Is there a future for meniscal surgery?

From my own experiences with knee injuries and my clinical experiences, I do not place much faith in 'special tests' for the knee, especially regarding the meniscus.  Following my knee injury, I had clicking and popping, joint line tenderness, pain with flexion and extension overpressure, and a positive McMurray's Test. I had 5/5 predictors for a meniscal tear (I also had a positive Thessaly's test). My MRI showed partial MCL and ACL tears without meniscal involvement. It is my understanding that the popping was occurring from swelling in the joint creating poor joint mechanics. During this experience I did not exhibit any locking or catching, which are two other significant symptoms for referral to Orthopedics. From my past clinical experiences, I would reason that persistent locking and painful catching are two symptoms that warrant orthopedic referral with high potential for surgery. 

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Due to a recent study, I may be questioning these symptoms as pertinent as well. The study out of Finland found that 146 patient with mechanical symptoms  (catching and locking) had no difference in outcomes from sham surgery vs. arthroscopic partial meniscectomy. While I will argue that these patients should be followed by Orthopedic physicians, I now question the efficacy of surgery in this population. As more studies are published we may find that the solution for individuals with mechanical symptoms may be more time and further physical therapy.

Meniscal Functions:
Load transmission
Shock absorption
Joint lubrication
Joint stability

Bottom line: The symptoms don't always match the anatomical tissue involved. Educate your patients that clicking, popping, and locking may be due to swelling, poor NM control, and joint hypomobility. Additionally, educate the importance of high repetition, low resistance exercise to directly target healing of the meniscal tissue. We must treat the impairments present and specifically target the type of tissue involved! 

I have included both the study from Finland and an article from Regenix. There is obvious bias in the Regenix article so read the literature contained in the article too.
Finnish Study
Regenix Article

-Jim

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