If you have a degenerative meniscus tear as well as early arthritis in your knee, should you have meniscus surgery? Should you try to get better without knee surgery and try injections, physical therapy, anti-inflammatory medications or a brace? I discuss these questions in my latest Ask Dr. Geier column.

Andrew asks:

What are the treatment options for a degenerative meniscal tear?

This might seem like a very simple question, but it unfortunately can be a more complicated answer than you might think. And since arthroscopy of the knee for meniscus tears is often listed as the most common operation performed in all of orthopaedics, I think it applies to many of you.

Significance of a degenerative meniscus tear

First of all, it is true that meniscus tears generally do not heal by themselves. Yes, there are exceptions, but for purposes of this post, they don’t. That doesn’t mean that every patient with a meniscus tear needs surgery. Some people have them and don’t even know it. The key is to determine if the meniscus tear is what is actually causing a patient to have pain.

Significance of arthritis

Older patients often have wear and tear of the articular cartilage lining on the ends of the femur and tibia (essentially arthritis of the knee) as well as a degenerative meniscus tear. That makes sense when you think about it, since the meniscus is a shock absorber. If it is torn, more stress might be transferred to the bones and cartilage, causing damage to those structures.

Note the fissuring and fraying of the articular cartilage lining on the end of the femur.

Determining the true cause of the knee pain

Trying to know if knee pain is coming from the meniscus or articular cartilage can be more difficult than you might think. The location and type of pain can be very similar. Sometimes a patient will note having a dull pain for years before starting to have a sharp, very localized pain recently. That could be a sign that they had arthritis pain before developing a new meniscus tear. And ordering an MRI only shows you that a meniscus tear exists, but it doesn’t tell the physician that the meniscus tear is painful.

Surgery for a degenerative meniscus tear

The reason that the true source of pain matters is that arthroscopy of the knee and trimming out the torn part of the meniscus only relieve pain from the meniscus tear. “Cleaning up” the damage to the articular cartilage might provide some short-term relief, but studies have shown that it does little to provide long-term relief. I equate it to a pothole in a road. Smoothing out the pothole might make it smoother, but you are not filling in the hole. So, if a meniscus tear is causing most of the patient’s pain, surgery to scope the knee and trim out part of the meniscus can be very effective. But if there is a significant amount of arthritis in the knee, surgery might not provide complete relief.

If you have a degenerative meniscus tear, I would recommend that you discuss your knee and your symptoms with an orthopaedic surgeon who specializes in arthroscopic surgery and sports medicine and discuss whether surgery is the appropriate intervention for you.

Surgery for a degenerative meniscus tear
While the shaver is trimming out part of the torn meniscus, note the irregular nature of the cartilage on the femur above the shaver.

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