Why I Stopped Recommending Meniscus Surgery

Added: 2026-05-09

[00:00:00]I'm going to tell you exactly why I stopped recommending meniscus surgery.

[00:00:04]If you're 40 years or older and have a degenerative meniscus tear, the information in this video might just save you from one of the most commonly performed procedures in orthopedics. And it turns out a surgery that is not even supported by evidence-based medicine.

[00:00:20]Hey everyone, Dr. Jeff Peng here. I'm a sports medicine doctor currently practicing in the San Francisco Bay Area and in treating thousands of active adults with knee pain. I've seen firsthand how meniscus surgery can lead to a lot of regret. The New England Journal of Medicine just published 10-year follow-up results that confirms what I've been telling my patients for years. In this video, I'll walk you through exactly what the results are and why meniscus surgery should definitely be the last resort for degenerative meniscus tears. I'll also share a non-surgical alternative that's gaining popularity with study showing over 90% of patients avoid surgery at 5 years. So first, why am I telling people to avoid meniscus surgery? The trial enrolled adults between 35 and 65 years old with MRI-confirmed degenerative meniscus tears. Half the patients got the real surgery, half got a sham procedure. And here's what the data showed 10 years later. With regards to pain, the surgery group did no better than the sham group.

[00:01:25]With regards to knee function, the surgery did no better. In terms of people's ability to return to normal activities, the surgery group did no better. In fact, only 71% of the surgery patients said they were able to return to normal activities at 10 years. And that's compared to 85% of the patients who got the sham procedure. Not only that, patient-reported satisfaction was lower in the surgery group. Meniscal symptoms and disability were lower in the surgery group. So after 10 years, every meaningful patient-reported outcome either showed no benefit from surgery or it favored the patients who got the fake surgery. What's even worse than everything I've said so far is that the researchers took serial x-rays over the full 10 years to track how each patient's knee was progressing. And what they found was that the surgery group had higher rates of osteoarthritis progression than the sham group. Their arthritis scores, which looked at signs like joint space narrowing and bone spur formation, were also much higher. So, what this means is that the meniscus surgery was associated with worse arthritis progression. And this is consistent with what we know about how the meniscus works. If you trim out or clean up or remove even a small piece of meniscus tissue, you change how force gets distributed within the knee. The cartilage that is supposed to pad and protect the joint takes on more load, and over the course of years, that increased wear and tear leads to worse arthritis. The researchers then tracked how many patients ended up needing a knee replacement surgery after 10 years.

[00:03:00]In the sham surgery group, that number was 4%. In the meniscus surgery group, that number was 12%. So, the patients who got meniscus surgery were three times more likely to end up needing a knee replacement surgery than the patients who got a fake surgery. This is the finding that fundamentally changed how I counsel patients. Because for years, the conversation around meniscus surgery has been about short-term pain relief, about a quick fix. But what this trial shows us is that the short-term trade-off comes with a long-term cost.

[00:03:32]And that cost is increased risk of progression of arthritis and three times higher risk for a knee replacement surgery. So, if meniscus surgery is not a good option, what should patients actually be doing instead? Viewers of my channel know that I am a huge advocate for orthobiologics and regenerative medicine treatments like platelet-rich plasma. And a recent systematic review looked at how PRP performed as a treatment for meniscus tears. Patients treated with PRP had over 80% surgery-free survival at midterm follow-up, meaning more than eight out of 10 patients with meniscus tears who received PRP never needed surgery. Their pain improved, their function improved, and in some studies follow-up MRIs of their meniscus showed that there was actual healing of the meniscus tissue itself. In one of the largest studies in the review, researchers treated nearly 400 patients with degenerative meniscus tears by injecting PRP directly into the meniscus tear, as well as injecting PRP into the knee joint, all done with ultrasound guidance. They followed these patients out for 5 years, and over 90% of these patients treated with PRP never needed surgery. This is actually the exact same approach that I like to use in my clinic. Let me give you an example of what this looks like in practice. Two years ago, I saw a 42-year-old patient who was diagnosed with a degenerative meniscus tear. He saw an orthopedic surgeon and was recommended to try physical therapy first. He did this for over 6 months, and while he did see improvements, he still couldn't get back to the tennis court. He saw two different orthopedic surgeons afterwards, and both of them told him that he needed meniscus surgery. But he didn't like that answer, so he came to see me. I gave him a PRP injection into the meniscus tear, and another one into the knee joint, both done at the same time and under ultrasound guidance. When I saw him at 3 months post injection, he had significant improvements to both pain and function. By 6 months, he was playing tennis again, cycling with his kids, and hiking with his wife. He had no more swelling in the knee, no more catching, and no more limitations on what he wanted to do. I actually saw him a few months ago for a completely different issue unrelated to his knee.

[00:05:40]But when I asked him about his knee, he gave me a surprised look and told me he actually no longer thinks about it anymore. And that's the goal. We don't want to just avoid surgery or manage pain. We want to give people their lives back and to do it in a way where we don't have to increase their risk for worse arthritis or triple their risk for any replacement surgery. Now, it's important to point out that not all PRP is the same. And it turns out that one specific variable can determine whether you have a successful outcome. So, in this next video, I'll discuss one of the most important factors that predicts whether you will get a good result from PRP. Check it out next and thanks for watching.