24/12/2025
Sharing for more general healthcare awareness sake: research continues to accumulate finding that long term outcomes for many orthopedic surgery procedures are comparable for non-operative care (ACL tear return to activity, meniscus tear , and Achilles tear) with surgical procedures for knee joint related conditions having higher rates of osteoarthritis down the road.
๐ง๐ผ ๐๐๐ ๐ผ๐ฟ ๐ก๐ผ๐ ๐๐ผ ๐๐๐? ๐ฅ๐ฒ-๐ฒ๐๐ฎ๐น๐๐ฎ๐๐ถ๐ป๐ด ๐ฆ๐๐ฟ๐ด๐ฒ๐ฟ๐ ๐ณ๐ผ๐ฟ ๐๐ฒ๐ด๐ฒ๐ป๐ฒ๐ฟ๐ฎ๐๐ถ๐๐ฒ ๐ ๐ฒ๐ป๐ถ๐๐ฐ๐ฎ๐น ๐ง๐ฒ๐ฎ๐ฟ๐ ๐๐ถ๐๐ต ๐ ๐ฒ๐ฐ๐ต๐ฎ๐ป๐ถ๐ฐ๐ฎ๐น ๐ฆ๐๐บ๐ฝ๐๐ผ๐บ๐
โฌ๏ธ For years, the management of degenerative meniscal tears has been a source of debate within the orthopaedic community.
โฌ๏ธ While evidence generally discourages arthroscopic meniscal surgery for degenerative tears, clinical guidelines have remained ambiguous regarding patients who present with mechanical symptomsโsuch as locking, catching, clicking, or popping of the knee.
โฌ๏ธ A new systematic review and meta-analysis published in the Journal of Orthopaedic Reports 2025 by Zilani et al. challenges the notion that mechanical symptoms justify surgical intervention, offering pivotal insights into the long-term outcomes of surgery versus non-operative management.
โ๏ธ ๐๐๐ ๐พ๐ก๐๐ฃ๐๐๐๐ก ๐ฟ๐๐ก๐๐ข๐ข๐
๐ Degenerative meniscal tears are common in older populations and are often associated with knee osteoarthritis.
๐ Current guidelines, such as those from the AAOS American Academy of Orthopaedic Surgeons, often provide unclear recommendations for tears accompanied by mechanical symptoms, leading many surgeons to view these symptoms as a valid indication for surgery.
๐ However, the efficacy of this approach has been questioned.
๐ This new review aimed to fill a critical gap in the literature by specifically analyzing 5-year outcomes in patients with degenerative tears and mechanical symptoms, comparing those who received surgery against those managed non-operatively such as physical therapy.
๐ ๐๐๐ฎ ๐๐๐ฃ๐๐๐ฃ๐๐จ: ๐๐ช๐ฃ๐๐ฉ๐๐ค๐ฃ ๐ซ๐จ. ๐๐ค๐ฃ๐-๐๐๐ง๐ข ๐๐๐๐ก๐ฉ๐
โฌ๏ธ The review analyzed six randomized controlled trials involving 1157 participants.
โฌ๏ธ The results highlight a distinct trade-off between subjective health perception and objective joint preservation.
โ
๐๐ค ๐๐๐๐ฃ๐๐๐๐๐๐ฃ๐ฉ ๐ฝ๐๐ฃ๐๐๐๐ฉ ๐๐ค๐ง ๐๐ฃ๐๐ ๐๐ช๐ฃ๐๐ฉ๐๐ค๐ฃ ๐ค๐ง ๐๐๐๐ฃ
โฌ๏ธ Contrary to the belief that surgery resolves mechanical dysfunction, the study found no significant difference between arthroscopic surgery and non-operative management regarding knee function, activity levels, or meniscal evaluation at the 5-year mark.
โฌ Scores for the Lysholm Knee Scoring Scale measuring limp, locking, and instability showed no statistically significant difference between the groups p = 0.07.
โฌ๏ธ Activity levels, measured by the Tegner Activity Scale, were identical between surgical and non-surgical patients p = 1.00.
โฌ๏ธ Pain scores VAS for activity and rest also showed no significant statistical difference.
โ ๏ธ ๐๐๐ "๐๐๐๐๐๐ฃ" ๐พ๐ค๐จ๐ฉ: ๐๐ฃ๐๐ง๐๐๐จ๐๐ ๐๐จ๐ฉ๐๐ค๐๐ง๐ฉ๐๐ง๐๐ฉ๐๐จ ๐๐ง๐ค๐๐ง๐๐จ๐จ๐๐ค๐ฃ
โฌ๏ธ Perhaps the most critical finding of this review is the long-term impact of surgery on joint health.
โฌ๏ธ Patients who underwent arthroscopic surgery demonstrated a significantly higher rate of osteoarthritis progression compared to those treated non-operatively.
โฌ๏ธ The odds ratio for radiographic osteoarthritis progression was 2.09 in the surgical group.
โฌ๏ธ This suggests that while removing torn tissue might intuitively seem helpful, the surgical intervention itselfโor the resulting loss of meniscal tissueโmay accelerate the degenerative process within the knee joint.
๐ง ๐ผ ๐๐๐ง๐๐๐ค๐ญ ๐๐ฃ ๐๐๐ฉ๐๐๐ฃ๐ฉ ๐๐๐ง๐๐๐ฅ๐ฉ๐๐ค๐ฃ
โฌ๏ธ Interestingly, while specific knee function scores did not differ, patients in the surgical group reported significantly better general health scores on the EQ-VAS European Quality of Life Visual Analog Scale compared to the non-operative group p < 0.00001.
โฌ๏ธ This suggests that surgery may offer a psychological benefit or a perceived improvement in overall well-being that is not captured by specific knee function metrics.
๐ฉป ๐๐ข๐ฅ๐ก๐๐๐๐ฉ๐๐ค๐ฃ๐จ ๐๐ค๐ง ๐๐ง๐๐๐ฉ๐ข๐๐ฃ๐ฉ
โฌ๏ธThis study provides high-quality evidence suggesting that mechanical symptoms should not automatically trigger a decision to operate.
๐ค For Patients
โฌ๏ธ If you have a degenerative tear with clicking or catching, physical therapy is likely to yield similar functional results to surgery over five years, without the increased risk of accelerating osteoarthritis.
๐จโโ๏ธ For Clinicians
โฌ๏ธ The presence of mechanical symptoms does not necessarily predict a better response to surgery.
โฌ๏ธ The "quick fix" of removing the mechanical obstruction must be weighed heavily against the doubled risk of long-term osteoarthritic changes.
๐ ๐พ๐ค๐ฃ๐๐ก๐ช๐จ๐๐ค๐ฃ
๐ The findings of Zilani et al. suggest that non-operative management should be the primary treatment pathway for degenerative meniscal tears, even when mechanical symptoms are present.
๐ While surgery may improve a patient's general perception of health, it fails to provide superior knee function and actively contributes to the worsening of osteoarthritis over time.
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โ ๏ธDisclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.โ ๏ธ
Link to Article ๐
