Alternative to knee surgery

May 7, 2013 2:47:07 PM PDT
A torn cartilage in the knee is a common problem. It's called a torn meniscus. If you've heard of it, you might think of surgery as the treatment. You might be wrong.

The meniscus is located in a shallow cup of cartilage on top of the leg bone, one on each side. Knobs on the end of the thigh bone move in the meniscus when you bend your knee.

A tear often requires surgery, but it may not be the only option.

Orthopedic surgeon Leon Popovitz of Lenox Hill Hospital is concerned about Brian Hatch's left knee. He has a torn meniscus cartilage. Over the counter Aleve has helped the pain until now.

"The last two weeks the Aleve hasn't been working and that's when I knew I needed help," he said.

Help for young active people may be arthroscopic surgery. It's a fast cure for a torn meniscus, but for older patients who might have some arthritis in the joint, is the pain from the arthritis or the tear?

"Now that's the big question, and that's why this article was really on point," Dr. Popovitz said.

The article in the New England Journal of Medicine found that patients with both a tear and arthritis in the knee did equally well with rehab as with surgery to fix the tear.

"I think this study confirms that the first line when there's mild arthritis and a meniscal tear the first line of treatment should be conservative," Popovitz said.

Rehab patients in the report had more good news. For the thirty percent who failed to improve, surgery even after several weeks of rehab led to the same good result as if they had had surgery right away.

Brian has only a tear, no arthritis, but Dr. Popovitz prescribed rehab as the first treatment. He says rehab often works even in young people with sports-related tears.

"If somebody has a little tear and mild symptoms, there's really no need to put them through surgery," he said.

So many patients want a quick fix and don't want to put in the time for rehab that some surgeons jump to arthroscopic surgery right away. An editorial in the New England Journal says that for those surgeons, "these results should change practice."