Horizontal meniscal tears (from side to side dividing the posterior horn in two parts) are the topic of a recent study from the Center for Joint Disease in Korea. The information they presented may be helpful to you in making the decision between exercise and surgery.
The goal of the researchers (orthopedic surgeons) was to see how patients with degenerative horizontal tears of the posterior horn of the medial meniscus responded to surgical treatment versus conservative care (strengthening program).
Treatment choice for this type of meniscal tear is not always easy. These are difficult tears because they can go deep into the joint capsule. Removing part or the entire meniscus can result in ongoing painful symptoms. A partial meniscectomy eventually leads to a second surgery to remove the entire meniscus (total meniscectomy). Studies also show that partial or total meniscectomy can lead to early arthritis.
All patients included (total of 102) in this study were between the ages of 43 and 62 and experiencing intense knee pain. Mechanical symptoms such as clicking and/or popping were also reported by most of the patients. Two groups were followed for two years after treatment: the surgical (meniscectomy) group and the strengthening (nonoperative) group. Patients were assigned to their group using random selection. There was a four-to-one ratio of women to men (81 women and 21 men).
The exercise group was supervised by a physical therapist as they worked on muscle strength, flexibility, and endurance. Details of the eight-week exercise program (including a home exercise portion) were provided. For the surgical group, arthroscopy was used to remove frayed tissue and smooth the joint surface (partial meniscectomy). One orthopedic surgeon performed all of the procedures. No one had a complete meniscectomy. Everyone in the surgical group participated in the same exercise program as the nonoperative group but without the benefit of a physical therapist’s supervision.
A variety of measurements were used to compare results including pain, knee motion, activity, and patient satisfaction. The statistical analysis showed no difference in outcomes between the two groups. Pain relief, improved function, and very satisfied patients were the final results for both groups. Only a small number of patients in both groups continued to report painful symptoms at the final check-up.
In summary, this study provides evidence that horizontal meniscal tears can be treated successfully with a nonoperative approach. The tear tends to remain stable and no further treatment is required. Previous routine management with arthroscopic partial meniscectomy may not be needed after all.
But even for those who have surgery, rehab afterwards with exercise is usually advised. Fortunately, the exercise program seems to yield long-lasting results. A short-term investment of your time and energy might be well worth it before being subjected to the potential for more serious complications from surgery.