MENISCUS TEARS: NON-OPERATIVE TREATMENT
Not all painful meniscal tears need surgery. The symptoms of pain generally will improve slowly over time, but may recur or worsen with activity. Some tears will go on to cause chronic pain, while others resolve almost completely. Non-operative treatment options include activity modification, elimination of painful activities, ice, compression, anti-inflammatory medications, rehab, and injections. Small meniscal tears without mechanical symptoms are often successfully treated with these conservative measures. A number of high-quality research studies have now shown that patients with the most common meniscal tear scenario (degenerative tears in patients over the age of 40 without mechanical symptoms), have failed to receive a benefit from surgery beyond that which is achieved from physical therapy alone.1-4
When symptoms have not responded to conservative treatment and persistently interfere with an individual’s quality of life, procedures and surgery becomes reasonable options. One procedure that can be performed in the clinic setting involves stimulating the meniscus under ultrasound-guidance with a needle to create a healing response (trephination). This is typically performed along with an injection of platelet-rich plasma (PRP) directly into the meniscus tear. A recent prospective, randomized, double-blind, parallel-group, placebo-controlled study revealed that percutaneous trephination of chronic meniscal tears induced healing and this benefit, along with improvements in functional scores and pain levels, was improved further with the addition of PRP.5
1. Herrlin S1, Hållander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc. 2007 Apr;15(4):393-401. Epub 2007 Jan 10.
2. Katz JN, Losina E. Surgery versus physical therapy for meniscal tear and osteoarthritis. N Engl J Med. 2013 Aug 15;369(7):677-8. doi: 10.1056/NEJMc1307177.
3. Yim JH1, Seon JK, Song EK, Choi JI, Kim MC, Lee KB, Seo HY. A comparative study of meniscectomy and nonoperative treatment for degenerative horizontal tears of the medial meniscus. Am J Sports Med. 2013 Jul;41(7):1565-70. doi:10.1177/0363546513488518. Epub 2013 May 23.
4. Herrlin SV1, Wange PO, Lapidus G, Hållander M, Werner S, Weidenhielm L. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc. 2013 Feb;21(2):358-64. doi: 10.1007/s00167-012-1960-3. Epub 2012 Mar 23.
5. Kaminski R, Maksymowicz-Wleklik M, Kulinski K, Kozar-Kaminska K, Dabrowska-Thing A, Pomianowski S. Short-Term Outcomes of Percutaneous Trephination with a Platelet Rich Plasma Intrameniscal Injection for the Repair of Degenerative Meniscal Lesions. A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study. Int J Mol Sci. 2019 Feb 16;20(4). pii: E856. doi: 10.3390/ijms20040856
Nels Sampatacos, MD
Orthopedic Surgeon and Sports Medicine Specialist
