Does Knee Arthroscopy Speed Recovery — and at What Price?

Arthroscopy can bring relief to a painful meniscal tear in the knee.

Meniscal tears are a common reason for knee pain, especially in middle age and beyond. The usual question is whether to start with physiotherapy or go straight to arthroscopic surgery — the “keyhole” clean-up of the torn cartilage.

The METEOR trial, published in the New England Journal of Medicine in 2013, compared these two options. It found what many surgeons observe in practice:

• The biggest reduction in knee pain happens in the first 3 months.

• Patients who had arthroscopy improved faster in the first three to six months.

• By twelve months, those who had physiotherapy alone had caught up — pain and function were essentially the same.

So, surgery tends to deliver earlier relief, but the long-term results are similar.

Why Waiting Matters

Most knees improve substantially within the first few months after a meniscal tear. With guided physiotherapy and time, inflammation and irritation often settle. Operating too soon risks treating knees that would have recovered naturally.

If symptoms are still troublesome after three to six months of good rehabilitation, then arthroscopy can still be worthwhile for faster improvement.

Uncertainty and Individual Difference

Like many large studies, the METEOR trial had some cross-over — a number of patients who began with physiotherapy eventually chose surgery because their pain persisted. Once they had surgery, their function improved as well.

This highlights an important truth: research describes what happens on average, not what’s best for every individual. Some knees recover beautifully without surgery; others don’t. That’s why decisions should always be made with a specialist who understands your specific situation.

The Long-Term Trade-Off

While arthroscopy can bring quicker short-term relief, removing part of the meniscus changes how the knee bears weight. Over time, that can increase wear and raise the risk of developing or worsening arthritis.So the short-term gain may come with a long-term cost — something every patient should weigh carefully.

Takeaway

• Arthroscopy often provides faster symptom relief.

• Physiotherapy reaches similar results by one year.

• Early surgery helps some patients but may accelerate arthritis later.

• Individual assessment is essential — one size never fits all.
  

Reference:Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. N Engl J Med. 2013;368(18):1675–1684.