Daniel Lawrence demonstrates Physical Therapy (Physiotherapy) for Knee Meniscus problems, including Pain & Locking to Avoid Surgery.
A 2020 study in the BJSM (Sihvonen et al 2020) MRI scanned 115 people (230 knees) with an age range of 25-73 years. All with no knee problems.
Amazingly the MRI reports found structural abnormalities in 97% of knees. 48% of the group had meniscal tears or meniscal degeneration.
Again, this group did not have any knee problems, no symptoms, asymptomatic, hopefully that’s clear here.
The study also noted that bucket handle and complex meniscal tears were reported for first time in asymptomatic knees.
The high rate of asymptomatic adults with knee joint abnormalities on MRI may indicate why arthroscopy and other surgical interventions for these do not result in better outcomes than sham surgery. Furthermore, there continues to be no evidence to suggest that meniscectomy benefits patients presenting with meniscal tear symptoms more than sham surgery.
In fact, meniscectomy and other surgical interventions could lead to further complications or deterioration of the articular cartilage and increase the risk of osteoarthritis.
The research supports a diagnosis primarily based on patient’s medical history and physical examination by an experienced clinician, instead of solely focusing on the MRI results. Sadly, this is currently the wrong way around in most healthcare settings.
Exercise and advice remain the safest and most evidence-based treatment option for meniscus related knee dysfunction and pain. Naturally any adjuncts that support the patients exercise endeavors could be utilized in the clinic or in the form of self-management.
Knee Taping may help improve knee exercise experience: https://youtu.be/oAF10VsB6n4?si=mGsIiwvCBTXPFAUy
Meniscal Rehab Video from ThePhysioChannel: https://youtu.be/gf0vy_OZQcQ?si=czn-bQcHCvelEW1l
References:
Sihvonen R, Paavola M, Malmivaara A for the FIDELITY (Finnish Degenerative Meniscus Lesion Study) Investigators, et al Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial British Journal of Sports Medicine 2020;54:1332-1339.
Cochrane Musculoskeletal Group, O'Connor, D., Johnston, R.V., Brignardello-Petersen, R., Poolman, R.W., Cyril, S., Vandvik, P.O. and Buchbinder, R., 1996. Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears). Cochrane Database of Systematic Reviews, 2022(3).