Meniscal tears are a common knee diagnosis and can occur either traumatically or gradually over time. This latter type of meniscal tear, degenerative, was previously treated with arthroscopic surgery and post operative physical therapy but more recent research has changed our practice patterns with this patient population. Specifically, research shows no benefit of surgery over placebo surgery or surgery over conservative care including Physical Therapy. The equivalent outcomes of arthroscopic surgery and Physical Therapy has let many medical groups to advocate against the use of surgery for this condition.
A recent article in the Journal of the American Medical Association supports these previous findings on the management of patients with meniscal tears (van de Graaf et al. 2018). Three hundred twenty one (321) patients were randomized to either a knee arthroscopic menisectomy (meniscal tear removal) or Physical Therapy consisting of 16 sessions over 8 weeks. These sessions primarily consisted of strengthening exercises of the lower quarter. Authors found Physical Therapy was equivalent to surgery for improving knee function at 2 year follow up and stated Physical Therapy may be considered as an alternate to surgery for patients with meniscal tears. Although some patients may eventually require surgery the vast majority of patients will benefit from Physical Therapy first for their meniscal tears.
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