Most importantly not all meniscal tears require surgery and my approach is to treat the patient not the MRI. Patients often come to my office, referred from another physician with an MRI that shows they have a meniscal tear or they are seeking a second opinion. In either case, before discussing the MRI, I ask “what are your symptoms”, “what activities are you trying to get back to” or “what do you do for exercise”. After I’ve gotten a thorough history of your symptoms and performed a complete exam then we can discuss what could be the cause of your pain, swelling, clicking, popping, etc.
Generally speaking if you already have arthritis in your knees and also a meniscal tear there is overwhelming research that you should NOT treat these tears with surgery. On the other hand, in an otherwise healthy knee and a tear that is causing true locking in your knee – you may want to consider surgery. However, even in this scenario most times it is recommended to address non-surgically initialing.
In either case I always discuss the role and importance of physical therapy (if needed) and other non-surgical options such as joint injections and bracing. Options for injections are cortisone, viscosupplement and platelet rich plasma (PRP). Cortisone, after an acute injury / exacerbation can be helpful to reducing swelling and pain to allow a return to physical activity and exercise. Repeated cortisone injections, too frequently, can be harmful to cartilage cells, therefore I use them cautiously. If pain is not well controlled, then generally I will discuss the role for Viscosupplement or PRP injections. Lastly I educate you on any recommended activity restrictions and alternatives that may be better tolerated in the short and long term.
Not all meniscal tears require surgery. Schedule an appointment if you have questions.
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Author Dr. Siatta Dunbar