• Patient Satisfaction
  • Surgery Always Needed?

    Meniscus Surgery Not Always Necessary

       Do all tears need surgery?

    Q: What do you think would be helpful for patients to know about meniscus tear surgery that they may not know?  Do all tears need surgery?

    “There’s an indication for surgery, but is the need there?”

    “Essentially, the way I practice, it’s their choice whether or not they want to have the surgery.  For about 70% of the patients I see, I tell them ‘I think that you’re probably going to need a surgery; and in all likelihood you’re going to come back.’  It’s not like cancer surgery where, if you don’t have it, you’re going to die. With regard to meniscus surgery, if you can tolerate the pain and go about your normal daily life and it’s not too bothersome, then it just depends whether or not you want to have it. There’s an indication for surgery, but is the need there? read moreTo me, the need is dependent on the patient’s perception.” Orthopaedic Surgeon
    Key Points

    Surgeon opinions: Not all patients with torn meniscus need surgery. Tears are common, patients can often wait, and many never get meniscus surgery.

    • Tears are common, and many people with torn meniscus never have surgery. For example, one study estimated that as many as 60% of people over 65 may have a degenerative tear.5 A second study estimated as many as one-third of all adults who have no symptoms at all may actually have a meniscus tear.6 So clearly not all meniscus tears require surgery.
    • Surgeons were asked what percent of patients need surgery right away and what percent could wait. On average surgeons said 41% could wait. But there were large differences in surgeon opinions: more conservative surgeons said as many as 80% could wait. More aggressive surgeons said under 10%. Such differences could also occur if a surgeon had a more severely affected patient population in the practice.
    • Surgeons thought that MRI results are sometimes used prematurely to refer a patient for meniscus surgery. They reiterated that just simply receiving a diagnosis of a torn meniscus does not mean surgery is inevitable, even if the diagnosis is from an MRI.

    Will Meniscus Tear Heal Without Surgery? It May Improve

    More Surgeon Quotes

    “If you don’t have pain, it’s not something that’s dangerous”

    “Some people have tears that don’t hurt. Just because you have an MRI that shows a tear, and somebody has recommended surgery – if you don’t have pain, it’s not something that’s dangerous or damaging to just have there.”
    Orthopaedic Surgeon

    “Not every tear needs surgery”

    “You have to understand that not every tear needs surgery because some people will come in with a tear on one side and the pain is on the other. That is something completely different. It’s a tendonitis; and that’s not going to benefit from arthroscopy, so the patient needs to know what are the risks if they don’t have knee surgery as well as is there anything else going on inside my knee that’s going to affect the outcome.”
    Orthopaedic Surgeon

    “Need to listen for symptoms of arthritis versus mechanical meniscus tear”

    “When you are treating older patients, say beyond the age of 60, if they have significant joint space narrowing on their weight-bearing x-rays, or if they have significant articular cartilage loss on their MRI; and in addition, they have a mild degenerative meniscus tear, you’re not really going to help them by operating on their meniscus. It’s not a hard-and-fast rule at 60. I’m using that kind of as a ballpark age group, but absolutely, you have to treat each patient individually because even at younger ages, they could have significant joint space narrowing and osteoarthritis. I think it’s our duty as surgeons to listen very carefully to the patient’s story at the outset of the exam in the office and help them with questions that get the information we need. You need to listen for the signs and symptoms of arthritis versus the signs and symptoms of a mechanical meniscus tear. That helps the surgeon make the right decision.”
    Orthopaedic Surgeon

    “Just for right person with the right indication”

    “Meniscal surgery should be done just for the right person with the right indication and with the right motivation to recover from the surgery. There are lots of people who have a torn meniscus who do not need an operation. If you operate on them, they aren’t going to get better because they have underlying degenerative arthritis; therefore, the results aren’t going to be as good.”
    Orthopaedic Surgeon

    “Those who can handle pain can avoid surgery forever”

    “The patients that shouldn’t wait are the ones with a bad tear, where they can’t fully extend their knee and it has mechanical lock. Those patients should have surgery soon. Those who can handle pain can avoid surgery forever. I tell them, ‘You’re in this gray area. It is not going to hurt your knee if you don’t have surgery. If you can live with this then you can certainly leave it alone. But, if the pain is too bad, you should probably get the surgery.’ You should do what they want to do. If someone comes in where there is a locking up of the joint or swelling or a clicking sound, then I put those people in the category that they should probably do something because the cartilage may be causing damage.”
    Orthopaedic Surgeon