To have surgery or not to have surgery… that is the question? At some point in most of our lives, we will be faced with this difficult decision regarding some injury, ache, or pain we are experiencing. Making informed decisions could be the difference between a pain-free existence or a potentially worse outcome. As physical therapists, we are frequently asked if “surgery is the right option for me?” In my experience, there is no instance where I hear this question more than with knee injuries, specifically, meniscus injuries.
You may be wondering, what the heck is a meniscus? At its core, your meniscus is a thickened cartilaginous pad between the two joints formed by the femur (the thigh bone) and the tibia (the shin bone), also known as your knee! The meniscus acts as a smooth surface for the joint to move on, serving as a shock absorber, a lubricant, and a joint protector all at once. The anatomical position and make up the meniscus make it a relatively avascular structure, meaning it receives very little blood flow. Why is that important? Well, should you be unfortunate enough to injure or tear your meniscus, it will not simply heal on it’s own, medical intervention will be warranted to help manage your pain and dysfunction.
What are my options? Most Orthopedics Physicians will give you two: Arthroscopic Surgery (a Partial Meniscectomy/the removal the damaged tissue) or Physical Therapy. For some of you the answer may seem straightforward… if surgery is an option, why wouldn’t I just have it done? For a few reasons…outside of the cliched “no surgery is a minor surgery” answer. The risks involved with even “minor surgeries” can be significant. Knee surgery specifically has proven to be a catalyst for more problems in the future. Invasive procedures can accelerate the development of Osteoarthritis and degrade the integrity of the knee joint, ultimately increasing chances of future knee pain and even more surgical intervention. Avoiding surgery could extend the life and health of your joint! But don’t fret…more and more evidence has emerged suggesting that the rush to invasive procedures may not necessarily yield better results.
In a recent randomized controlled trial involving nearly 200 symptomatic participants, (>45 years old), it was found that at 6 and 12 month evaluations, pain scores and reports of improvement between a surgical intervention only group and a physical therapy only group were nearly identical. The study additionally reported that nearly 30% of the group eventually classified as a“crossover group,” receiving both surgery and PT. This group showed markedly better improvement when compared to the surgery only group as well. According to their findings, the researchers concluded that attempting a prolonged bout of physical therapy prior to exploring surgical interventions was shown to be equally as effective as immediately opting for surgery. Meaning surgical intervention and PT yielded similar results with PT presenting a fraction of the risks, making it the more highly recommended option.
Studies like this exist throughout the literature and the evidence continues to remain consistent… physical therapy is the BEST FIRST option with meniscus injuries. The risks of surgery and possible consequences of invasive interventions simply outweigh the reward. Physical therapy presents a low-risk, high-reward option that has been repeatedly proven to be as effective as surgery with a fraction of risk and trauma involved. If bouts of PT are at first ineffective, it may then be time to consider secondary options.
If you take anything from this post, let it be this: Should you ever find yourself in this type situation, take the time to get informed! Ask your physician about your options or consult a physical therapist to see how they can help. It is a decision that could save you from the trauma of surgical intervention while prolonging the health and integrity of your joints!