„You can't say that across the board“, says Dr. med. Peter Kupatz, who runs a practice for orthopaedics and sports medicine in Bad Doberan. „You always have to look at which operation is performed for which illness. In Germany, we have a relatively well-cared-for healthcare system with a wide range of services, which makes quick decisions possible. Whereas in the UK, for example, you wait three months for an artificial knee joint, an operation is often possible within two weeks in this country.

Surgery or not?

Opinions differ on the benefits of meniscus surgery, especially among those affected. Some argue that every meniscus tear requires surgery. Almost as often, however, it is argued that surgery is not necessary in many cases of meniscus injuries. Dr. Kupatz explains that it depends on the type of injury. „A distinction must be made here: Is it an acute tear, for example in a young adult playing football, or is it a meniscus degeneration in an older osteoarthritis patient - the indications for surgery differ massively.

„Certain diseases require a surgical procedure,“ says Dr. Kupatz further. If there is a clear indication for surgery, various aspects must be considered together. This always includes a medical history, i.e. a description of the symptoms, and a clinical examination. Finally, suitable imaging is carried out and then, if necessary, a recommendation for or against surgery is made. The decision must then be made by the patient.“

Individual assessment necessary

It is certain that the treatment method for a meniscus lesion depends on various influencing factors, which can be assessed using the „Guideline Meniscus Disease“ of the German Society for Orthopaedics and Trauma Surgery (DGOU). The choice of therapy depends on the severity of the pain, the age of the patient and the requirements for the load-bearing capacity of the menisci. Every patient is different. And so the decision for or against an operation must always be made on an individual basis. Dr. Kupatz explains this with the following example: „If we are dealing with clear classifications of complaints, examination findings and imaging, then the answer to the question 'conservative or surgical?' is often very precise.

Two examples for the knee joint:

Dr. Kupatz: 1. a 25-year-old patient complains of persistent pain at the inner joint space of the left knee joint since a twisting trauma during a football match two weeks ago. The clinical meniscus tests are clearly positive. The MRI shows a basket handle tear of the medial meniscus. Surgery (arthroscopy) is primarily indicated here.

Dr. Kupatz: 2. A 25-year-old patient has been complaining of pain on the inside of the left knee joint for four weeks. A twisting of the left ankle had occurred 14 days previously while playing football. There is a restriction of the knee extension as well as localized pressure pain at the inner joint space and the inner ligament attachment. Of the meniscus tests performed, four are negative and two are positive. The radiologist finds a change in the MRI, which he interprets as a tear of the medial meniscus. Surgery is not a priority here, as the further course of events confirms: The treating orthopaedic surgeon first prescribes six sessions of physiotherapy to eliminate the extensor defect. The physiotherapist treats a pelvic dysfunction of the sacroiliac joint on the left and a blockage of the lower left ankle joint, which occurred after the foot trauma and was responsible for the knee pain. The patient quickly becomes symptom-free - and remains so.“

Before deciding to undergo surgery, alternatives should be carefully considered, as knee operations are certainly fraught with risk. This applies both to subsequent damage to the joint and the risk of infection. Seek detailed advice from your doctor or, if necessary, get an additional opinion (second opinion).

„I am a fan of second opinions“, so Kupatz, „our healthcare system is so highly specialized today that you can easily get a second medical opinion. The legislator has also reacted to this and paved the way for patients to obtain a second opinion before certain operations at the expense of the statutory health insurance - i.e. without having to pay for them privately.