If you’re a middle-aged athlete who hasn’t had meniscus surgery, you probably feel left out. It seems like most of your friends have, and many of those who haven’t are considering it.
But recent research and a growing medical consensus are telling us that this rite of passage for aging athletes is probably unnecessary and very likely useless for most of us. What might be indicated for younger athletes may well be useless for those of us with aging, and likely arthritic, knees.
Yet 400,000 Americans a year undergo arthroscopic meniscus surgery, according to a recent New York Times article.
Quick anatomy lesson: Meniscus is your knees’ shock absorber—the cushion that keeps your femur and tibia bones from painfully rubbing on one another.
Meniscus damage and wear/tear is common in our middle-aged cohort. Thirty-five percent of us who are past 50 have some degree of damage. Fortunately, two-thirds of us experience no symptoms at all.
But another one-third of us with meniscus damage endure pain, grabbing, popping in the knee . . . and it’s those athletes who go looking for a fix. Hundreds of thousands of us find their way to a bone doc who goes in with an arthroscope and trims back or repairs the meniscus tear.
But here’s the deal: A significant number of those middle-aged athletes have osteoarthritis of the knee—a condition that afflicts 9 million of us. And when that’s the case, meniscus surgery is virtually useless, especially in cases of more advanced osteoarthritis.
The Evidence Against Meniscus Surgery
Here’s a quick summary of the mounting evidence against meniscus surgery in middle-aged patients:
- “A highly questionable practice without supporting evidence of even moderate quality,” proclaims a recent editorial in the British Medical Journal titled “Arthroscopic Surgery for Knee Pain.”
- “Considering the enormous volume (of meniscus surgery among middle-aged to older adults), it is natural to think that there is compelling evidence for the procedure being beneficial. Remarkably, this is not so,” the BMJ goes on to report.
- A 2013 study published in the New England Journal of Medicine titled Surgery Versus Physical Therapy for a Meniscal Tear and Osteoarthritis revealed that patients 45 and older experiencing knee pain fared no better after six months—whether they were assigned to undergo arthroscopic surgery or a regimen of physical therapy.
Let’s see…PT or cut the knee? Same outcome. Which would you choose?
- Maybe even more eye-opening is this article in the BMJ titled “Arthroscopic Meniscal Tear Surgery Is No Better Than Sham Surgery, Study Shows.” The title says it all. The article describes a trial that compared arthroscopic meniscus surgery with a completely fake surgery and found “no clinically important difference between the arthroscopic and nonoperative groups with respect to functional improvement or pain relief over a period of 24 months.”
So if you’re a middle-aged athlete with knee pain, significant osteoarthritis, and a torn meniscus—and this apparently useless surgery is offered up as an option—what should you do?
That’s exactly the topic of our next post.