today which brought slightly different results. Here are some of those (“Searches related to”) for the keyword “can you tear your knee again after meniscus surgery”:
- knee pain 1 year after meniscus surgery
- knee swelling months after meniscus surgery
- continued knee pain after meniscus surgery
You hope that surgery would help, but it looks like it didn’t work well for them.
Note:
Search related to queries (on the bottom of the search results page) vary according to time, your location, search history and other factors Google doesn’t mention.
HAVE YOU HEARD ABOUT THE DREADED “RED AND WHITE” ZONE?
Can tears in the white zone heal? (03:53)
That depends who you ask.
The inner white part of the meniscus is non-vascular and some ortho’s will say tears in the white zone “cannot” heal, but is that true?
Is the meniscus a dead tissue? Is it like a piece of rubber on a tire?
Well, it’s living tissue surrounded by skin, bone and fluid. The meniscus receives nutrition from the synovial fluid, bone and outer (red zone) meniscus.
Here’s a study that shows that cells in the “red” zone were able to cross over to the white zone.
To say that it can’t repair itself is false. It may be difficult, take more time or need prompting, but it’s not without nutrition & it’s not a dead tissue.
Also some surgeons do stitches on the white zone of the meniscus.
I remember seeing a before and after (1 year later) arthroscopy of the meniscus repair. It showed the stitch right after the operation and then again 1 year later. The stitch was gone and you could see a slight scar of where the stitch was.
It grew back together.
And it didn’t matter that it was in the “white” zone.
Also…
How did it grow in the first place if there was no blood supply?
Hmmm…
Sure, you may be thinking you are older, but there are a number of things that you can do to promote those growth elements to help regenerate.
You also have stem cells in your knee after an injury.
https://pubmed.ncbi.nlm.nih.gov/18390894/
And macrophages… (they clean debris + dead cells in the joint)
So why do some people get arthritis if you have stem cells in your knee? Well, one problem is chronic inflammation.
Also as you age your body’s ability to repair itself decreases, but again there are things you can do to increase this ability of cell turn over not matter what your age.
CAN CARTILAGE HEAL AND REGENERATE ITSELF?
(03:23)
If you ask an orthopedic surgeon many will say “no” (00:26 someone from the Mayo clinic comments). You’d think that someone from the Mayo clinic would be hip to the latest in cartilage regeneration, but this guy certainly isn’t.
That’s what I was saying before that medicine and institutions are bound by convention and bureaucracy. They are slow to change.
Facts…
Here is a study that shows 37% of the subjects had an improvement in the defects in their knees and 33% had a worsening over a period of 2 years.
So it has the potential to heal.
That’s 69% so what about the rest?
I gathered the rest did not complete the study. It was over a period of 2 years.
So did you learn something new?
Do you want to heal your knee and get back in the game? Maybe even come back stronger then when you left? Wanna explore some alternatives?
Here’s how to help your body heal your torn meniscus…
