After an MRI scan, I have got the results dictating that I have a crack in the longitudinal of posterior Meniscus...

I still did not meet the doctor to actually tell me what to do about it, but I was wondering if it does require a surgery, or is it curable with some kind of corrective exercise?


As shown in this study, the results of surgery are no better than the results of sham surgery. Such studies had been done previously with the same result, but these earlier studies included typical patients, a significant fraction of such patients suffer from degenerative disease like osteoarthritis. Then if surgery is found to not work, you don't know if that's due to the nature of the disease process or if surgery wouldn't even work under ideal circumstances. That's why this study was done and the results were negative:

In conclusion, the results of this randomized, sham-controlled trial show that arthroscopic partial medial meniscectomy provides no significant benefit over sham surgery in patients with a degenerative meniscal tear and no knee osteoarthritis. These results argue against the current practice of performing arthroscopic partial meniscectomy in patients with a degenerative meniscal tear.

  • I find the conclusion amusing. If both real and sham surgery improved the outcome, why wouldn't the surgery still be done? Just because some physicians hate the placebo effect?
    – rumtscho
    Oct 11 '15 at 10:23
  • @rumtscho I would imagine the real surgery carries far greater risk of complications. If the procedure is ineffective then that risk is unacceptable.
    – Carey Gregory
    Oct 11 '15 at 14:43
  • @CareyGregory but the point is that the procedure is not ineffective, it's "not more effective than placebo". So, if it has, say, 75% chance of helping and 5% chance of complication, as a patient, I'd want it.
    – rumtscho
    Oct 11 '15 at 16:07
  • @rumtscho But if placebo is equally effective and carries a .001% chance of complications, wouldn't you prefer that? Even if you say no, I think the problem will be for the surgeons. How do they justify that 5% risk knowing the procedure has no actual benefit above and beyond placebo, which is the usual criteria for judging effectiveness?
    – Carey Gregory
    Oct 11 '15 at 22:01
  • The placebo effect has to be considered together with the nocebo effect. So, in the old situation where surgery was recommended you would have had a placebo effect from the surgery but also a nocebo effect from the diagnosis and the recommendation that the problem be fixed via surgery. Obviously, if you hear the news that you need surgery, then you won't have much faith in your knee getting better all by itself, you're more likely to believe that it will start to deteriorate until it gets fixed. The surgery then eliminates that nocebo and adds a placebo effect on top. Oct 12 '15 at 5:19

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