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19.12.2018 09:39:30
If a meniscus or a part of it is removed during surgery, it is meniscectomy (total or partial). The torn parts are smoothed out with special instruments. The goal is to fully restore the mobility of the knee. But with a meniscus tear surgery is not always the right decision. A study has shown that a year after surgery, the pain is very often no less than without surgery. Scientists at Erasmus University Rotterdam have figured out what patients are likely to benefit from partial meniscus surgery and who will not. In addition, during the systematization, they identified three factors that statistically significantly affect the chances of success of the surgical procedure.
Scientists led by Suzanne Eijgenraam used data from 32 studies with 4250 patients in total. The quality of the study, however, is not uniform, and the evidence of the results is only average. So, only one of the analyzed studies was randomly monitored, four ‒ prospectively, and the rest ‒ retrospectively. The follow-up period was usually an average of one year.
As it turned out, three parameters were statistically relevant for the success or failure of the surgery. So, a longer persistence of pain (over 3 or 12 months) is associated with a poor result. In patients with detected osteoarthritis of the knee, there was less improvement than in those who did not suffer from arthrosis. A more extensive removal of the meniscus, as a rule, was associated with poorer chances of success.
But sports activity before the operation and the type of the tear did not affect the result. Also, the assumption that with degenerative changes in the meniscus the intervention would be less promising could not be confirmed in this analysis.
Based on these data, the authors of the study recommend that patients should consider the duration of the pain and the presence of arthrosis when making a decision on whether to be operated on for the meniscus tear. And during surgery it is necessary to consider the scale of the intervention with respect to forecasts. However, according to the scientists, a worse result is not necessarily equivalent to an unsatisfactory result. “This means only that a patient-relevant result is worse in the presence of a specific factor than in its absence.”
Recently, a study conducted by scientists at Radboud University Nijmegen has indicated that patients suffering from arthrosis of the knee joints and who had a meniscus tear treated surgically, later needed knee replacement surgery more often than non-operated ones. In this case, it is also a retrospective observational study. With this type of research it cannot be excluded that other factors also influenced the result. So it may be that the operated patients have factors that make endoprosthesis replacement necessary earlier without the previous surgical intervention.
However, in total, this testifies that when choosing a treatment for a damaged meniscus, it is imperative to weigh the pros and cons. Under certain circumstances, targeted physiotherapy may be more beneficial than surgery. This treatment strengthens the muscles, and the knee joint is stabilized.
