Knee Cartilage Tear? The Evidence Says Start with Physiotherapy.
The knee cartilage we are talking about here is the meniscus. Each knee has two menisci, crescent-shaped cartilage between the tibia and the femur.
They work to disperse friction, impact, and pressure between the leg bones meeting at the knee joint. As such, tearing is common. Meniscal tears seem to occur as part of a degenerative process in the knee. On the other hand, more than half of people age 50+ have meniscal tears without pain and do not require treatment.1
In previous decades, surgery has been considered the gold standard of treatment. Specifically, the surgery is arthroscopic partial meniscectomy. However, there has been a growing consensus that first-line treatment for non-obstructive meniscal tears should be conservative / non-surgical approaches.2,3 “Non-obstructive” refers to meniscal tears that do not result in locking of the joint. The growing consensus that physiotherapy should be the first line of treatment before surgery is bolstered by one of the largest studies to date on the subject, recently published in the Journal of the American Medical Association.4
The study was conducted by Victor A. van de Graaf, MD, Department of Orthopedic Surgery - OLVG Amsterdam, and his research colleagues. They randomized 321 patients into physiotherapy or surgery treatment groups. The surgery groups also received physiotherapy following their surgery, so there’s no getting out of your exercises.
After two years, both groups enjoyed significant improvements in pain, and the physiotherapy treatment appeared to be not inferior to surgery. Within two years, three out of ten patients receiving physiotherapy elected surgery, representing a 71% two-year success rate from therapeutic exercise alone. Delaying surgery to try physical therapy first did not reduce the effectiveness of surgery.
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- Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. New England Journal of Medicine. 2008 Sep 11;359(11):1108-15.
- Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M, Seil R. Surgical management of degenerative meniscus lesions. Arthroskopie. 2017 Jun 1;30(2):128-37.
- Stone JA, Salzler MJ, Parker DA, Becker R, Harner CD. Degenerative meniscus tears-assimilation of evidence and consensus statements across three continents: state of the art. Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine. 2017 Mar 1;2(2):108-19.
- van de Graaf VA, Noorduyn JC, Willigenburg NW, Butter IK, de Gast A, Mol BW, Saris DB, Twisk JW, Poolman RW. Effect of early surgery vs physical therapy on knee function among patients with nonobstructive meniscal tears: the ESCAPE randomized clinical trial. JAMA. 2018 Oct 2;320(13):1328-37.