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.”

Basketball is the most popular youth sport in the US. A study by the National Athletic Trainers Association found that 22% of male basketball players have an injury that causes them to miss playing time each year. 42% of the time, that injury is to the ankle or foot, making this the most injured area. Some other common injuries to basketball players include:

Lower Extremity

1. Muscle strains such as a groin pull, quadriceps, hamstring, or calf strain

2. Knee ligament injuries such as ACL, LCL, MCL tears or sprains

3. Ankle sprains, including high ankle sprain

4. Ankle fractures

5. Overuse injuries such as patellar tendonitis, IT band pain, shin splints

Upper Extremity

1. Falls, leading to fractures, dislocation, or sprains of the wrist, elbow, or shoulder

2. Jammed fingers

Head

1. Concussion as a result from a collision between head and the ground, usually from falling

Knowledge of the most common types of injuries gives us a place to start thinking about prevention. While not all injuries can be prevented, there are some things parents and players can do to reduce the risk of being injured.

1. Have an annual physical completed by a physical therapist or other qualified professional This should include baseline testing of strength, ROM, and a baseline concussion test

2. Make sure you have an adequate base of strength and aerobic fitness The annual physical mentioned above should identify areas needing addressed here. Your PT or other professional can help design a training a program to address your specific needs.

3. Improve your balance and proprioception – this can help reduce the risk of the foot and ankle injuries so common in basketball This can be accomplished with off-season strength and conditioning as well as participation in injury prevention programs to work on jumping and landing skills

4. Avoid overuse injuries and burnout Taking time off throughout the season and the year will let the body recover

5. Hydrate adequately before and during practice and games

6. Wear properly fitted shoes

7. Be aware of the environment

Especially when playing basketball on outside courts – the court may not be smooth and even everywhere.