Providers need to rethink recommendations for meniscal tear surgery

Whenever health care providers recommend that individuals undergo surgery, the expectation is that patients will be better off and that they will experience improvements in their quality of life. However, this may not always be the case.

One team of scientists from Boston University School of Medicine and the University of Erlangen-Nuremberg in Germany suggested that a common surgical procedure used to repair torn meniscuses may actually drive the development of osteoarthritis for a significant number of patients, as presented at the annual meeting of the Radiological Society of North America. This research may have implications for the way doctors approach this injury, as well as the patient narratives that providers describe within orthopedic EMR systems.

Different treatment options are available
According to the American Academy of Orthopaedic Surgeons, the meniscus, which acts as a shock absorber between the femur and tibia, usually gets torn for two reasons. Among athletes, this injury is often the result of abnormal or forceful twisting of the knee, or a direct blow, which can happen in a tackle during football. For older individuals, the meniscus may tear because of the accumulation of mechanical stress over time on the cartilage. As the tissue becomes thin, it is more likely to become damaged.

The treatment that doctors recommend for meniscal tears depends on the type of tear as well as its size and location. Mild injuries, such as tears that occur in parts of the tissue with an ample blood supply, may heal on their own or with the help of conservative approaches. These include RICE therapy (rest, ice, compression and elevation) or nonsteroidal anti-inflammatory drugs.

More serious injuries, such as the ones that occur in parts of the tissue with little blood flow, can require surgery. Common procedures include a meniscectomy to trim away damaged cartilage, or operations that suture the torn pieces of cartilage together.

Surgery may not be as helpful as doctors think
To understand the impact of meniscal surgery, the authors of the new study evaluated the MRI scans of 355 knees that developed osteoarthritis within a period of five years. Results showed that 100 percent of the knees that underwent meniscal surgery became arthritic within a year. The same was true for only 59 percent of the knees that showed signs of meniscal damage but were never operated upon. Overall, 80.8 percent of knees that had surgery showed signs of cartilage loss. That figure was 39.5 percent among those who had meniscal damage and never had an operation.

"Meniscal surgery is one of the most common orthopedic procedures performed to alleviate pain and improve joint function," said researcher Frank Roemer, M.D. "However, increasing evidence is emerging that suggests meniscal surgery may be detrimental to the knee joint … The indications for meniscal surgery might need to be discussed more carefully in order to avoid accelerated knee joint degeneration."

Although meniscal tears can be serious, osteoarthritis comes with its own complications. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the pain and physical limitations associated with osteoarthritis may lead to depression, anxiety and feelings of helplessness. Careful consideration of whether surgery is suitable for meniscal tear patients is not just a matter of reducing health care costs, but also an issue of maintaining the best quality of life for patients.

Instead of going through an invasive procedure, patients with meniscal tears may benefit from more conservative treatments, such as RICE therapy, medication or physical therapy that is designed to strengthen the muscles or increase range of motion.