Your MRI shows that you have a tear in the medial meniscus of your knee and you have resigned yourself to the fact that surgery is the only fix.
The belief has always been that the posterior horn (the back half) of the medial meniscus (the shock absorbing pad on the inside part of your knee) does not have a very good blood supply. For this reason, any tears that occur are not going to heal on their own. This means surgery is your only option.
I’ve never been one to believe in dogma.
From an anecdotal standpoint, I have had more than my share of patients with documented medial meniscus tears that do perfectly fine without surgery. I still remember one of my early ones. This particular patient was on track for surgery, but just did not have the time off of work needed for the surgery and recovery. So he waited. In the meantime, we treated his knee, thinking that anything we could do to restore balance to the knee prior to surgery would be a good thing. Turns out, he did really well and never had the surgery. Later, he even forgot which knee it was that used to bother him.
Over the years, I have seen patients with meniscal tears do very well. Typically, the patient that responds best is closer to an ideal weight and more active. Patients who don’t fit this mold don’t do as well and seem to be more likely to end up in surgery.
Of course, my personal experiences do have some backing in the medical literature. For example:
- There is little correlation between MRI findings and knee symptoms.
- Although the rates of knee replacements are going up, knee findings on MRI are NOT going up.
In case all this isn’t enough to sway your decision away from surgery, pay attention to this particular study.
In it, researchers looked at the outcome of patients with medial meniscus tears who had surgery and compared these outcomes to those who didn’t have surgery and instead did rehab for his or her torn cartilage. They were evaluated using the WOMAC scoring (0-100, with higher numbers equating to more severe symptoms). Here’s what they found:
- At 6 months the surgical WOMAC score was 20.9 points.
- At 6 months, the rehab group score was 18.5 (yes–better, if ony slightly).
- At 6 months, 30% of those in the rehab group ended up having surgery.
- On the flip side, 6% of the surgical group had not undergone surgery.
- At 12 months the situation did not change from the 6 month scores.
- Adverse events did not differ in the groups.
Overall, there was no difference in long term outcomes between the surgical and non-surgical groups. Although 30% of the non-surgical patients ended up with surgery, this seems to match up with what we see in our office–some patients (overweight, sedentary) just don’t seem to do as well.
Either way, it seems clear that, if you discover that you have a torn medial meniscus and you are told you have to have surgery, it’s a very good chance that this just is not true.
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