What is the meniscus?
The meniscus is a rubbery ring of cartilage that sits between the thigh and shin bones in the knee joint and helps provide cushioning as well as contribute to stability of the knee with rotational movements. Injury to the meniscus is common, and may occur acutely (e.g. due to an awkward twisting movement) or due to overuse following years of stress to the knee joint.
Traditional Management of Meniscus Injuries
These injuries have traditionally been managed by surgically repairing or removing the meniscus, or non-surgically through rehabilitation. Research over the past 2 decades has shown that for gradual onset meniscus tears, particularly in older people, placebo surgery is just as effective as actual repair or resection. However for traumatic (acute onset) meniscus tears in younger populations, the consensus was that surgery was required for optimal function.
New Research
Two recent studies out of Europe, the DREAM and STAR trials, have brought these notions into question. Both of these studies showed that a plan of care that included rehabilitation with the option of surgery if this was unsuccessful (which occurred in 25-40% of these individuals), was equally effective as early surgery at either 12 or 24 months post injury in cohorts of young (18-45 years), active individuals.
These results provide a great deal of optimism for those who have suffered meniscus injury. While there are certain types of meniscus tears ("bucket handle tears" that cause locking of the knee) where early surgical intervention is required, for most people, even younger and active individuals, an initial trial of rehabilitation is a reasonable option.
If you have suffered a meniscus tear and want to discuss your management options, come and speak to one of our experienced clinicians today! Take advantage of our new online booking system!
References
Skou, S. T., Hölmich, P., Lind, M., Jensen, H. P., Jensen, C., Garval, M., & Thorlund, J. B. (2022). Early surgery or exercise and education for meniscal tears in young adults. NEJM evidence, 1(2), EVIDoa2100038.
Van der Graaff, S. J., Eijgenraam, S. M., Meuffels, D. E., van Es, E. M., Verhaar, J. A., Hofstee, D. J., ... & Reijman, M. (2022). Arthroscopic partial meniscectomy versus physical therapy for traumatic meniscal tears in a young study population: a randomised controlled trial. British Journal of Sports Medicine, 56(15), 870-876.
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