Peter Kupatz, MD, © Dr. med. Peter Kupatz

Arthroscopy (endoscopy) to treat the meniscus is one of the most frequently performed operations in Germany. The aim of this procedure is to make the knee joint pain-free and able to bear weight again. If possible, an attempt is made to reconstruct the normal anatomical conditions as well as possible. However, even if the pain in the knee persists for a longer period of time, surgery is not necessarily required. In certain cases, therapy without surgery is sufficient.

"You can't make that sweeping statement," says Peter Kupatz, MD, who runs a practice for orthopedics and sports medicine in Bad Doberan. "You always have to look at which surgery is performed for which condition. In this country, we have a relatively 'high-brow' health care system with many offers, which allows for quick decisions. For example, while in the UK you wait three months for an artificial knee joint, in this country surgery is often possible within two weeks."

Surgery or not?

Opinions differ about the benefits of meniscus surgery, especially among sufferers. Some argue that every meniscus tear requires surgery. Almost as often, it is countered that in many cases of meniscus injury, surgery is not necessary. Dr. Kupatz explains that it depends on the type of injury. "Here you have to differentiate already: Is there an acute tear, for example, in a young adult playing soccer, or is it meniscal degeneration in an older osteoarthritis patient - there are massive differences in surgical indications."

"Certain conditions require a surgical approach," Dr. Kupatz continued. "If there is a clear indication for surgery, various aspects must be considered together. This always includes first the anamnesis, i.e., the description of the complaints, as well as a clinical examination. Finally, appropriate imaging takes place and then - if necessary - a recommendation for or against surgery. The decision must then be made by the patient."

Individual assessment necessary

What is certain is that the method of treatment for a meniscus lesion depends on various influencing factors, which can be evaluated using the "Guideline Meniscus Disease" of the German Society for Orthopedics 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 surgery must always be made on an individual basis. Dr. Kupatz explains it with the following example: "If we are dealing with clear allocations of complaints, examination findings and imaging, then the answer to the question 'conservative or surgical?' often emerges very precisely.

Two examples for the knee joint:

Dr. Kupatz: 1. A 25-year-old patient complains of persistent pain at the medial joint space of the left knee joint since a twisting trauma during a soccer game two weeks ago. Clinical meniscus tests are clearly positive. MRI shows a basket handle tear of the medial meniscus. Here, surgery (arthroscopy) is primarily indicated.

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 before while playing soccer. There is restriction of knee hyperextension and localized tenderness at the medial joint space and at the insertion of the medial ligament. Of the meniscus tests reviewed, four are negative and two are positive. The radiologist finds a change on MRI that he interprets as a tear of the medial meniscus. Here, surgery is not a priority, as the further course also confirms: The treating orthopedist initially prescribes physiotherapy six times to eliminate the extension defect. The physiotherapist treats a pelvic dysfunction of the sacroiliac joint (sacroiliac joint) on the left as well as a blockage of the left lower ankle joint, which occurred after the soccer trauma and was responsible for the knee complaints. The patient quickly becomes symptom-free - and stays that way."

Before deciding on surgery, alternatives should be carefully considered, as knee operations are definitely risky. This applies to both subsequent impairments to the joint and the risk of infection. Get detailed advice from your treating physician or, if necessary, get an additional opinion (second opinion).

"I'm a fan of second opinions," Kupatz says, "Our healthcare system is so highly specialized today that it's easy to get a second medical opinion. Legislators have also responded to this and paved the way for patients to get a second opinion before certain surgeries at the expense of their public health insurance - that is, without having to pay for them privately."

Arthroscopy (endoscopy) to treat the meniscus is one of the most frequently performed operations in Germany. The aim of this procedure is to make the knee joint pain-free and able to bear weight again. If possible, an attempt is made to reconstruct the normal anatomical conditions as well as possible. However, even if the pain in the knee persists for a longer period of time, surgery is not necessarily required. In certain cases, therapy without surgery is sufficient.

"You can't make that sweeping statement," says Peter Kupatz, MD, who runs a practice for orthopedics and sports medicine in Bad Doberan. "You always have to look at which surgery is performed for which condition. In this country, we have a relatively 'high-brow' health care system with many offers, which allows for quick decisions. For example, while in the UK you wait three months for an artificial knee joint, in this country surgery is often possible within two weeks."

Surgery or not?

Opinions differ about the benefits of meniscus surgery, especially among sufferers. Some argue that every meniscus tear requires surgery. Almost as often, it is countered that in many cases of meniscus injury, surgery is not necessary. Dr. Kupatz explains that it depends on the type of injury. "Here you have to differentiate already: Is there an acute tear, for example, in a young adult playing soccer, or is it meniscal degeneration in an older osteoarthritis patient - there are massive differences in surgical indications."

"Certain conditions require a surgical approach," Dr. Kupatz continued. "If there is a clear indication for surgery, various aspects must be considered together. This always includes first the anamnesis, i.e., the description of the complaints, as well as a clinical examination. Finally, appropriate imaging takes place and then - if necessary - a recommendation for or against surgery. The decision must then be made by the patient."

Individual assessment necessary

What is certain is that the method of treatment for a meniscus lesion depends on various influencing factors, which can be evaluated using the "Guideline Meniscus Disease" of the German Society for Orthopedics 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 surgery must always be made on an individual basis. Dr. Kupatz explains it with the following example: "If we are dealing with clear allocations of complaints, examination findings and imaging, then the answer to the question 'conservative or surgical?' often emerges very precisely.

Two examples for the knee joint:

Dr. Kupatz: 1. A 25-year-old patient complains of persistent pain at the medial joint space of the left knee joint since a twisting trauma during a soccer game two weeks ago. Clinical meniscus tests are clearly positive. MRI shows a basket handle tear of the medial meniscus. Here, surgery (arthroscopy) is primarily indicated.

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 before while playing soccer. There is restriction of knee hyperextension and localized tenderness at the medial joint space and at the insertion of the medial ligament. Of the meniscus tests reviewed, four are negative and two are positive. The radiologist finds a change on MRI that he interprets as a tear of the medial meniscus. Here, surgery is not a priority, as the further course also confirms: The treating orthopedist initially prescribes physiotherapy six times to eliminate the extension defect. The physiotherapist treats a pelvic dysfunction of the sacroiliac joint (sacroiliac joint) on the left as well as a blockage of the left lower ankle joint, which occurred after the soccer trauma and was responsible for the knee complaints. The patient quickly becomes symptom-free - and stays that way."

Before deciding on surgery, alternatives should be carefully considered, as knee operations are definitely risky. This applies to both subsequent impairments to the joint and the risk of infection. Get detailed advice from your treating physician or, if necessary, get an additional opinion (second opinion).

"I'm a fan of second opinions," Kupatz says, "Our healthcare system is so highly specialized today that it's easy to get a second medical opinion. Legislators have also responded to this and paved the way for patients to get a second opinion before certain surgeries at the expense of their public health insurance - that is, without having to pay for them privately."