Meniscal Tear

When people have knee pain, one of the primary suspected culprits from the general population is a meniscal tear. The fear is that if there is something torn then this might require surgery. This is certainly a logical thought process as we have long been told by numerous healthcare providers that if something is torn, degenerated, or if you have arthritis, the only thing that can be done is surgery.

While this was the prevailing narrative in the past, we now have new information that gives us many more options. For example, there was a systematic review (a research study synthesizing tons of other research studies) done in 2013 which compared a meniscectomy (removal of the meniscus) vs. sham meniscectomy (fake surgery). In this study, published in the New England Journal of Medicine, they found that after a 12 month follow up, those that had received the actual surgical intervention did not have any better outcomes than those who received the sham.

This is important information as it shows us that pain is not always related to a tear or tissue damage. Sometimes things hurt for other reasons that are a bit more gray.

A particular patient experience that i’d like to share involves a 57 year old man who was having knee pain. He had an MRI report of both knees, which showed osteoarthritis and meniscal tears in each knee. The left knee had severe radiographic (x-ray) osteoarthritis and two large meniscal tears. The right knee had minimal osteoarthritis and one small meniscal tear. Guess which side had pain?

You may have guessed the left side as this one had more “problems,” however he actually had right knee pain and absolutely zero pain on the left knee. He was also completely stumped by this as his assumption was that whatever shows up on the image is what’s going to hurt.

A few years ago, I would have been stumped by this as well, however in the past 10 years we have had numerous examples including rotator cuff tears, meniscal tears, herniated discs, labral tears, spinal stenosis, and other changes that are completely asymptomatic (no symptoms).

This is good news for all of us as it tells us that diagnostic imaging and the findings found therein is not destiny. It means that many of these pain problems can be treated non-operatively, with physical therapy.

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