Knee pain is among one of the most common types of chronic pain among adults in the United States. When it comes to chronic knee pain, the most common culprit is aging, specifically the injuries and repeated stress on the knees that come with age. One injury, in particular, is quite common, especially among older adults: meniscal tears.
Statistics show that about 61 of 100,000 people experience an acute tear of the meniscus. Degenerative tears of the meniscus are more common in older people. Sixty percent of the population over the age of 65 probably has some sort of degenerative tear of the meniscus.
If you’ve just found out that the pain and swelling in your knee is a torn meniscus, chances are you’ve probably weighed the decision of surgery versus physical therapy. But, which is better?
A recent study published in JAMA Network Open has found that physical therapy remains “non-inferior” to traditional arthroscopic partial meniscectomy for patients with a degenerative meniscal tear. To better understand these findings, let’s take a closer look at the findings.
Why Physical Therapy for a Torn Meniscus May Be Better
Physical therapy (PT) is often part of what most doctors call “conservative treatment” to avoid surgery. This type of treatment is typically used early on, as these types of tears are usually minor, and don’t require surgery. People who are middle-aged or older, or who have conditions like osteoarthritis, often experience meniscus tears simply because their knees are worn down. For them, PT may be as effective or even better than surgery.
PT isn’t just for older people. In fact, this type of conservative treatment is typically a good starting point for younger, more athletic people. It can work well, depending on the direction of the tear, how long it is, and where it’s located.
A major part of your decision between PT and surgery may hinge on how limited you are by the tear. For younger individuals or those who may not be able to work, PT simply may not be an option due to time constraints. However, even with surgery, a torn meniscus will require PT afterward. Your doctor may send you to a physical therapist, but at the very least you’ll get PT exercises to do at home. This will help bring your knee back to full health.
What the Study Says About Physical Therapy or Surgery for a Torn Meniscus
Led by Julia C.A. Noorduyn, from OLVG Amsterdam, and colleagues, the team compared the five-year effectiveness of arthroscopic partial meniscectomy and exercise-based physical therapy in 321 patients aged 45 to 70 years with a degenerative meniscal tear. Participants were randomly assigned to arthroscopic partial meniscectomy or 16 sessions of exercise-based physical therapy; 87.1 percent competed in the five-year follow-up (mean follow-up, 61.8 months).
The researchers found that the mean improvement was 29.6 and 25.1 points on the International Knee Documentation Committee Subjective Knee Form in the surgery and physical therapy groups, respectively, from baseline to follow-up. There was a 3.5-point crude between-group difference (95 percent confidence interval, 0.7 to 6.3 points; P < 0.001 for noninferiority); the 95 percent confidence interval did not exceed the 11-point noninferiority threshold. Rates of progression of radiographic-demonstrated knee osteoarthritis were comparable between both treatment groups.
“Findings from this trial further support the recommendation that exercise-based physical therapy should be the preferred treatment over surgery for degenerative meniscal tear,” the authors write.
What Does Physical Therapy for a Meniscus Tear Look Like?
Whether you use PT as a conservative treatment or to help you heal after surgery, the goal is the same: to get you back to your normal range of motion, strength, and control.
While PT will vary for everyone, there are a few standard exercises and tests your physical therapist will likely have you try. They usually look something like this:
- You will first start with exercises that focus on improving your range of motion, like flexing and extending your knee as much as you can without pain.
- Once you’re able to do this, your physical therapist will have you move on to stretches that keep your leg muscles loose. These may include hamstring stretches, calf stretches, or more hip flexor-focused stretches.
- After this, you will then begin basic exercises, like straight leg raises and toe raises to help build and improve your strength.
- Lastly, once you’re able to do all of this without pain, you will move on to more advanced exercises like toe raises with weights, squats, and more advanced stretches.
Depending on your age, the severity of the tear, and whether or not you have had surgery, the length of PT will vary. When done as a part of conservative care, you’ll probably try PT for around four to six weeks on a regular, weekly basis. This will also include at-home exercises that are to be done alongside PT.
If you have surgery that involves removing part of your meniscus, PT will likely last anywhere from three to six weeks before you’re back to normal. Surgery to repair your entire meniscus will likely take upwards of three months of PT to get you up and running.
Bottom Line: Physical Therapy or Surgery for a Torn Meniscus?
So, what’s the best option for a torn meniscus: physical therapy or surgery? The short answer is whatever you and your doctor decide is best for you. While studies like this show that physical therapy yields better long-term results, it is not always an option.
People with more active lifestyles, those who need to return to work quickly, or those who may not be able to dedicate the time necessary for PT all may opt for surgery instead. On the other hand, people with degenerative meniscus tears, like those involved in the study, may not only choose to undergo PT, but the evidence suggests that they may benefit from it more than surgery.
Ultimately, the treatment option you and your doctor decide is best for you is the route you should choose. Both physical therapy and surgery for a torn meniscus are tried and true methods to get you back in working order. As always, if you have any questions or concerns about existing or new knee pain, it’s important to talk with your doctor or healthcare provider before making any decisions.
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