Therapy or Surgery for Knee Injuries?

Breaking News in the World of Knee Injuries: The meniscus is a C-shaped piece of soft and fibrous cartilage serving as a shock absorber in the knee. Meniscal tears in the knee are very common. More than half of us will develop them, but for some, they can be painful and debilitating.1 Did you know that exercise therapy is widely considered a viable first-line treatment option for degenerative meniscal tears in the knee?2,3 However, all of the research supporting those recommendations has been done with patients older than 50 . . . until now.

In January, the New England Journal of Medicine published a first-of-its-kind study helping people decide between physical therapy or surgery for certain knee injuries. Søren T. Skou, Ph.D., University of Southern Denmark, led a study about meniscal tears. More importantly, his team was the first to compare surgical repair and exercise therapy for patients age 18 to 40. They found results similar to those with patients age 50+. In terms of pain, function, return to sport, and quality of life, the results of surgery and exercise therapy were about the same after a year. Dr. Skou’s team found that three out of four people offered exercise therapy before surgery did not go on to have surgery after a year.

Exercise therapy may have advantages. Exercise-treated knees have fewer degenerative changes and lower risk of total knee replacement later in life compared to knees that underwent arthroscopic partial meniscectomy (one type of surgical repair). Even people who are considered surgical candidates for knee pain/injury should weigh their options and keep physical therapy in mind.


  1. Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. New England Journal of Medicine. 2008 Sep 11;359(11):1108-15.
  2. Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M, Seil R. Surgical management of degenerative meniscus lesions. Arthroskopie. 2017 Jun 1;30(2):128-37.
  3. Stone JA, Salzler MJ, Parker DA, Becker R, Harner CD. Degenerative meniscus tears-assimilation of evidence and consensus statements across three continents: state of the art. Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine. 2017 Mar 1;2(2):108-19.
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