Adam’s Journal
Here’s a question from a reader:
I’ve been told my knee needs a meniscus repair. My pain level is mostly moderate, and I don’t take any pain relievers.
I’ve read this surgery isn’t always successful, with a full knee replacement possible in the future. I’ve also heard about other treatments like platelet-rich plasma (PRP).
At 79, I’m not sure that I want to do this surgery. What pros and cons should I consider?
Jane Walker
Dr. Jeffries Prescribes
We have very good clinical data about whether to operate in situations like this. But before we go there, let’s start with a one-paragraph anatomy lesson.
The meniscus is a C-shaped piece of cartilage in your knee. You have two in each knee, and they act as shock absorbers between the thigh bone and cartilage and the shin bone and cartilage. If a meniscus gets torn, often by trauma (twisting, deep bending) or by the process of osteoarthritis itself, it can cause pain, swelling, stiffness and instability.
A 2013 trial compared physical therapy to surgery for middle-aged and older patients with meniscal tears and mild-to-moderate knee osteoarthritis. At both six months and one year, patients who underwent surgery fared no better functionally or pain-wise than those who received physical therapy.
A more recent study also looked at people aged 45-70 with meniscal tears. Researchers followed patients for five years and, again, found no difference in knee function between those who opted for surgery and those who chose physical therapy.
Even in younger adults, a pair of studies found that in the two years following meniscal surgery, surgical repair was no better than exercise (with no surgery) for improving pain, quality of life or knee function.
So, when it comes to knee function and pain, surgery for a meniscal injury does not appear any better than standard physical therapy. This remains true so long as the meniscal injury is not so extensive that it keeps the knee from moving at all – a “locked” knee – or if the knee has very high levels of instability, which is a fairly uncommon situation.
For the large majority of meniscal injuries, rather than surgery, we should focus on physical therapy and treating the knee like we would treat typical knee osteoarthritis. Indeed, many researchers in the field view meniscal tears and knee osteoarthritis as different manifestations of the same disease.
As far as platelet-rich plasma treatment is concerned, no large studies have shown a definitive benefit to PRP over placebo. As a result, Medicare or other insurers likely will not cover the procedure.
The risk associated with PRP is probably low, so it would be a shared decision between you and your physician about whether to pursue this course of treatment. On balance, I’d favor standard treatments like physical therapy and a trial of corticosteroid injection, which can reduce pain and inflammation.
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Dr. Matlock Jeffries is a rheumatologist and associate professor at the Oklahoma Medical Research Foundation, where he also serves as director of OMRF’s Arthritis Research Center. Adam Cohen is OMRF’s senior vice president and general counsel. Send your health questions to contact@omrf.org.
