Partial Meniscectomy

Recent research is showing that surgery might not be needed as often as we think. A large review estimates that 10% to 20% of surgeries might be unnecessary and that in some specialties such as cardiology and orthopedics, that number might be higher. The reasons for so many unneeded surgeries being performed are varied, but the most common is that more conservative options aren’t tried first, or lack of knowledge by the operating physician.

Physicians undergo long and rigorous training programs to become surgeons, but if they don’t work hard to keep learning, their knowledge often stops growing when they leave residency. Recent research is showing that certain common surgeries aren’t any better than placebo surgery (basically a sham treatment). Two such examples are kyphoplasty – a procedure for spinal compression fractures, and partial meniscectomy – a procedure used to treat tears of the meniscus in the knee (yet, we still see these done all the time!).

If a surgeon hasn’t continued to learn (think of how busy providers get with managing patients not to mention managing home and family life), they won’t know that these surgeries often don’t offer any more benefit than a non-surgical treatment and will continue to perform them. Although not ethically legal, we need to also be aware that every surgery performed can also have a benefit to the pocketbook of the surgeon or company, so some surgeons may be incentivized to fill their surgery schedule just as some providers are incentivized to carry on a lengthened treatment program for monetary benefit (we will talk about how to identify an ethical provider in future blogs!).

Every surgery, even “minor” ones carries risks. These include complications from anesthesia, blood clots after surgery, delayed healing of the incision, infection, and unintended damage to nerves or other organs near the surgical site. Some of these risks cause discomfort for a period after surgery and go away, but others can result in permanent disability or even death. For some patients and conditions, surgery is a great treatment option, but with all the associated risks, when meniscus surgery can be avoided, it should be.

For musculoskeletal problems like back, joint, and knee pain, sprains, and strains seeing your PT before a surgeon can help keep you out of the operating room and get you back to life without surgery. Studies have shown that physical therapy is just as good if not better than surgery for a multitude of conditions and carries less risk. Some examples would include rotator cuff tears, meniscal tears, spinal stenosis, low back pain, and osteoarthritis.

Physical therapy can’t fix every problem, and for some patients, meniscus repair via surgery is the best choice. However, research is showing that surgery isn’t a cure-all, and is sometimes just a very expensive and risky placebo. In most cases, starting with physical therapy is the right choice, and for many patients, PT for meniscus tears is the only treatment necessary.

How long is the recovery of a partial meniscectomy?

Your doctor may recommend physical therapy as part of your recovery. It’ll help increase your range of motion and help your knee get stronger. They may also share some exercises you can do at home. You may have to wear a brace or cast to keep your knee stable. You’ll likely also have to use crutches for at least a month to keep weight off your knee. If you have a partial or total meniscectomy, you can expect your recovery to take about a month. If your meniscus was repaired, it may take as long as 3 months.

Physical therapy is often part of what doctors call “conservative treatment” to avoid surgery, at least early on. People who are middle-aged or have osteoarthritis often have a partial meniscectomy simply because it’s worn down. For them, physical therapy may be as effective as surgery.

An article in The New England Journal of Medicine studied this. The article, “Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear” wrote that “Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.” It concluded that “In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.”

Furthermore, “In conclusion, the results of this randomized, sham-controlled trial show that arthroscopic partial medial meniscectomy provides no significant benefit over sham surgery in patients with a torn meniscus (meniscus injury) and no knee osteoarthritis. These results argue against the current practice of performing arthroscopic partial meniscectomy in patients with a degenerative meniscal tear.”

It turns out that while our early ancestors spent their days out in the wilderness hunting and foraging for food, they may also have been keeping their brains sharp. Researchers at the University of Arizona have found a connection between the highly active lifestyle that was prevalent in those ancient days and the prevention and treatment of Alzheimer’s disease and other age-related diseases.

Some two million years ago, our ancestors covered long distances—mixing moderate and intense bouts of aerobic activity throughout the day—as a means of survival. In sharp contrast, today’s average American starts his day by getting ready for work or school, then travels by car or train to an office where he’ll likely spend hours in meetings or in front of a computer, only to retire home to catch up on the latest series on Netflix. For the most active among us, exercise might consist of an hour at the gym three or more days a week and perhaps a few short walks sprinkled in throughout the day. But contrary to popular belief, that level of activity doesn’t completely erase the damage we do to our bodies during the other 23 hours in the day—which are largely spent sitting in a desk chair or at the dining room table, reclining on the family sofa or sleeping.

An obvious connection can be drawn between today’s sedentary lifestyle and a host of prevalent modern-age health problems like obesity and chronic illness, but how do low levels of activity affect our cognitive abilities? The study’s co-authors hypothesize that the amount of exercise that our ancestors engaged in reduced the burden of a genotype that leads to a high risk of Alzheimer’s disease, cardiovascular disease and increased mortality. As a result, the researchers stress the importance of exercise as a potential disease prevention and intervention tool.

Beyond reducing the risk of disease, the role that movement and exercise play in a person’s cognitive performance cannot be underestimated. Many research studies have proven that engaging in regular physical activity keeps our brains in top form, helping us to focus, recall and think more clearly. And while it’s not exactly feasible to adopt a hunter/gatherer way of life in today’s world, perhaps the takeaway is that moving—more frequently and for longer periods of time—can help stave off disease and boost our brain function. Just some food for thought next time you settle in to binge watch Game of Thrones or pass up an opportunity to bike to the office.