Torn meniscus: surgery or integrative healthcare?

July 23, 2019   |   Evidence in Integrative Healthcare

Knee pain is a common complaint among older adults.  Up to 25% of persons 55 years and older consult a doctor for it.  Torn meniscus and osteoarthritis are frequently seen with a painful knee.  Surgical repair of meniscus tears has often been recommended and currently up to 4 million arthroscopic menisectomy procedures are performed each year.

However, controversy around this surgery for older adults has brewed for years.[i]  It has been observed that arthritis and meniscal tears are seen in up to 30% of adult knees regardless of whether or not the person has knee pain.  A recent systematic review and meta-analysis published in the British Journal of Sports Medicine on February 22, 2019 further questions the wisdom of the surgery in adults with a torn meniscus and osteoarthritis.[ii]

The authors of this review compared the outcomes of non-surgical intervention, drugs, surgery and no treatment. The research showed no difference between surgical menisectomy and a placebo, sham surgery. The conclusion was that while more research is needed, performing surgery “in all patients with knee pain and a meniscal tear is not appropriate, and surgical treatment should not be considered the first-line intervention.”

In contrast, the evidence supporting typical IH interventions for knee pain is emerging. A 2016 meta-analysis concluded that acupuncture provided short term pain relief and, more importantly, improved short and long-term physical function. Preliminary evidence from case reports suggest that manipulative treatment can also be effective for improving knee pain and function.[iii],[iv]

Clearly, a trial of conservative care such as that offered by IH providers is a reasonable, safe and potentially effective first-line treatment.

[i] Englund M, et al. Meniscus pathology, osteoarthritis and the treatment controversy. Nature Reviews Rheumatology volume 8, pages 412–419 (2012)

[ii] Abram SGF, Hopewell S, Monk AP, et al.  Arthroscopic partial meniscectomy for meniscal tears of the knee: a systematic review and meta-analysis.  Br J Sports Med Published Online First: 22 February 2019. doi: 10.1136/bjsports-2018-100223

[iii] Karmali A. Conservative management of MRI-confirmed knee osteoarthritis with instrument-assisted soft-tissue mobilization, joint manipulation, and platelet-rich plasma. J Can Chiropr Assoc. 2017;61(3):253-260.

[iv] Nakajima M. Clinical Validation of Pain Management Manipulative Therapy for Knee Osteoarthritis With the Squeeze-Hold Technique: A Case Series. J Chiropr Med. 2017;16(2):122-130.