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.”

When you kick off a new project at work, chances are you spend a fair amount of time setting and reviewing goals. These goals help you—and those you’ll be working with—get a clear sense of what you’re looking to achieve and begin to map out a plan of attack. Along with specific goals, you also probably find it helpful to set some key milestones to ensure that you stay on task and to prevent your motivation from waning.

These same principles apply when going to physical therapy for an injury. Communicating what you hope to get out your therapy sessions can help your physical therapist to individualize the treatment plan and design an exercise program that aligns with your goals. The idea is to move from “I’m here because my knee hurts” to “I’d like my knee to feel better so I can get back to doing X, Y and Z.”

Let’s talk about a concrete example to illustrate goal-setting in action: A father of three ruptures his Achilles tendon while playing a game of pickup basketball after work. When he lands in rehab, he explains to his PT that he’s due to walk his oldest daughter down the aisle at her wedding in a few months. This gives the PT a specific goal—and a timeline—to aim for. Of course, not every patient has a goal tied to such a momentous occasion. It can be as simple as carrying your groceries to your car unassisted or lifting your grandchild into a high chair. Either way, it’s important to have goals—and to communicate them clearly to your physical therapist.

Your PT wants you to get better but without the right guidance from you, he might default to following a checklist and design a program that unknowingly misses your goals. Only you know precisely what you want out of PT: If you have a wrist injury and getting back to your knitting hobby is important to you, then be specific! Another patient could come in with the same injury but have completely different goals, so guide your PT to help you achieve what’s most important.

Proper communication ensures success, and that means you can’t passively participate in your care and simply listen to what the PT recommends. Instead, communication needs to be a two- way street. So next time you’re at physical therapy, speak up: Make sure that your PT knows precisely why you’ve made the appointment, what you hope to get out of it and why it’s important to you. This information not only helps your PT make important decisions about your care but also to think of new ways to keep you motivated during therapy.

If you find yourself making an appointment to see a physical therapist for a new injury or a nagging pain, make sure that you prepare in advance. Being prepared to answer this one simple question can help to ensure that rehab is a success: What brings you to physical therapy today? After all, you wouldn’t walk into a kickoff meeting at work without first giving some thought to the goals that you planned to share with your team, would you?

When the calendar year comes to a close, we often find ourselves physically and mentally depleted from the holidays and the end-of-the-year rush. It’s no wonder that three of the most common self-improvement resolutions uttered as the clock strikes midnight are: eat more healthily, lose weight and commit to a regular exercise program.

January is a great time to press the restart button and revisit our ongoing quest to be better versions of ourselves, and not just because the longstanding New Year’s Eve tradition tells us to. Each year, however, Americans struggle to turn the goals they’ve set out for themselves into long-term change. In fact, according to Statistic Brain Research Institute, of the 41% of Americans who make resolutions each year, just 9.2% successfully achieve their objectives.

When it comes to committing to a regular exercise program, don’t become a statistic! For those looking to make exercise a regular habit, enlisting help in achieving your goals is one way to ensure success. You might consider recruiting an exercise buddy (to make you accountable), using a calendar app to schedule workouts (to dedicate time in your day) or consulting a healthcare professional (to supervise your program and keep you safe).

Physical therapy is a great resource for those interested in beginning a new exercise program or overcoming a nagging injury. Rehab professionals are trained to assess limitations and dysfunction, teach proper body mechanics and prevent—and treat—injuries. Your physical therapist will ask about any issues you’re encountering, evaluate your functional abilities, gather a thorough medical history and discuss your fitness and activity goals.

One rule of thumb is to start slow—particularly if you’re trying a new form of exercise or haven’t been active for some time. And once you start to form the habit of regular activity, mix it up by engaging in multiple activities rather than focusing on one. Many lingering injuries occur because of overuse or repetitive stress, most often at the hands of participating in one activity—such as running or biking—exclusively.

If you’re experiencing pain, inflammation or weakness, make an appointment to be evaluated by a physical therapist. The movement specialist will assess and identify the cause of the nagging injury and teach you how to modify your behavior to distribute stress to different parts of the body and reduce the repetitive nature of your movement patterns.

But that doesn’t necessarily mean putting your resolution to exercise regularly on hold. Your PT can work with you to identify an appropriate fitness program, including the safest frequency, intensity and duration of each workout session. The best part? There will be no excuses because you’ll have all the tools you need to be make this your most fit year yet.

Recently we have seen a rise of diseases in children that in the past had only been seen in adults. Things like obesity, type 2 diabetes, and high blood pressure are being seen more frequently in children. One of the best ways to combat the rise of these diseases is to make sure that your kids are getting enough physical activity.

The Department of Health and Human Services has developed guidelines recommending that youth ages 6-17 participate in 60 minutes or more of physical activity 7 days/ week. This is total activity time, so 1 hour, 2 30 minute sessions, or 4 sessions of 15 minutes each in a day would all satisfy this recommendation. Most of this activity should be at either moderate or vigorous intensity.

An easy way to distinguish vigorous vs moderate intensity exercise is as follows:

Moderate intensity allows you to talk but not sing during or right after activity

Vigorous intensity allows you to say only a few words at a time

As part of the 60 minutes daily, it is recommended that children participate in muscle strengthening activities 3 days/wk and bone strengthening activities 3 days/wk. Some activities that would fit into these categories are listed below:

Muscle Strengthening Activities

1. Games like tug of war

2. Climbing playground equipment

3. Push ups, pull ups, or sit ups

4. Activities like crab walking, bear walking, or wheelbarrow with a partner

Bone Strengthening Activities

1. Hopscotch

2. Jumping rope

3. Skipping

4. Sports that include jumping like basketball or volleyball

To get and keep kids participating, physical activity should be fun and incorporated into playful activities that are age appropriate. Being involved in physical education in school is important, especially if children are not involved in extracurricular activities that meet the requirements. Summer camps can be a great way to keep kids active during summer vacation.

For more information check out:

1. https://health.gov/paguidelines/midcourse/youth-fact-sheet.pdf

2. https://www.cdc.gov/healthyschools/physicalactivity/facts.htm