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Degenerative meniscal injury: This is why your surgeon will not operate

I have had two very similar patients coming to see me last months complaining of knee pain.  Both patients were “of a certain age” and developed knee pain after twisting the knee wrongly.   Both patients struggled to walk, taking stairs was a nightmare and sleeping with both knees against each other impossible. Their painful knee felt like it locked at times or even give way.  Clearly these patients suffered from a meniscal (also called wrongly cartilage) injury.  And what did we do for meniscal tear we refer to a surgeon….

…. except that, no, we do not not anymore.  This recent study and very informative diagram explains why.

The authors have shown that there is very little difference between having an operation and having a conservative treatment in the long-term (although when you look closely the patients who had an operation had less pain pain and generally did slightly better after 1-2 years but that was not statistically significant).

I am still not sure whether the patient had an operation had (good) physiotherapy afterwards and if this would make a difference.  We know that an op helspa in the short-term and physio helps in the long-term so surely adding both together would make sense, No?!