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From Fellrnr.com, Running tips
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* '''NSAIDs'''. Using NSAIDs does not generally improve healing, can mask symptoms and is a cause of cartilage damage<ref name="KneeNSAID"/>. An animal study showed that Asprin resulted in greater cartilage degeneration<ref name="KneeAsprin"/>. More at [[NSAIDs and Running]].
=Surgery=
Surgery for knee problems is a common treatment, but the research suggest is may not be worthwhile. While surgery and exercise seem to generally result in improved pain, function, and quality of life, it doesn't do better than a program of exercise. (So far I'm continuing my ve found no researchsupporting knee surgery, so this is preliminary, but though most of the research I've yet to find a study showing improved outcomes from surgeryfound has been on meniscus tears.) * A 2012 study looked at 102 patients with a meniscus tear and compared surgery with strengthening and found no difference in terms of function or pain after two years<ref name="YimSeon2013"/>. Both groups reported a high degree of satisfaction with their treatment. The exercise group was given supervised training three times per week for three weeks, then a further eight weeks of unsupervised exercise. The exercise consisted of stretching the hamstrings and quads (1 min each), 3 x 10 reps of leg extensions, leg curls, half squats and full squats, plus 15 minutes of cycling. The squats were only for the last 3 of the 8 weeks, and all exercise was to be with some strain but almost pain free. There's no reason to believe this regime is optimal, but it's an interesting starting point.
* A 2013 study looked at with a meniscal tear and osteoarthritis in 351 subjects, with half randomly assigned to surgery, the others to physical therapy<ref name="KatzBrophy2013"/>. The study did not find any significant difference in functional improvement after 6 months. (30% of those assigned to physical therapy elected to have surgery before the 6 months were up.)
* A 2008 study found that 60% of subjects aged 50+ had meniscus tears<ref name="EnglundGuermazi2008"/>. The rate of meniscus tears was similar in patients with and without knee pain symptoms. What's not clear is that if you have a meniscus tear and you have knee pain, what's the chance of the two being unrelated? It seems quite possible from the data that you could have surgery for a meniscus tear that has nothing to do with your pain.
* A 2013 study looked at 96 subjects over five years after either surgery plus 2 months of exercise or just exercise for with degenerative meniscal tears<ref name="HerrlinWange2012"/>. No difference was found in the outcomes at the 2 and 5 year marks. It's worth noting that a third of the exercise only group still had disabling knee problems after the exercise therapy but they improved to the same level as the other subjects after surgery.
* There are indications that meniscus A 2013 study comparing surgery with sham surgery may increase the risk for osteoarthritis, with meniscus tears in 146 subjects over 12 months found no difference between the amount of meniscus removed tending to predict a higher osteoarthritis riskgroups<ref name="PapaliaDel Buono2011Sihvonen-2013"/>. The subjects had knee pain for more than three months prior and had not responded to conservative treatment. Both groups improved over the 12 months, but there was no difference between the groups. This is one of the highest quality studies available, with some lengths taken to blind the subjects to their knowledge of the surgery or sham surgery.
* A 2007 study looked at 90 subjects with degenerative meniscal tears who were given either exercise or exercise plus surgery<ref name="Herrlin-2007"/>. Both groups reported similar improvements in pain, knee function and quality of life. The exercise consisted of cycling, calf raises, leg press, stair walking, wobble board, jumping, stretching, and similar exercises to improve strength and balance.
* A small 2012 study of just 17 subjects compared surgery (n=8) with exercise (n=9) over three months and found no difference in pain levels or knee function<ref name="ØsteråsØsterås2012"/>. However, the study did find that the surgery group had statistically more anxiety and depression.
* A 2014 analysis of the available research concluded that "There is moderate evidence to suggest that there is no benefit to arthroscopic meniscal débridement for degenerative meniscal tears"<ref name="Khan-2014"/>. This review looked at seven trails (all of them noted here in more detail.)
* A 2013 study compared surgery with steroid injections for meniscus tears in 114 subjects<ref name="Vermesan-2013"/>. They randomly received surgery or injections of betamethasone and lidocaine and evaluated at one month and one year. The study found only a marginal improvement in the surgery subjects over the steroid injection. However, given the evidence that surgery is no more effective than avoiding surgery, it might be better to say that steroid injections are worse than no surgery or surgery.
* There are indications that meniscus surgery may increase the risk for osteoarthritis, with the amount of meniscus removed tending to predict a higher osteoarthritis risk<ref name="PapaliaDel Buono2011"/>. However, it's also possible that a meniscus tear without surgery also increases risk for osteoarthritis <ref name="EnglundGuermazi2009"/>.
* A 2010 study of 121 young adults compared two treatment approach for acute, traumatic ACL injury<ref name="FrobellRoos2010"/>. One group received rehabilitation and surgery within 10 weeks (early group), the other group received rehabilitation with an option for surgery if required (delayed group). Only 40% of the delayed group underwent surgery, and both groups had similar success in terms of pain, quality of life, and difficulty in sports/recreational activities.
* A 2008 study of arthroscopic surgery for osteoarthritis found that surgery had the same success rate as those who did not undergo surgery<ref name="KirkleyBirmingham2008"/>. The study looked at 92 surgical patients and 86 controls over 2 years, with both groups receiving 12 weeks of physical and medical therapy, including exercise. The patients were told to continue the exercise unsupervised for the rest of the study. The evaluations at 3, 6, 12, 18, and 24 months showed both groups improved a similar amount. This was a follow on to a 2002 study that had also found no difference in outcome from surgery or a placebo surgery<ref name="MoseleyO'Malley2002"/>,
=References=
<references>
<ref name="Vermesan-2013">D. Vermesan, R. Prejbeanu, S. Laitin, G. Damian, B. Deleanu, A. Abbinante, P. Flace, R. Cagiano, Arthroscopic debridement compared to intra-articular steroids in treating degenerative medial meniscal tears., Eur Rev Med Pharmacol Sci, volume 17, issue 23, pages 3192-6, Dec 2013, PMID [http://www.ncbi.nlm.nih.gov/pubmed/24338461 24338461]</ref>
<ref name="ØsteråsØsterås2012">Håvard Østerås, Berit Østerås, Tom Arild Torstensen, Medical exercise therapy, and not arthroscopic surgery, resulted in decreased depression and anxiety in patients with degenerative meniscus injury, Journal of Bodywork and Movement Therapies, volume 16, issue 4, 2012, pages 456–463, ISSN [http://www.worldcat.org/issn/13608592 13608592], doi [http://dx.doi.org/10.1016/j.jbmt.2012.04.003 10.1016/j.jbmt.2012.04.003]</ref>
<ref name="Khan-2014">M. Khan, N. Evaniew, A. Bedi, OR. Ayeni, M. Bhandari, Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis., CMAJ, volume 186, issue 14, pages 1057-64, Oct 2014, doi [http://dx.doi.org/10.1503/cmaj.140433 10.1503/cmaj.140433], PMID [http://www.ncbi.nlm.nih.gov/pubmed/25157057 25157057]</ref>
<ref name="Sihvonen-2013">R. Sihvonen, M. Paavola, A. Malmivaara, A. Itälä, A. Joukainen, H. Nurmi, J. Kalske, TL. Järvinen, J. Nyrhinen, Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear., N Engl J Med, volume 369, issue 26, pages 2515-24, Dec 2013, doi [http://dx.doi.org/10.1056/NEJMoa1305189 10.1056/NEJMoa1305189], PMID [http://www.ncbi.nlm.nih.gov/pubmed/24369076 24369076]</ref>
<ref name="EnglundGuermazi2009">Martin Englund, Ali Guermazi, Frank W. Roemer, Piran Aliabadi, Mei Yang, Cora E. Lewis, James Torner, Michael C. Nevitt, Burton Sack, David T. Felson, Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: The multicenter osteoarthritis study, Arthritis & Rheumatism, volume 60, issue 3, 2009, pages 831–839, ISSN [http://www.worldcat.org/issn/00043591 00043591], doi [http://dx.doi.org/10.1002/art.24383 10.1002/art.24383]</ref>
<ref name="MoseleyO'Malley2002">J. Bruce Moseley, Kimberly O'Malley, Nancy J. Petersen, Terri J. Menke, Baruch A. Brody, David H. Kuykendall, John C. Hollingsworth, Carol M. Ashton, Nelda P. Wray, A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee, New England Journal of Medicine, volume 347, issue 2, 2002, pages 81–88, ISSN [http://www.worldcat.org/issn/0028-4793 0028-4793], doi [http://dx.doi.org/10.1056/NEJMoa013259 10.1056/NEJMoa013259]</ref>
<ref name="KirkleyBirmingham2008">Alexandra Kirkley, Trevor B. Birmingham, Robert B. Litchfield, J. Robert Giffin, Kevin R. Willits, Cindy J. Wong, Brian G. Feagan, Allan Donner, Sharon H. Griffin, Linda M. D'Ascanio, Janet E. Pope, Peter J. Fowler, A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee, New England Journal of Medicine, volume 359, issue 11, 2008, pages 1097–1107, ISSN [http://www.worldcat.org/issn/0028-4793 0028-4793], doi [http://dx.doi.org/10.1056/NEJMoa0708333 10.1056/NEJMoa0708333]</ref>
<ref name="Herrlin-2007">S. Herrlin, M. Hållander, P. Wange, L. Weidenhielm, S. Werner, Arthroscopic or conservative treatment of degenerative medial meniscal tears: a prospective randomised trial., Knee Surg Sports Traumatol Arthrosc, volume 15, issue 4, pages 393-401, Apr 2007, doi [http://dx.doi.org/10.1007/s00167-006-0243-2 10.1007/s00167-006-0243-2], PMID [http://www.ncbi.nlm.nih.gov/pubmed/17216272 17216272]</ref>
<ref name="HerrlinWange2012">Sylvia V. Herrlin, Peter O. Wange, Gunilla Lapidus, Maria Hållander, Suzanne Werner, Lars Weidenhielm, Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up, Knee Surgery, Sports Traumatology, Arthroscopy, volume 21, issue 2, 2012, pages 358–364, ISSN [http://www.worldcat.org/issn/0942-2056 0942-2056], doi [http://dx.doi.org/10.1007/s00167-012-1960-3 10.1007/s00167-012-1960-3]</ref>
