DEAR DR. ROACH: About eight months ago, I was diagnosed with a torn meniscus in my right knee. Over the course of six months, I received physical therapy and two cortisone shots and had fluid drained from my knee, but I still have pain when I walk. The pain level is about a 2 on scale of 1-10. But it’s discomforting, and I walk with a limp.

The sports medicine doctor I saw didn’t recommend surgery and said to come back if the pain becomes unbearable, at around a 5 or 6. Should I get a second opinion on whether surgery will correct this? I’m 66 years old, and the pain/discomfort while walking restricts what I can do. — R.L.

ANSWER: The menisci are cartilage structures inside the knee that provide support and shock absorption. They can be damaged by trauma and can also deteriorate over time. Most meniscal tears in people over 50 are degenerative. I am assuming that yours is a degenerative tear.

Years ago, a person with a symptomatic degenerative meniscal tear would have been taken to surgery right away, and most of them would have done very well. However, a very powerful study challenged our understanding of what happens to degenerative meniscal tears. Patients who were referred to surgery either got the recommended arthroscopic surgery, or they underwent a “sham” procedure where the arthroscope was placed into the knee (but no actual repair took place). The patients didn’t know if they had gotten surgical repair or not.

At the end of the study, there were no significant differences between the “sham” surgery subjects and “real” surgery subjects in terms of pain or function. After this study was published back in 2013, there has been significantly less interest in performing surgery for nontraumatic meniscal tears.

This doesn’t mean, however, that surgery is useless. If conservative management (including anti-inflammatories and physical therapy) isn’t effective, and a person has symptoms that are severe enough to restrict their daily activities, I certainly recommend the consideration of surgical treatment.

I do understand a surgeon not rushing to operate, but this has been going on for a long time. Waiting too long to operate can be a problem, too; it’s faster and easier to return to your previous level of function if you have surgery within six months, and you are already past this point. I definitely recommend a second surgical opinion.

DEAR DR. ROACH: I am bedbound due to back problems. I can walk, but I have to sit often. I don’t go outside, except maybe for fresh air. Do I need the shingles vaccine? — K.G.

ANSWER: Yes, I absolutely recommend the shingles vaccine. You don’t get shingles from being exposed to someone else. You get it when your immune system weakens over time and the chicken pox that you had when you were a child escapes your body’s defenses.

Shingles in an older person can be horrifically painful and predisposes them to strokes and dementia. A sore arm for a day or two is worth the high protection that you get from the vaccine. This isn’t just my opinion; it’s the consensus of the experts.