1. science
2. medicine
3. surgery

A SHARED DECISION-MAKING™ PROGRAM
T R E AT M E N T C H O I C E S
F O R TO R N M E N I S C U S
This program content, including this booklet is
copyright protected by Health Dialog Services
Corporation (HDSC), a related entity of Bupa
Health Dialog Pty Limited (Bupa Health Dialog),
who is licensed to use the material in Australia.
You may not copy, distribute, broadcast,
transmit, perform or display this program or
any part thereof, without permission from Bupa
Health Dialog. You may not modify the contents
of this program without permission from Bupa
Health Dialog. You may not remove or deface
any labels or notices affixed to the program
package. © Bupa Health Dialog Pty Limited 2012
FO R E WO R D
As Bupa’s Chief Medical
Officer I’m delighted
to introduce Bupa’s
Treatment Choices for
Torn Meniscus after age
40 Shared Decision Guide.
Important instructions:
° The information in this program is
not intended to be medical advice, a
diagnosis of your condition, or a treatment
recommendation. It is intended to
help you learn about your symptoms,
conditions, and various options so that
you can participate more effectively in
making decisions about your health with
your doctor.
Making decisions about
the steps needed to improve your health
and make more informed choices can be
complicated. This guide offers practical
advice to help you better understand your
condition and treatment choices, and
support your discussion with your treating
health professional.
° Not all of the options discussed may be
appropriate for your individual medical
situation. Talk with your doctor about how
the information presented relates to your
specific condition.
By keeping better informed you can be
more confident that the care you receive is
appropriate to your personal circumstances,
priorities and preferences.
° Bupa Health Dialog does not approve or
authorise care or treatment. If you have
questions about whether a particular
treatment is covered by your private
health insurance, please contact your
private health insurer.
We are grateful to Associate Professor James
Sullivan,1 at Macquarie University Hospital and
Professor Mark Harris2 and his team3 from
the University of NSW who have reviewed
this valuable tool. They have confirmed that
it is based upon high quality, evidence based
resources, and aligns with current Australian
practice and guidelines.
For more information
° Visit bupa.com.au
We hope this Shared Decision Guide will be
useful to you and your health professional
when you are needing to make decisions
together about yours or your family’s health
and health care.
1
Associate Professor James Sullivan is Head of Arthroplasty, Australian School of Advanced Medicine, Macquarie University.
2
Mark Harris is foundation Professor of General Practice and Executive Director of the Centre for Primary Health Care and
Equity at UNSW.
3
Dr Nighat Faruqi, Centre for Primary Health Care and Equity at UNSW.
1
2
TR E ATM ENT
C H O I C E S FO R
TO R N M EN I SC U S
ABOUT THIS PROGRAM
What is Shared Decision-MakingTM?
Communicate openly with your
healthcare provider
About Shared
Decision-MakingTM Programs
4
Meniscus tears and arthritis
often go together
Arthroscopic surgery does not
help arthritis pain
4
4
How can this program help you?
4
Are the options discussed in this
program appropriate for you?
5
Who made this program?
5
Who are the people in
this booklet?
How can you know if the
information in this program
is up-to-date?
TORN MENISCUS WITH
OSTEOARTHRITIS
16
18
EXERCISE THERAPY
5
How does exercise therapy help?
21
Exercises for a torn meniscus
22
Exercising with arthritis
23
PAIN MEDICATIONS
5
INTRODUCTION
Medications that may be helpful
24
Medication side effects and
safety tips
25
ARTHROSCOPIC SURGERY
How can this booklet help you?
7
Be sure this information is right
for you!
7
Arthroscopic surgery for a
torn meniscus
Risks and recovery after
arthroscopic surgery
KEY FACTS TO KNOW
28
30
MAKING YOUR DECISION
Real people tell real stories
9
What should you ask your doctor
About the meniscus
11
How do you feel about surgery
and recovery when the chance of
improvement is uncertain?
How would you manage your
symptoms without surgery?
IS YOUR PAIN FROM
A TORN MENISCUS?
What do symptoms and MRIs
tell you?
13
Overview of treatments for torn
meniscus symptoms
15
3
32
32
32
DEFINITIONS OF
MEDICAL TERMS
34
FOR MORE INFORMATION
35
RESEARCH PUBLICATIONS
36
ABO UT TH IS PROG R AM
ABOUT THIS
PROGRAM
WHAT IS S HAR ED DECISIO N - MAKI N G™ ?
ABOUT SHARED
D EC I S I O N - M A K I N G ™ P R O G R A M S
Shared Decision-Making™ is working with your
doctors and other healthcare professionals
to make decisions about your care. In Shared
Decision-Making™, your doctor is the expert in
medicine, but you are the expert on how you
feel and what’s important to you. Together
you make up a decision-making team. Family,
friends, and other healthcare providers may
also be part of this team.
This Shared Decision-Making™ program is
provided through Bupa Health Dialog for
your individual use. The program is designed
to support your participation in an informed
dialogue with your healthcare provider as you
work together to make important decisions
about your health. Shared Decision-Making™
programs are based on medical evidence
researched and evaluated by the Informed
Medical Decisions Foundation.
Participating in healthcare decisions helps
ensure that you are getting the care that best
meets your needs. To do this, you’ll need to
be informed about your condition and the
different ways to manage it. You’ll also need to
think about how each management approach
can affect you so that you can choose what
makes the most sense for you.
The Informed Medical Decisions
Foundation has been working for over two
decades to advance evidence-based shared
decision making through research, policy,
clinical models and patient decision aids.
Visit informedmedicaldecisions.org for
more information.
C O M M U N I C AT E O P E N LY W I T H YO U R
H E A LT H C A R E P R OV I D E R
H OW C A N T H I S P R O G R A M H E L P YO U ?
Getting good care also requires good
communication between you and your
healthcare team. To get the right care,
you and your doctor or other healthcare
professional, need to talk about your health
goals and what you’re able to do to protect
or improve your health.
The information in this program can help you
prepare to talk with your doctor so you are
ready to ask questions and discuss how you
feel about your healthcare options. Then you
and your doctor can talk about which option
may be best for you and make a decision
together—a shared decision. You might be
wondering, is this information right for me?
Where did it come from? How can I use it? In
this program, you’ll find answers to these and
other questions you may have.
4
WHO ARE TH E PEOPLE IN
THIS BOOKLET?
Some of the options in this booklet may not
be appropriate for your individual medical
situation. Talk with your doctor about how the
information in this program relates to your
specific health condition. Note that neither
Bupa Health Dialog or any of its related
entities approve or authorise care, treatments
or tests. The care, treatments or tests
described in this program may not be covered
by your private health insurance. If you have
questions about whether your private health
insurance provides cover in respect of a
particular treatment or test, speak with your
private health insurer or your doctor.
The people who are quoted in this booklet
volunteered to share their stories about how
they decided to treat a torn meniscus. They
received a small fee for their time. They do
not profit from recommending any treatment
or self-care strategy. These people were
chosen because their stories show many of
the reasons people have for making different
treatment choices.
The physician featured in this booklet
is Dr. John Wright. He is an orthopaedic
surgeon who specialises in treating
osteoarthritis of the knee.
H OW C A N YO U K N OW I F T H E
I N F O R M AT I O N I N T H I S P R O G R A M
I S U P -TO - DAT E ?
WHO MADE THIS PROGRAM?
Bupa Health Dialog and the Informed Medical
Decisions Foundation produced this program
booklet. In accordance with the relevant
requirements of the licence provided to
Bupa Health Dialog, it has been adapted
from the original version produced for use
in the United States. Information regarding
suitability for publication in Australia was
provided by the University of New South
Wales Centre for Primary Health Care and
Equity. To ensure the content is appropriate
and acceptable for Australian consumers
and health professionals, Australian clinical
practice guidelines have been reviewed and
the Australian healthcare system, language
and culture taken into account.
All booklets are reviewed regularly and
updated. If you received this program some
time ago, or if someone passed it along to
you, do not use it. The information may be
out of date. To make sure you have the most
recent program, please visit bupa.com.au.
Please use the product number located on the
back of the booklet to determine if you have
the most recent copy.
Bupa Health Dialog does not profit from any
of the treatments discussed in the program.
5
ABOUT THIS PROGRAM
ARE THE OPTIONS DISCUSSED IN THIS
P R O G R A M A P P R O P R I AT E F O R YO U ?
I NTRO D U C TI O N
INTRODUCTION
H OW C A N T H I S B O O K L E T H E L P YO U ?
B E S U R E T H I S I N F O R M AT I O N I S
R I G H T F O R YO U !
You’re probably reading this booklet because
you have a knee problem, and your doctor
has told you that your symptoms could be
from a torn meniscus. Your symptoms may
include pain, stiffness, a catching feeling in
the knee, and difficulty walking.
This booklet includes information from
recent medical studies about treating
meniscus tears that happen as people age.
But this information does not apply to
everyone who has a torn meniscus.
This booklet will help you understand your
knee problem and your treatment
options—exercise, pain medication, or
arthroscopic surgery to remove the torn or
damaged part of the meniscus. After you’ve
learned about your options, there’s a chapter
called Making Your Decision at the end of
this booklet that will help you think about
what you want to do to help your knee.
This information is right for you if all these
things apply to you:
This information can help you get ready to
talk with your doctor and make an informed
decision about the treatment that’s best
for you.
° Your doctor told you that a tear in your
°
You are 40 or older.
The meniscus changes with age. The
studies used to write this booklet looked at
treating meniscus tears in people 40 and
older. Younger people may have different
treatment options and results.
meniscus is the likely cause of your
knee symptoms.
Not all meniscus tears cause problems.
° You may or may not have osteoarthritis
in the knee.
The studies in this booklet included people
with knee osteoarthritis (often called arthritis)
because it is common among people 40 and
older who have a meniscus tear.
6
INTRODUCTION
This information is not right for you if any of
these things apply to you:
° Your knee locks, or gets stuck, in a bent
° You are younger than 40.
When this happens you need to massage it
or make other efforts to get it moving again.
This booklet is about choosing a treatment for
your knee. But if your knee locks, arthroscopic
surgery may be your only treatment option.
You can still use this information to learn about
meniscus tears and what happens during
arthroscopic surgery and recovery.
or straight position for a long time.
The information in this booklet comes from
studies of people 40 and older. If you’re younger
than 40, the results may not apply to you and
you may have different treatment options.
° You have a type of arthritis other than
osteoarthritis (for example,
rheumatoid arthritis).
Note: Italics are used in this booklet
to emphasise key words or to identify
medical terms. See the Definitions of
medical terms section at the end of the
booklet for full descriptions of medical
terms that are italicised.
This booklet talks about treating a torn
meniscus in people with osteoarthritis. It
does not include information about other
types of arthritis.
° Your doctor has recommended surgery to
stitch together the tear in your meniscus.
This type of arthroscopic surgery isn’t included
in this booklet because after age 40, the
meniscus is usually too worn and fragile to
stitch back together. For people 40 and older,
arthroscopic surgery is usually done to remove
torn and damaged pieces of meniscus—not to
stitch the tear together.
° Your knee osteoarthritis bothers you so
much that you would consider having a
knee replacement.
People with severe osteoarthritis may choose
knee replacement surgery when nonsurgical
approaches no longer help. If your knee pain is
this bad, you may want to talk to your doctor
or Health Coach about deciding whether to
have knee replacement surgery.
7
K E Y FAC TS TO K N OW
K E Y FA C T S
TO K N OW
W H Y A R E T H E S E K E Y FAC T S
S O I M P O R TA N T ?
° Torn meniscus and osteoarthritis
Some health problems have one treatment.
For example, if you break a bone in your arm
there’s no decision to make—you’ll probably
have a cast for a while.
People over 40 who have tears in a meniscus
often have knee osteoarthritis, too.
often go together.
The treatment for a torn meniscus after age
40 is not so clear-cut. You have choices:
Osteoarthritis is commonly called arthritis.
Having both a torn meniscus and arthritis
makes it harder to know which problem is
causing the symptoms that bother you.
° you can wait to see if your symptoms get
° Exercise can help relieve knee pain.
better without treatment
Exercise is generally safe and helpful for
different types of knee problems, including
meniscus tears and arthritis. Many people try
exercises before considering arthroscopic
surgery for a torn meniscus. Taking time to try
exercise will not affect the results of arthroscopic
surgery if you decide to have it later.
° you can choose to try exercise
° you can use pain medication temporarily to
reduce pain
° you can choose to have arthroscopic
surgery to remove the torn or damaged
parts of the meniscus.
To make an informed decision, you need to
understand the following key facts.
° Arthroscopic surgery for torn meniscus
° A torn meniscus may not be the cause of
There hasn’t been enough research on
arthroscopic surgery for a torn meniscus to
know if it is better for pain relief than knee
exercises and pain medication.
pain may not be better than exercise.
your symptoms.
If you have a meniscus tear and
symptoms—like knee pain and problems doing
the things you want and need to do—you may
think that the meniscus tear is the cause. But
that may not be true. A different knee problem
could be causing your symptoms.
If exercises don’t help enough, arthroscopic
surgery may be a reasonable choice for
some people who have symptoms that seem
to be from a torn meniscus. But having a
torn meniscus doesn’t mean you need to
have surgery.
Some meniscus tears (also called meniscal
tears) don’t cause any symptoms. And other
knee conditions can cause symptoms a lot
like a torn meniscus. This makes it impossible
for doctors to know for sure when a torn
meniscus is the cause of knee pain.
° Arthroscopic surgery does not help pain
from arthritis.
If arthritis is the most likely cause of your
discomfort, arthroscopic surgery will not
help. Medical experts used to think that
arthroscopic surgery could help arthritis,
but now they know it does not.
8
Marcia E, age 61
Condition: torn meniscus, mild arthritis.
Treatment: exercise.
Result: Marcia is satisfied with the improvement
in her knee pain and is able to lead an active life.
Many people think that because the
meniscus is torn ... they need to have
surgery to address it. But the meniscus
being torn is only important if you’re
having pain and disability because of it.
We also know that in many instances, a
meniscus tear that causes pain initially
may settle down over time.
Marcia taught in preschool and kindergarten
classrooms and would sometimes sit in very low
chairs, which caused a lot of pain. “I would have
to stretch my leg out straight because it would
be very painful.”
She started to notice the pain when she
walked. Her doctor told her that she had a
torn meniscus and some osteoarthritis. Her
doctor explained that exercise could help
relieve her knee pain. “Initially, I really didn’t
understand how exercise could affect the
pain and the problem I was having,” she says.
“But the doctor and his team took the time
to explain it and the physiotherapist followed
up with explanations of what she was doing
and how that would make a difference. Then I
understood it.”
Dr John Wright
R E A L P E O P L E T E L L R E A L S TO R I E S
Steve K, age 59
Condition: torn meniscus, mild arthritis.
Treatment: after trying exercise, Steve chose
arthroscopic surgery.
Result: Steve recovered quickly and is nearly
pain free.
Marcia’s healthcare team helped her
understand how doing exercises to strengthen
the leg muscles could help her knee pain. She
continues with her exercises and is satisfied
with the improvement.
Steve’s knee pain was so bad that he could
not sit at his desk in the office for long
without getting up and walking around to
stretch his legs. “I would make frequent trips
down the hall to use the lavatory, I would go
get a drink from the vending machine just as
a way to stretch my legs,” he says. This would
continue all day and interfered with his work.
Beryl A, Late 50s
Condition: torn meniscus, arthritis.
Treatment: two arthroscopic surgeries
on one knee.
Steve wanted to get back to playing
active sports, including running. He tried
physiotherapy and it did not work. He then
chose arthroscopic surgery.
Result: After an unsuccessful first surgery, Beryl
has had some relief from a second surgery.
Beryl had severe pain in her knee. “When I went
to see the doctor, I was having terrible, terrible
pain, excruciating pain in my knee,” she says.
“I wasn’t so much of an astute student, in terms
of my healthcare, at the time. So I did not do
the research. I didn’t know what important
questions to ask.”
Steve recovered quickly and is nearly pain
free. “Physiotherapy wasn’t successful for
me, it was from that point forward that I
worked with a specialist to come to the
decision I did regarding surgery.”
Beryl had arthroscopic surgery but it did not
help relieve her pain. She had a second surgery
on her knee, which has given her some relief.
“I’m not 100%, but I’m at a point where I can live
with the pain,” she says.
9
KEY FACTS TO KNOW
If you’re considering arthroscopic surgery for
a torn meniscus and you also have arthritis, it’s
important to ask your doctor which problem is
most likely causing your knee pain.
K E Y FAC TS TO K N OW
10
When you’re older, the trauma to the knee
may not be noticed. It may be multiple
small injuries over a period of time that
lead to the tearing of the meniscus.
In this chapter:
° The meniscus is like a cushion that pads
the knee
Dr John Wright
° As you age, the meniscus can tear
more easily
A torn meniscus doesn’t always hurt
° A torn meniscus doesn’t always hurt
Meniscus tears often don’t cause any
problems and don’t need treatment. But
some meniscus tears cause pain, stiffness,
and other problems.
The meniscus is like a cushion that pads
the knee
The meniscus is a disc of tissue that works
like padding between the thighbone and
shinbone. It cushions impact when you walk,
run, and jump. The meniscus also helps spread
your body weight evenly over the entire knee.
Your doctor will try to find out what seems
to be causing your symptoms—a meniscus
tear or another knee problem. This is
important because your treatment options
depend on what’s causing the problem.
Each knee has two meniscus discs. They are
each shaped like the letter C.
Normal knee
Ligaments are strong bands of tissue that
connect the bones of the upper and lower
leg and help keep the joint stable. Muscles
(not shown in the illustration on the right)
also help support the knee. The illustrations
on the right show a normal knee and a knee
with a meniscus tear.
As you age, the meniscus can tear more easily
Meniscus tears are common among people
40 and older. In young people with healthy
knees, the meniscus is difficult to tear. With
age, the meniscus can become thin and
fragile like worn, frayed cloth. Sometimes
parts of the meniscus wear away completely.
The meniscus cushions impact and helps spread
body weight over the entire knee.
Knee with meniscus tear
A weak meniscus can tear easily during
normal activity that puts stress on the knee.
For example, getting in and out of a car or
squatting down can damage a thin meniscus.
You may remember doing something that
suddenly started your knee pain, or your
symptoms may begin slowly so that you don’t
know exactly how or when they started.
With age, the meniscus can become thin and fragile.
11
KEY FACTS TO KNOW
ABOUT THE MENISCUS
I S YO U R PAI N FRO M A TO R N M EN ISC U S ?
12
WHAT DO SYMPTOMS AND MRIS TELL YOU?
My knee pain came on suddenly ...
I was not able to carry out my duties at
work as well as I should have.
In this chapter:
° Symptoms of a torn meniscus are like other
Beryl
knee problems
° MRIs show meniscus tears, but not the likely
MRIs show meniscus tears, but not the
likely cause of pain
cause of pain
° MRIs aren’t always necessary
A magnetic resonance imaging (MRI) scan can
show a tear in your meniscus, where the tear
is, and how large it is. An MRI can’t tell you for
sure whether a meniscus tear or something
else is the reason for your symptoms.
° When should you see a specialist and
what type?
Symptoms of a torn meniscus are like other
knee problems
Remember, meniscus tears don’t always
cause pain. It’s possible that your symptoms
are from arthritis, or another type of knee
problem that an MRI may or may not show.
Symptoms of a torn meniscus can include:
° pain that you feel in one specific part of
your knee
° popping, clicking or catching feelings
when you move your knee in certain ways,
or a feeling that something is getting
stuck in your knee (these feelings are
often called “mechanical symptoms”)
The problem with the MRI scan is that
it’s very sensitive. It finds all kinds of
things. But it doesn’t necessarily tell us
which of the things that it finds are the
actual cause of the problem. That’s why
the history and then the physical exam
are necessary to decide what the actual
cause is.
° “buckling” or giving way in your knee.
If you have one or more of the symptoms
listed on this page, a tear in your meniscus
could possibly be the source of your pain.
But other knee problems can also cause
these symptoms:
Dr John Wright
° a new, sharp knee pain that starts suddenly
° stiffness
° swelling
° pain only during certain movements, such
as twisting or pivoting.
These symptoms may be mild or severe
enough to make walking and daily activities
difficult. Sometimes symptoms from a torn
meniscus go away on their own.
13
IS YOUR PAIN FROM A TORN MENISCUS?
I S YO U R PA I N
F R O M A TO R N
MENISCUS?
I S YO U R PAI N FRO M A TO R N M EN ISC U S ?
To find out if a meniscus tear is the most
likely reason for your pain, your doctor will:
When should you see a specialist and
what type?
° ask you about your symptoms and how
If you don’t want to consider surgery, you
probably don’t need to see a specialist. Your
GP can help you manage your knee symptoms
or refer you to a trained professional who will
teach you exercises that can help.
they started
° examine your knee
° look at the results of an MRI, if you’ve
had this test.
You may want to see a specialist if:
MRIs aren’t always necessary
° you would consider having arthroscopic
You don’t need an MRI if you want to try
helping your knee with exercise or pain
medication. That’s because these approaches
can help many types of knee problems, so
you don’t need to know for sure that your
meniscus is torn before you try them.
surgery and your GP thinks it could help
your symptoms
° you want more information about what is
going on in your knee.
Orthopaedic surgeons and rheumatologists
are doctors who have had special training to
evaluate joint problems. They can provide
more complete information about your knee
and can help you decide if arthroscopic
surgery is a reasonable option for you.
You do need an MRI to make sure your
meniscus is really torn if you’re considering
arthroscopic surgery. But it’s important to
remember that an MRI may find tears that
are painless. That’s why the decision to have
arthroscopic surgery for a torn meniscus
should never be based on an MRI alone.
Remember, even a specialist can’t be 100%
sure about the cause of your knee pain.
14
Arthroscopic surgery removes torn parts of
the meniscus
Arthroscopic surgery is also called
arthroscopy. It is a surgery that uses three
small incisions around the knee.
In this chapter:
° You have time to try exercise therapy and
pain medication
In one incision, the surgeon inserts a video
camera about the size of a pencil. The camera
shows the inside of the knee on a TV screen.
The surgeon inserts surgical tools into the
other two incisions. Surgeons use arthroscopic
surgery to do different types of procedures.
° Arthroscopic surgery removes torn parts
of the meniscus
° Why not stitch a torn meniscus together?
If a doctor thinks that a meniscus tear is the
most likely cause of your symptoms, you have
a choice about what to do—and time to decide.
For a torn meniscus in people 40 or older,
arthroscopic surgery is done to remove torn
and damaged parts of the meniscus, leaving as
much of the meniscus in the knee as possible.
This procedure is called a partial meniscectomy.
A torn meniscus is not an emergency. There is
no reason to rush to have surgery.
You have time to try exercise therapy
and pain medication
The surgery typically takes an hour or less,
and people usually go home the same day.
Doctors often recommend exercise to help
with recovery.
Taking time to try exercise will not affect the
results of arthroscopic surgery if you decide
to have it later. Some people get pain relief
after several weeks of exercising . Exercise
works mainly by increasing the strength in
the muscles around the knee so that they
support the joint better. Some people also
use pain medication for a short time to help
with discomfort.
Why not stitch a torn meniscus together?
You may have heard about someone who had
arthroscopic surgery to stitch the meniscus
tear back together. This surgery sometimes
works for people younger than 40.
If exercise and pain medications do not help
enough and the symptoms make it hard to
get around, some people consider the pros
and cons of having arthroscopic surgery.
In people 40 and older, the meniscus is usually
too thin and worn to be stitched together. So
instead, the surgeon removes the torn parts of
the meniscus that may be causing symptoms.
If you’re in your early 40s, you may want to
know if your meniscus is still in good enough
condition to be stitched together. Your
doctor can discuss this with you.
But if your doctor recommends arthroscopic
surgery involving stitches, or sutures, to
sew together a tear in your meniscus, the
information in this booklet is not right for
your condition.
15
IS YOUR PAIN FROM A TORN MENISCUS?
OV E R V I E W O F T R E AT M E N T S F O R
TO R N M E N I S C U S S Y M P TO M S
TO R N M EN ISC US WITH OS TEOARTH R ITIS
TO R N
M EN ISCUS WITH
OSTEOARTH R ITIS
Arthritis doesn’t go away. Symptoms can get
worse over time or stay the same for years.
Sometimes pain and the ability to move will
get better. But, there’s no way to predict what
will happen to your symptoms over time.
MENISCUS TEARS AND ARTHRITIS
O F T E N G O TO G E T H E R
In this chapter:
° Arthritis affects the entire knee joint
° Meniscus tears and arthritis have
The illustrations on the next page show
a normal knee compared to a knee with
arthritis and a meniscus tear.
similar symptoms
° Doctors use several types of information to
find the likely cause of symptoms
Both the arthritis and the meniscal tear
may be causing pain. The treatment for
the two can be quite different. So, it’s
important to get an understanding of
which of them is causing which parts of
the pain and what needs to be addressed.
People over 40 who have tears in a meniscus
often have knee arthritis too. Having both
problems makes it harder to know which one
is causing the symptoms that bother you.
Arthritis affects the entire knee joint
Dr John Wright
In a normal knee, smooth, firm cartilage
covers the knee bones and helps them glide
easily when you move.
When people have arthritis, the cartilage on
the bones wears away and becomes rough.
Bone spurs are another sign of arthritis.
When cartilage in the knee wears away,
bone spurs form as the body tries to make
up for this damage. In a knee with arthritis,
the meniscus may tear or completely wear
away over time.
Arthritis can cause pain and stiffness. Your
knees may swell or be painful to bend. These
symptoms can make it hard to walk or do
daily activities.
16
Knee with arthritis and a meniscus tear
In a normal knee, smooth, firm cartilage covers
the knee bones and helps them glide easily
when you move.
In a knee with arthritis, the cartilage on the bones
wears away and becomes rough. Bone spurs are
another sign of arthritis. The meniscus may tear or
completely wear away over time.
Meniscus tears and arthritis have similar symptoms
A torn meniscus and arthritis can cause the same types of knee pain. If you have both
problems, it’s impossible to know for sure which one is causing pain. The table below shows
symptoms that could be caused by a torn meniscus or arthritis.
Possible symptoms
Torn meniscus
Knee arthritis
Swelling/Stiffness
Common
Common
Knee “buckles”
or gives way
Common
Common
Catching, clicking or
popping feelings
Common
Less common
Pain
° often a sharp pain that may
° usually a dull ache that
start suddenly
° in one area of the knee
° happens predictably with
certain movements, like
turning or squatting.
comes slowly over time;
sometimes a sharp pain
° usually the whole knee
° may come and go
° worse after standing or
walking for a long time.
17
TORN MENISCUS WITH OSTEOARTHRITIS
Normal knee
TO R N M EN ISC US WITH OS TEOARTH R ITIS
A R T H R O S C O P I C S U R G E RY D O E S N OT
H E L P A R T H R I T I S PA I N
Doctors use several types of information to
find the likely cause of symptoms
To find out whether arthritis or a torn
meniscus is the likely cause of your knee
problem, a doctor will examine your knee, ask
you about your symptoms, and look at plain
x-rays and sometimes, MRIs.
In this chapter:
° One study compared arthroscopic surgery
and nonsurgical treatments for arthritis
° Arthroscopic surgery plus nonsurgical
treatments didn’t help more than nonsurgical
treatments alone
Both x-rays and MRIs can show how much
arthritis you have. But the amount of
arthritis shown on pictures may have little
to do with the amount of pain and other
symptoms you have.
Doctors used to think they could help knee
arthritis symptoms by doing arthroscopic
surgery to smooth the rough surfaces in the
joint and to remove loose pieces of bone,
cartilage, and meniscus.
° Some people feel a lot of pain from the early
stages of arthritis, but their x-rays and MRIs
show little or no arthritis.
Now, medical studies show that arthroscopic
surgery for arthritis does not reduce arthritis
pain or make it easier to do everyday
activities better than nonsurgical treatments,
like exercise and pain medication.
° Other people feel little or no pain, but their
x-rays and MRIs show a lot of arthritis.
MRI
X-ray
Arthritis
Torn
meniscus
Cause
of pain
Yes
Yes
No
Yes
No
This chapter gives you information about a
study that showed arthroscopic surgery does
not improve pain from knee arthritis.
One study compared arthroscopic surgery
and nonsurgical treatments for arthritis
No
One large, good study looked at 178 people
who were divided into two groups.
It’s important to remember: x-rays and MRIs
cannot tell you if your symptoms are coming
from arthritis, a torn meniscus, or another
knee problem that may not show on pictures.
People in both groups:
° had moderate to severe knee arthritis
on x-rays
° used nonsurgical treatments, including
That’s why treatment decisions should not be
made on x-rays and MRIs alone.
exercises, pain medication, and cold and
heat treatment
If you have knee arthritis and you’re
considering arthroscopic surgery for a
meniscus tear:
° learned about arthritis and how to avoid pain
doing daily activities.
One of the two groups also had arthroscopic
surgery for arthritis symptoms.
° make sure to tell your doctor which
symptoms bother you the most
° then ask if arthritis seems to be the cause
of those symptoms.
If your doctor thinks that some or all of your
symptoms are from arthritis, you can learn how
exercise can help knee pain in this booklet.
18
Two years after treatment, people who had nonsurgical treatments improved as much as
people who had arthroscopic surgery plus nonsurgical treatments, as shown in the chart below.
Arthroscopic surgery doesn’t help more than nonsurgical treatment
Two years after treatment, people rated their symptoms the same, whether they had arthroscopic
surgery or not. Symptoms included pain, stiffness and difficulty doing daily activities such as climbing
stairs, housework, shopping and getting in and out of the car.
People in both groups rated their symptoms
the same—between “mild” and “moderate”.
Adding arthroscopic surgery to nonsurgical
treatments did not make a difference.
On average, everyone in the study had:
The study also looked at surgery results for
people who had moderate, but not severe,
arthritis before treatment. Arthroscopic
surgery did not help these people either.
° less pain
° less stiffness
° less difficulty doing daily activities like
The results of the study are clear:
Arthroscopic surgery did not help pain or
other symptoms of knee arthritis.
climbing stairs, housework, shopping and
getting in and out of a car.
19
TORN MENISCUS WITH OSTEOARTHRITIS
Arthroscopic surgery plus nonsurgical treatments didn’t help more than nonsurgical
treatments alone
E XERCIS E TH ER APY
20
EXERCISE THERAPY
EXERCISE
THERAPY
H OW D O E S E X E R C I S E
THER APY HELP?
Three types of exercise improve strength,
balance, and movement
To ease knee pain and other symptoms
of arthritis, it helps to do three types
of exercises.
In this chapter:
° Exercise therapy strengthens muscles and
reduces pain
1. Exercises to strengthen the muscles
around the knee
° Three types of exercise improve strength,
balance and movement
When your knee hurts, it’s natural to want to
limit your activity. But if you don’t use your
muscles, they can become weak. Weak thigh
muscles can’t support the knee, and that can
cause more pain.
° Professionals can help you get started
° It may take several weeks to feel better
° If exercises don’t help, you can still
consider surgery
° Exercising with arthritis
Exercises that strengthen your thigh muscles
can help your knee feel better and prevent
your pain and other symptoms from getting
worse. Strong thigh muscles help support your
knee. They absorb the impact when you move,
and they can help you stay active longer.
Exercise can help relieve symptoms from a
torn meniscus and knee arthritis.
Exercise strengthens muscles and
reduces pain
When your knee hurts, you may have a hard
time thinking about exercise. But exercise can
help your knee feel better over time because
it can strengthen the muscles that support
your knee and help your knee move better.
2. Exercises to improve balance
Knee problems can make your knee less
stable, which can affect balance and
coordination. Doing exercises to improve
your balance improves the stability of your
knee and your muscle coordination.
Many doctors recommend exercise for at least
a couple of months for most people who have
a torn meniscus—with or without arthritis.
3. Exercises to improve movement
Range-of-motion exercises and stretching
can reduce stiffness and help you move
more comfortably.
° Range-of-motion exercises help the knee
joint move farther in all directions.
° Stretching exercises make your muscles
more flexible.
21
E XERCIS E TH ER APY
° Exercise regularly. Try to exercise at least
Professionals can help you get started
two to three times a week, for 30 to 60
minutes each time.
You may find it helpful to work with a
trained professional who can teach you knee
exercises that you can continue to do on
your own.
° Be patient. It may take several weeks, or
even a few months, to feel improvement.
If exercises don’t help, you can still
consider surgery
Physiotherapists, sports medicine physicians,
and exercise physiologists are some of the
professionals who can show you which
exercises are right for you, how to do them
correctly, and how often to do them.
If you find that exercise and other
nonsurgical treatments don’t improve your
symptoms enough, you can still consider
having surgery if your symptoms are likely to
be from a torn meniscus.
Your GP may be able to recommend
someone who can help you.
Taking time to try exercise will not affect the
results of arthroscopic surgery if you decide
to have it later.
It may take several weeks to feel better
You may need to do exercises for
several weeks or more before you notice
improvement, so patience is important.
The next two sections give more information on
exercises for a torn meniscus and for arthritis.
Exercise may not get rid of all your
symptoms, but it can reduce your pain and
increase your ability to do the things you
want and need to do.
Exercises for a torn meniscus
The exercises listed below have helped some
people with symptoms that seemed to be
from a torn meniscus.
To keep your knee as comfortable as
possible, it’s a good idea to continue
doing exercises even after your
symptoms improve.
These exercises are safe for people who also
have arthritis:
° riding a bicycle or stationary bicycle
I started feeling an improvement within
a few weeks and I did stay doing the
exercises pretty regularly. It certainly
helped to have the check-in with the
physiotherapist weekly because if I
cut back, she would let me know that I
wasn’t doing as well.
° jogging or jumping on a mini trampoline
Marcia
° balancing on a wobble board
° leg presses with weights
° lunges
° bending (flexion) and straightening
(extension) the knee against resistance to
strengthen muscles
° standing on one leg for balance
° calf raises (lifting up on your toes).
These tips can help you stick to your exercise
and get the most out of it:
Before starting any exercise program, it’s
a good idea to check with your doctor that
the exercise program is safe for you. A
physiotherapist, sports medicine physician
or an exercise physiologist can show you
how to do the exercises correctly and safely.
° Exercise at a time of day when you have the
least stiffness and pain.
° If you have pain when you exercise, try
taking pain medication before exercising.
Some discomfort is normal, especially when
you start exercising for the first time. If you
have serious pain, talk with your doctor.
22
There are many … low-impact exercises
that you can do that will build strength
but not aggravate the pain. It’s
important as you start to exercise to
expect that you’re going to have some
discomfort. So you need to have a
program that’s not painful and will start
out very gradually.
Some activities can worsen arthritis symptoms
Exercise activities and sports that require
jumping on hard surfaces, twisting or fast
turns (for example, basketball or soccer) may
not be good for people with knee arthritis.
These activities can hurt more than help,
because they may put too much stress on
the knee.
Before you choose an exercise, get advice
from your doctor, physiotherapist, or
exercise physiologist to find out what will be
safe for you.
When I go to the gym, I use different
machines that keep those muscles strong
that align with the knee. I’m really glad I
made that decision, it really worked.
Dr John Wright
Marcia
Exercising with arthritis
Exercise therapy can help
If you have knee arthritis, exercise therapy
to strengthen the muscles that support your
knee can help you feel better. The exercises
for a torn meniscus listed on the previous
page are safe and helpful for people who
have arthritis symptoms, too.
Exercises using elastic bands (also called
resistance bands) are another way to
strengthen your muscles.
Get enough regular aerobic exercise
It’s helpful to get enough regular aerobic
exercise, such as walking or swimming, to
make your heart pump faster. Exercise that
doesn’t put a lot of impact on your knees
is generally good for people with knee
arthritis—for example, walking, riding a
bicycle, swimming and pool exercises.
Getting regular exercise can help you:
° build stronger muscles
° improve your overall physical fitness
° reduce stiffness and make you more flexible
° boost your energy and mood.
23
EXERCISE THERAPY
When you first start doing these exercises,
your knee may hurt more for a while. This
is normal and usually gets better as you
become used to doing the exercises. Some
people use pain medication to help get
through the temporary discomfort from
doing new exercises.
PAI N M ED I C ATI O N S
PA I N
M E D I C AT I O N S
M E D I C AT I O N S T H AT M AY B E H E L P F U L
You can buy these NSAIDs without
a prescription:
In this chapter:
° diclofenac
° Paracetamol is safe for most people
° ibuprofen
° NSAIDs reduce pain and swelling, but have
° naproxen.
more risk
Prescription NSAIDs may not relieve pain
more than the ones you can buy
over-the-counter. Some prescription NSAIDs
are higher doses of the same ingredients in
over-the-counter products, like ibuprofen
and naproxen. Some over-the-counter
painkillers are available in higher doses
by prescription; however, there’s no good
evidence that higher doses are any better
at relieving pain than the same doses of the
over-the-counter versions.
° An NSAID skin gel may have fewer risks
° Doctors usually don’t recommend opioids
for knee arthritis or a torn meniscus
Paracetamol is safe for most people
Paracetamol relieves pain and is generally
safe for most people if they follow directions.
The biggest risk from paracetamol is taking
too much, which can damage the liver. The
risk of liver damage may be higher in people
who drink alcoholic beverages while taking
paracetamol. If you have liver disease, talk to
your doctor before taking paracetamol.
The risks are the same for over-the-counter
and prescription NSAIDs.
The most common side effects of NSAIDs
are problems with stomach irritation that can
lead to bleeding or ulcers. Less commonly,
people taking NSAIDs develop kidney or
heart problems and high blood pressure.
Only take NSAIDs for short periods of time
(up to three weeks) and talk to your doctor
before taking an NSAID if you have had
stomach ulcers, asthma, or kidney problems.
Other medications you take may contain
paracetamol. You’ll need to read labels to
make sure you’re not getting too much.
Medications that contain paracetamol include:
° over-the-counter cold and cough medicines
° prescription and non-prescription medications
containing combination paracetamol and
codeine—an opioid painkiller.
A new class of NSAIDS called COX-2
medications (e.g. celecoxib) were introduced
some years ago. Although some studies
found these had fewer stomach side
effects than standard NSAID, other studies
have not found a difference. There is also
a slight increase in risk of heart attack
with these medications.
NSAIDs reduce pain and swelling, but have
more risk
NSAIDs stand for Nonsteroidal
Anti-Inflammatory Drugs. NSAIDs relieve
pain and reduce swelling. They come in
over-the-counter and prescription versions.
24
There are things you can do to lower the risk
of problems from NSAIDs:
° Don’t take two different NSAIDs together
(like naproxen and ibuprofen) unless your
doctor tells you it’s okay.
° Ask your doctor about lowering your
chance of stomach upset and ulcers by
taking proton pump inhibitors with an
NSAID. Proton pump inhibitors include:
esomeprazole, lansoprazole, omeprazole,
pantoprazole, rabeprazole.
Simple safety tips
Prescription and over-the-counter pain
medications can provide temporary relief
from knee pain. All medications can cause
side effects, so use them with care.
To avoid problems while using
pain medication:
° Make a list of everything you already
take, including:
– prescription medications
° Ask your doctor if an NSAID skin gel is a
– over-the-counter medications
good option for you.
– vitamins
– herbal or other dietary supplements.
An NSAID skin gel may have fewer risks
An NSAID skin gel is a product that you can
rub directly on your knee.
Studies show that NSAID gels can help
relieve pain from osteoarthritis as well as the
pill version of the same drug, but with fewer
side effects.
Some people have skin irritation from the
gel. In rare cases, the gel may cause liver
problems. More study is needed to find out if
an NSAID gel is safe to use for a long time.
° To avoid serious problems from drug
interactions, show your list to your
doctor and pharmacist. Ask them if a new
medication could interact with anything
you are taking.
° Ask your doctor if the pain medication
could affect any other health conditions
you have.
° Read all labels and make sure you follow
the directions.
° Try not to use pain medications regularly
for long periods of time. Long-term use
increases your chance of having side
effects. Ask your doctor how long you can
safely take a pain medication.
Doctors usually don’t recommend opioids
for knee arthritis or a torn meniscus
Opioid pain medications, including codeine,
pethidine and morphine are strong pain
medications. Doctors generally do not
recommend opioids for relief of knee pain
from arthritis or a torn meniscus because
they can have serious side effects, and they
can become habit-forming.
Continued on page 27 X
M E D I C AT I O N S I D E E F F EC T S A N D
SAFET Y TIPS
Possible side effects
The table on page 27 shows the possible
side effects from many prescription and
over-the-counter pain relievers.
This information can help you talk with your
doctor about which medication may be best
25
PAIN MEDICATIONS
for you.
PAI N M ED I C ATI O N S
26
° Use medications for short periods. Some
° Take the lowest dose possible to reduce
people take medication for a brief time to
help with:
the chance of having a problem.
° Stop taking medication when your
– sudden pain flare-ups
pain improves.
– activities that increase pain, like starting
to exercise
– activities that they want to enjoy, such
as going to a special event.
Common pain relievers and possible side effects
Medication type
Active ingredient
Possible side effects
Analgesics
paracetamol
° liver damage with overdose or excess
alcohol use
° worsening of existing liver disease
° kidney or liver damage with long-term use
° weak evidence of an interaction with warfarin.
If you take warfarin talk with your doctor
about taking paracetamol.
NSAIDs –
over-the-counter
diclofenac
ibuprofen
naproxen
° stomach problems including ulcers; risk is
further increased when used with warfarin
° worsening of existing stomach problems
° increased risk of high blood pressure, heart
attacks or strokes
NSAIDs –
prescription
celecoxib
diclofenac
etoricoxib
ibuprofen
indomethacin
ketoprofen
meloxicam
naproxen
parecoxib
piroxicam
sulindac
tiaprofenic acid
° gas, heartburn, nausea or diarrhoea
° headache or dizziness
° excess bleeding from wounds
° drug allergy
° skin rashes
° kidney damage (more likely in people with
kidney problems or high blood pressure and
in people who take both blood pressure and
heart medications)
° occasional liver damage.
27
PAIN MEDICATIONS
Continued from page 25
ARTH ROSCO PI C S U RG ERY
ARTHROSCOPIC
SURGERY
A R T H R O S C O P I C S U R G E RY F O R A
TO R N M E N I S C U S
I wanted to do exercise rather than go
directly to surgery. The pain is gone. It
comes and goes at different times, but it’s
changed completely.
In this chapter:
° What happens in arthroscopic surgery?
Marcia, chose exercise, no surgery
° Comparing arthroscopic surgery
and exercise
Comparing arthroscopic surgery
and exercise
° Arthroscopic surgery for a torn meniscus
won’t help arthritis symptoms
If a torn meniscus seems to be causing your
pain, can arthroscopic surgery plus knee
exercises help more than knee exercises alone?
° The benefits of arthroscopic surgery for a
knee that catches are not known
What happens in arthroscopic surgery?
During arthroscopic surgery for a torn
meniscus, a surgeon removes the torn and
damaged parts of the meniscus, leaving as
much of the meniscus in the knee as possible.
This procedure is called a partial meniscectomy.
To do arthroscopic surgery, the surgeon makes
three small incisions around the knee joint.
In one incision, the surgeon inserts a video
camera about the size of a pencil. The
camera shows the inside of the knee on a TV
screen. The surgeon inserts surgical tools
into the other two incisions. These tools are
used to remove part of the meniscus.
The answer is unclear. The benefits of
arthroscopic surgery for a torn meniscus
are uncertain for people 40 and older. More
research is needed to get final answers.
Until those studies are done, doctors may
disagree on which treatment is better.
The results of one small study are provided next.
A study compared arthroscopic surgery
and exercise therapy for meniscus tears
A well-designed, small study looked at 90
middle-aged people with meniscus tears.
The people were divided into two groups.
In each group, people had a range of
osteoarthritis on x-rays from none to mild.
The surgery typically takes an hour or less,
and people usually go home the same day.
Arthroscopic surgery is also called arthroscopy.
° One group did knee exercises two times
a week.
° The other group had arthroscopic surgery
to remove the torn parts of the meniscus.
After having surgery, this group also did
knee exercises.
There’s always a possibility that
surgery won’t work. In this case, I had a
very favourable outcome …
I’m virtually pain free.
After six months, both groups got better. There
was no difference in the amount of pain they felt
or how well they could do physical activities.
Steve, had arthroscopic surgery
followed by exercise
28
Comparing the benefits
The chart below compares people who had
arthroscopic surgery followed by exercise,
with people who did exercise alone.
During the six months of the study, people were
asked to rate their pain. The chart shows that
both groups had the same improvement in pain.
Six months after treatment, the average pain
rating for each group was less than “mild pain”.
Arthroscopic surgery for a torn meniscus
may not help more than excercise
Arthroscopic surgery for a torn meniscus
won’t help arthritis symptoms
If you have arthritis but your symptoms
seem to be from a torn meniscus, you can
consider arthroscopic surgery to remove the
torn part of the meniscus.
If you’re considering arthroscopic surgery,
keep these two facts in mind:
° experts agree that arthroscopic surgery
will not help arthritis symptoms
° if arthroscopic surgery helps your
meniscus pain, you may still have knee
problems from arthritis.
When you look at the chart, keep these
things in mind:
° The chart shows the average results for
each group of people. An individual could
have better or worse results than the
average results shown in the chart.
° Most people in both groups got better.
No one had worse pain after surgery
or exercise.
° More research is needed to find out for
certain whether arthroscopic surgery can
help pain from a torn meniscus more than
exercise alone in people who are middle
aged or older.
After I had the first surgery, I realised that
the improvement was not what I expected.
I did do a second surgery. The pain comes
and goes.
Six months after treatment, the average amount
of pain people felt was the same with or without
arthroscopic surgery. Their pain level was less
than “mild pain”.
Beryl
You may wonder if arthroscopic surgery to
remove the torn parts of the meniscus could
make arthritis pain worse in the future. Experts
don’t know the answer to this question.
29
ARTHROSCOPIC SURGERY
In this study, arthroscopic surgery followed
by knee exercises did not help relieve knee
pain more than exercises alone. Although
this study was well done, it was too small to
give definite answers.
ARTH ROSCO PI C S U RG ERY
The benefits of arthroscopic surgery for a
knee that catches are not known
Recovery can take weeks to months
After arthroscopic surgery, most people
can expect:
Many doctors believe that arthroscopic
surgery can help a knee that catches. They
believe that removing torn or loose pieces of
meniscus that get in the way of normal knee
movement can help this problem.
° to go home the same day
° to put weight on the leg immediately after
Experts have not done well-designed studies
to find out if arthroscopic surgery helps when
a torn meniscus seems to cause catching in
the knee. So, there’s no good evidence that
surgery is better than nonsurgical treatments
for this type of problem. Sometimes catching
symptoms get better with time, and some
people get better with exercise.
surgery (some people may need to use
crutches or a stick for a few days or weeks)
° to use pain medication (some people use
medication for the first few weeks, and
others need it for less time).
It’s likely that if you have been having
problems with your knee for a long time …
your recovery will be longer. Other factors
that may influence your outcome are
whether you have other illnesses, such as
heart disease or diabetes.
A knee that catches is different from a
knee that locks and requires effort to get it
moving again. Surgery may be needed for a
knee that locks.
R I S K S A N D R EC OV E RY A F T E R
A R T H R O S C O P I C S U R G E RY
In this chapter:
° Arthroscopic surgery is generally safe
° Recovery can take weeks to months
° Exercises are an important part of
your recovery
Arthroscopic surgery is generally safe
Dr John Wright
Several weeks after surgery, most people
are able to walk normally without a limp.
Within a few weeks or months after surgery,
many people are able to return to their
normal activities. Your doctor will tell you
when it’s okay to drive again.
If you have painful arthritis that limits your
ability to do daily activities, your recovery
may take longer.
Fewer than two out of 100 people will have a
complication after arthroscopic surgery.
Exercises are an important part of
your recovery
Serious complications include:
Doctors sometimes recommend exercise
after arthroscopic surgery to help your knee
heal and get strong.
° infection
° a blood clot in the leg
° damage to the knee joint
Even if you choose surgery, you may still
need to exercise your knee to get better.
° problems from anaesthesia.
The exercise that I did consisted of
resistance bands, aerobic steps, and
mainly a lot of stretching. After six weeks,
I was able to do it on my own. So that went
for another six weeks, which was very
helpful in my recovery.
More than 98 out of 100 people will not have
any complications.
Your chance of having problems from
surgery may depend on your overall health.
Talk with your doctor about your risks and
any concerns you have.
Beryl
30
ARTHROSCOPIC SURGERY
31
MAKI N G YO U R D ECISIO N
M A K I N G YO U R
DECISION
In this chapter:
° What else could be making my knee hurt?
° What should you ask your doctor?
It’s not possible to know for certain that a
torn meniscus is causing your symptoms.
Other knee conditions, including arthritis,
can cause symptoms that are a lot like a
painful meniscus tear.
° How do you feel about surgery and
recovery when the chance of improvement
is uncertain?
° How would you manage your symptoms
without surgery?
° Could my symptoms get better with exercise?
What treatment do you want to try for your
knee symptoms? To decide what’s right for
you, talk with your doctor about the most
likely cause of your symptoms and how
different treatments may help. This chapter
includes some questions that may help you
make your decision.
Exercises to strengthen the muscles around
the knee and to improve the ability to move the
joint can help many types of knee problems.
° Could arthroscopic surgery help me?
Medical experts don’t know if arthroscopic
surgery to remove torn parts of the
meniscus can help more than exercises in
people 40 and older. Arthroscopic surgery
will not help arthritis pain.
What should you ask your doctor?
If a doctor thinks a meniscus tear is causing
your pain, be sure to ask:
Do your homework. See what’s out there.
Because surgery is not always the answer
to the problem.
° Why do you think my pain is from a
torn meniscus?
A meniscus tear that shows on an MRI may
not be the cause of your symptoms. A
doctor will consider your symptoms and the
results of your knee exam, x-rays or MRIs to
look for the most likely cause of pain.
Beryl
If your doctor recommends arthroscopic
surgery for your torn meniscus, make sure you
know why your doctor thinks it can help you.
32
You’re the only person who can answer
this question.
Arthroscopic surgery is generally safe, but
there are risks, and you need time to recover.
It may help to think about these questions:
° How much is your knee pain affecting your
life? Is it bothering you so much that the
chance of getting some pain relief is worth
having a surgery that might not relieve all
your pain?
How would you manage your symptoms
without surgery?
Exercise takes time, and pain medications
can have side effects. What are you willing
to try? What makes sense in your life?
As you consider your options, remember
that surgery isn’t a way to avoid exercise.
People who have arthroscopic surgery for
a torn meniscus often do knee exercises
during recovery. And many people continue
exercising to manage symptoms they may
have after surgery.
If I hadn’t had the surgery and I was
still in pain, I would always be second
guessing myself.
° How worried are you about having a
complication from surgery?
° How long can you be away from work or
Steve
other responsibilities?
° How will you manage daily activities
during your recovery if walking is difficult?
33
MAKING YOUR DECISION
How do you feel about surgery and
recovery when the chance of improvement
is uncertain?
D EFI N ITIO N S O F M ED I C AL TER M S
Active ingredient: The active ingredient is
the name of the chemical in the medicine
that makes it work. The manufacturer of the
medicine also gives it another name—the
brand name. There are often many brand
names given to a single medicine; however,
medicines with the same active ingredient
are usually interchangeable.
Arthritis: The term often used for
osteoarthritis, the most common type of
arthritis. In knee arthritis, the cartilage on
the bones wears away and becomes rough.
Bone spurs form as the body tries to make
up for this damage. The meniscus may tear
or completely wear away over time.
Arthroscopic surgery [ar-thro-SKOP-ik]:
A type of surgery done with three small
incisions. A tiny camera is put into the
knee to show the joint on a TV monitor. For
people 40 and over with a torn meniscus,
arthroscopic surgery is used to remove
torn and damaged parts of the meniscus,
leaving as much of the meniscus in the knee
as possible.
Femur [FEE-mur]: The thighbone.
Meniscus [meh-NIS-kus]: The disc of tissue
between the bones of the knee that absorbs
impact and helps distribute body weight
across the entire knee.
MRI: Stands for magnetic resonance
imaging. A way to take pictures of the
organs and tissues inside the body. MRI uses
a powerful magnet instead of radiation.
Nonsteroidal anti-inflammatory drugs
(NSAIDs) [EN-seds]: Drugs such as aspirin,
ibuprofen, and naproxen, which reduce
inflammation, pain, and swelling.
Orthopaedic surgeon [or-thuh-PEE-dik]:
A surgeon with special training in surgery on
bones, joints, and muscles.
Osteoarthritis [OS-tee-oh-ar-THRI-tis]:
The most common type of arthritis. It
includes the breakdown of the cartilage in
a joint, often causing pain, stiffness, and
limited motion. Often called arthritis.
Bone spur: A growth on the side of a bone
that is often a sign of arthritis.
Partial meniscectomy [men-i-SKEK-tuh-mee]:
A surgery that removes torn and damaged
parts of the meniscus, leaving as much of the
meniscus in the knee as possible.
Cartilage [KARTL-ij]: A firm, smooth
material that allows the bones of a joint to
slide smoothly against one another.
Patella [PUH-tel-uh]: The kneecap.
Drug interaction: A situation when another
drug, supplement, or food affects the way a
drug works in the body, usually by making
the drug too strong or too weak.
Exercise (for knee pain): A set of exercises
designed to strengthen muscles, increase
how far the knee can bend and straighten,
and improve balance and coordination.
Exercise physiologist: A health professional
who specialises in treating people
through exercise. You can find an exercise
physiologist through Exercise and Sports
Science Australia (ESSA) essa.org.au
Physiotherapist: A professional trained
to teach exercises to strengthen muscles,
reduce stiffness, and increase range
of motion.
Rheumatologist [roo-ma-TOL-uh-jist]: A
doctor who specialises in treating people
who have arthritis and related diseases.
Sports medicine physician: A doctor who
specialises in treating injury and disease
with physical methods, like exercise.
Tibia [TIB-ee-uh]: The shinbone.
34
Agency for Healthcare Research and Quality
Australian Rheumatology Association
The Agency for Healthcare Research and
Quality provides a consumer guide to
choosing pain medications for osteoarthritis.
The Australian Rheumatology Association
website has a series of patient information
sheets covering a number of categories—
“Your condition explained” and “Managing
your condition”. There is also a tool to help
you find a rheumatologist.
effectivehealthcare.ahrq.gov
Arthritis Australia
The Arthritis Australia website has a series
of information sheets and brochures
covering different forms of arthritis and
different treatment options. Click through
to your state organisation to access
self-management courses.
arthritisaustralia.com.au
Australian Orthopaedic Association
rheumatology.org.au
National Prescribing Service (NPS)
NPS provides practical tools and information
about medicines used to treat arthritis. The
NPS Medicine Name Finder can help you learn
to identify your prescription medicines by
the active ingredient name and brand name.
nps.org.au
The Australian Orthopaedic Association
website has a tool to help you find
an orthopaedic surgeon and links to
comprehensive patient information.
aoa.org.au
Australian Physiotherapy Association
The Australian Physiotherapy Association
website contains a tools to help you find
a physiotherapist, links to a database of
evidence for physiotherapy as well as
relevant information about physiotherapy
and what to expect.
physiotherapy.asn.au
35
DEFINITIONS OF MEDICAL TERMS AND FOR MORE INFORMATION
FO R M O R E I N FO R MATI O N
R E S E A RC H P U B LI C ATI O N S
This booklet was written using the most
up-to-date medical and scientific research.
The research is described in the articles
listed below. Each listing includes the
authors of the article, the article title, the
journal in which it was published, and the
publication year. If you are interested in
reading any of these articles, your doctor or
librarian may be able to help you get a copy.
Ageberg E, Link A, and Roos EM. Feasibility
of neuromuscular training in patients with
severe hip or knee OA: the individualized
goal-based NEMEXTJR training program.
BMC Musculoskelet Disord. 2010;11:126.
Agency for Healthcare Research and
Quality (AHRQ). Choosing Pain Medicine
for Osteoarthritis: A Guide for Consumers.
Rockville, MD: Agency for Healthcare
Research and Quality; 2007. AHRQ
Publication Number: 06(07)-EHC009-2A.
Antman EM, Bennett JS, Daugherty A,
Furberg C, Roberts H, and Taubert KA;
American Heart Association. Use of
nonsteroidal anti-inflammatory drugs: an
update for clinicians: a scientific statement
from the American Heart Association.
Circulation. 2007;115(12):1634–1642.
Baer PA, Thomas LM, and Shainhouse Z.
Treatment of osteoarthritis of the knee with
a topical diclofenac solution: a randomized
controlled, 6-week trial [ISRCTN53366886].
BMC Musculoskelet Disord. 2005;6:44.
Bhattacharyya T, Gale D, Dewire P, et al.
The clinical importance of meniscal tears
demonstrated by magnetic resonance
imaging in osteoarthritis of the knee.
J Bone Joint Surg Am. 2003;85-A(1):4–9.
Bjordal JM, Ljunggren AE, Klovning A, and
Slordal L. Non-steroidal anti-inflammatory
drugs, including cyclo-oxygenase-2 inhibitors,
in osteoarthritic knee pain: meta-analysis of
randomized placebo controlled trials.
BMJ. 2004;329(7478):1317.
Dervin GF, Stiell IG, Wells GA, Rody K,
and Grabowski J. Physicians’ accuracy and
interrator reliability for the diagnosis of
unstable meniscal tears in patients having
osteoarthritis of the knee. Can J Surg.
2001;44(4):267–274.
Englund M, Guermazi A, Gale D, et al.
Incidental meniscal findings on knee MRI in
middle-aged and elderly persons.
N Engl J Med. 2008;359(11):1108–1115.
Ericsson YB, Dahlberg LE, and Roos EM.
Effects of functional exercise training on
performance and muscle strength after
meniscectomy: a randomized trial. Scand J
Med Sci Sports. 2009;19(2):156–165.
Fransen M and McConnell S. Exercise
for osteoarthritis of the knee. Cochrane
Database Syst Rev. 2008;(4):CD004376.
Hawker GA, Stewart L, French MR, et
al. Understanding the pain experience in
hip and knee osteoarthritis—an OARSI/
OMERACT initiative. Osteoarthritis Cartilage.
2008;16(4):415–422.
Herrlin S, Hallander M, Wange P,
Weidenhielm L, and Werner S. Arthroscopic
or conservative treatment of degenerative
medial meniscal tears: a prospective
randomized trial. Knee Surg Sports
Traumatol Arthrosc. 2007;15(4):393–401.
Jordan KM, Arden NK, Doherty M, et al;
Standing Committee for International
Clinical Studies Including Therapeutic
Trials ESCISIT. EULAR Recommendations
2003: an evidence based approach to the
management of knee osteoarthritis: Report
of a Task Force of the Standing Committee
for International Clinical Studies Including
Therapeutic Trials (ESCISIT). Ann Rheum
Dis. 2003;62(12):1145–1155.
Chan AT, Manson JE, Albert CM, et al.
Nonsteroidal anti-inflammatory drugs,
acetaminophen, and the risk of cardiovascular
events. Circulation. 2006;113(12):1578–1587.
36
Laupattarakasem W, Laopaiboon M,
Laupattarakasem P, and Sumananont C.
Arthroscopic debridement for knee
osteoarthritis. Cochrane Database Syst Rev.
2008;(1):CD005118.
Lim HC, Bae JH, Wang JH, Seok CW,
and Kim MK. Non-operative treatment
of degenerative posterior root tear of
the medial meniscus. Knee Surg Sports
Traumatol Arthrosc. 2010;18(4):535–539.
McKnight PE, Kasle S, Going S, et al.
A comparison of strength training,
self-management, and the combination for
early osteoarthritis of the knee. Arthritis Care
Res. 2010;62(1):45–53.
Meserve BB, Cleland JA, and Boucher TR.
A metaanalysis examining clinical test
utilities for assessing meniscal injury.
Clin Rehabil. 2008;22(2):143–161.
Moseley JB, O’Malley K, Petersen NJ, et al.
A controlled trial of arthroscopic surgery
for osteoarthritis of the knee. N Engl J Med.
2002;347(2):81–88.
National Collaborating Centre for Chronic
Conditions. Osteoarthritis: national clinical
guideline for care and management in adults.
London: Royal College of Physicians, 2008.
Nuesch E, Rutjes AW, Husni E, Welch V,
and Juni P. Oral or transdermal opioids for
osteoarthritis of the knee or hip. Cochrane
Database Syst Rev. 2009;(4):CD003115.
Richmond J, Hunter D, Irrgang J, et al;
American Academy of Orthopaedic
Surgeons. American Academy of
Orthopaedic Surgeons clinical practice
guideline on the treatment of osteoarthritis
(OA) of the knee. J Bone Joint Surg Am.
2010;92(4):990–993.
Rimington T, Mallik K, Evans D, Mroczek K,
and Reider B. A prospective study of the
nonoperative treatment of degenerative
meniscus tears. Orthopedics. 2009;32(8).
Roos EM, Bremander AB, Englund M, and
Lohmander LS. Change in self-reported
outcomes and objective physical function
over 7 years in middle-aged subjects with or
at high risk of knee osteoarthritis.
Ann Rheum Dis. 2008;67(4):505–510.
Scheiman JM. Unmet needs in non-steroidal
anti-inflammatory drug-induced upper
gastrointestinal diseases. Drugs.
2006;66(Suppl 1):15–21.
Towheed TE, Maxwell L, Judd MG, Catton M,
Hochberg MC, and Wells G. Acetaminophen
for osteoarthritis. Cochrane Database Syst
Rev. 2006;(1):CD004257.
Tugwell PS, Wells GA, and Shainhouse JZ.
Equivalence study of a topical diclofenac
solution (pennsaid) compared with oral
diclofenac in symptomatic treatment of
osteoarthritis of the knee: a randomized
controlled trial. J Rheumatol.
2004;31(10):2002–2012.
U.S. Food and Drug Administration.
Voltaren Gel (diclofenac sodium topical gel)
1% - Hepatic Effects Labeling Changes. Page:
fda.gov/safety/medwatch/safetyinformation
/safetyalertsforhumanmedicalproducts/
ucm193047.htm. Updated December 5, 2009.
Accessed November 5, 2010.
Wai EK, Kreder HJ, and Williams JI.
Arthroscopic debridement of the knee for
osteoarthritis in patients fifty years of age
or older: utilization and outcomes in the
Province of Ontario. J Bone Joint Surg Am.
2002;84-A(1):17–22.
Zhang W, Nuki G, Moskowitz RW, et al.
OARSI recommendations for the
management of hip and knee osteoarthritis:
part III: Changes in evidence following
systematic cumulative update of research
published through January 2009.
Osteoarthritis Cartilage. 2010;18(4):476–499.
Resources used in the preparation of this
booklet for use in Australia:
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Australian Medicines Handbook 2011 –
amh.net.au. Updated July 2011. Accessed
March 2012.
37
RESEARCH PUBLICATIONS
Kirkley A, Birmingham TB, Litchfield RB,
et al. A randomized trial of arthroscopic
surgery for osteoarthritis of the knee. N Engl
J Med. 2008;359(11):1097–1107.
FO R M OR E IN FO R MAT I O N
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