Meniscal injuries are one of the most common causes of knee pain, particularly in older adults. Among the available treatments, partial meniscectomy – the surgical removal of the damaged part of the meniscus – has long been a standard approach. However, as research evolves, so too does our understanding of how effective this procedure truly is, especially for degenerative meniscal tears that occur without a traumatic injury.
In this article, we’ll take a closer look at:
- What a partial meniscectomy involves
- The nature of degenerative meniscal tears
- What the latest research says about surgical vs. non-surgical treatment
- Why physiotherapy may now be considered a first-line approach
Whether you’re a patient considering your options or a clinician staying up-to-date, understanding the current evidence around partial meniscectomies is essential.
What Is a Partial Meniscectomy?
A partial meniscectomy is a type of knee arthroscopy, often referred to by patients as a “knee scope.” It is a minimally invasive surgical procedure where a small camera (arthroscope) and surgical instruments ate inserted into the knee through small incisions. The surgeon then views the inside of the joint on a monitor and carefully trims away the torn or damaged portion of the meniscus.
This procedure typically takes between 30 minutes to an hour, and is done under general or regional anaesthesia. Patients are usually discharged the same day and may begin rehabilitation shortly after.
Historically, partial meniscectomy has been popular due to its short recovery time, minimal scarring, and early improvements in pain and function. However, this approach is now under increasing scrutiny, particularly in cases where meniscal damage results from degenerative changes rather than traumatic injury.
Understanding Degenerative Meniscal Tears
The meniscus is a crescent-shaped piece of cartilage that cushions and stabilises the knee joint between the femur (thighbone) and tibia (shinbone). There are two menisci in each knee – medial and lateral. These structures absorb shock and help distribute weight across the joint.
A degenerative meniscal tear typically develops over time due to wear and tear, rather than from a specific injury. The type of tear is more common in adults over the age of 50 and often coexists with osteoarthritis. Symptoms can include:
- Persistent or intermittent knee pain
- Swelling and stiffness
- A sensation of clicking or catching
- Difficulty with bending or weight-bearing
Unlike traumatic meniscal tears seen in younger, athletic individuals, degenerative tears are part of the natural aging process and occur in weakened tissue. As a result, they may not always respond well to surgical intervention.
Is Partial Meniscectomy Effective for Degenerative Tears?
While partial meniscectomy was once widely accepted for managing degenerative meniscal tears, recent research suggests that it may not be as beneficial as previously believed.
Key Studies You Should Know:
1. The New England Journal of Medicine Study
One of the most influential studies in this space compared outcomes between patients who underwent partial meniscectomy and those who had sham surgery. In this randomised controlled trails, the sham surgery group went through all the motions of the operation – including anaesthesia and incisions – but no actual issue was removed.
Findings: There was no significant difference in pain relief or function between the two groups. This strongly indicated that the perceived benefits of surgery can be largely due to the placebo effect rather than the surgical removal of tissue itself.
2. British Medical Journal (BMJ) Study
This study compared partial meniscectomy with structured physical therapy. Participants with degenerative meniscal tears were randomly assigned to receive either surgery or physiotherapy.
Findings: Both groups reported similar improvements in pain and knee function over time. However, those in the physiotherapy group avoided surgical risks and incurred lower treatment costs.
3. Knee Surgery, Sports Traumatology, Arthroscopy (2023)
A high-quality Level 1 evidence review concluded that there was no added benefit of partial meniscectomy over non-surgical management in adults with non-obstructive degenerative meniscal symptoms. The outcomes from structured physiotherapy were found to be just as effective, without the need for surgical intervention.
The Risks of Surgery: Why a Conservative Approach May Be Better
While partial meniscectomy is considered minimally invasive, it’s not without risks. Complications may include:
- Infection
- Blood clots
- Joint stiffness
- Accelerated osteoarthritis progression
Additionally, removing part of the meniscus can reduce its cushioning ability, which may increase pressure on the joint surfaces and lead to long-term joint damage.
With these risks in mind, and considering the evidence showing little difference in outcomes compared to conservative care, many orthopaedic specialists and physiotherapists are recommending non-surgical approaches as a first step.
The Role of Physiotherapy in Managing Degenerative Meniscal Tears
Structed physiotherapy aims to reduce pain, improve joint function, and strengthen the surrounding muscles to support the knee.
Key components of a physiotherapy program for degenerative meniscal tears may include:
- Range of motion exercises to improve flexibility and joint mobility
- Quadriceps and hamstring strengthening
- Balance and proprioceptive training
- Manual therapy for soft issue and joint mobilisation
- Education and activity modification to prevent flare-ups
Over time, many patients experience significant relief from symptoms and are able to return to their usual activities without needing surgery.
When is Surgery Still Appropriate?
It’s important to note that not all meniscal tears are the same, and there are scenarios where surgery remains appropriate. Partial meniscectomy may still be considered for:
- Acute traumatic tears in younger individuals, especially those causing mechanical symptoms like locking
- Tears that fail to respond to structured physiotherapy program
- Cases where a surgeon determines that a repair (rather than removal) is possible
In these instances, a detailed assessment and shared decision-making process between the patient, surgeon, and physiotherapist is essential.
The Shift Toward Conservative Management
In recent years, the medical consensus has begun to shift away from routine partial meniscectomy for degenerative meniscal tears. A growing body of research suggests that:
- Surgery offers no added benefit over non-surgical treatments
- Physiotherapy can achieve similar or better outcomes with fewer risks
- A conservative, patient-centred approach may lead to better long-term joint health
If you’ve ever been diagnosed with a degenerative meniscal tear, it’s worth exploring non-surgical options first. At Logan Physio, our team is well-equipped to develop evidence-based rehabilitation programs that help you manage pain, regain function, and return to the activities you enjoy – without going under the knife.
Need help managing knee pain?
Book an appointment with one of our experienced physiotherapists at Logan Physio today. Let’s work together to keep you moving – safely, confidently, and without unnecessary surgery.
