Meniscal tears and repairs

The Healthy Knee

The knee joint is made up of three bones:
the thigh bone (femur), the shin bone (tibia), and the kneecap (patella). In each knee, between the femur and the tibia, there are two c-shaped pieces of cartilage. Each cartilage, called a meniscus, is smooth and rubbery, adds stability to the joint and acts as the knee's shock absorber.

Meniscus Tears

Meniscus tears are one of the most common knee injuries, affecting approximately 1 million people in the US each year.3 The meniscus can tear from acute injury to the knee or from degeneration over time.

Symptoms of Meniscus Tears

  • Joint pain and stiffness
  • Swelling of the joint
  • Limited range of motion of the knee
  • Sensation of the knee "giving way"
  • Knee joint locking, catching, or audible clicking
  • Pain with bending and twisting the knee

Steps to Getting Treated

Doctor Examination

After a thorough review of symptoms and medical history, your doctor will physically examine and manipulate your knee to check for the signs of a meniscus tear. Imaging tests such as X-ray or MRI may be ordered to help your doctor diagnose and confirm the injury.

Treatment Options

The surgeon will recommend the best treatment option for your situation based on the type of meniscus tear, its size, location, and consideration for your age and activity levels.

If surgery is indicated, your doctor may recommend a minimally invasive procedure called arthroscopy. Arthroscopy allows the surgeon to gain access inside your knee via small incisions to see and assess your meniscus and perform either a repair or a procedure called meniscectomy.2

Typically, a meniscus repair is done by stitching together your meniscus, preserving the tissue and its normal size, shape and function. A meniscectomy involves the permanent removal of the torn meniscus tissue in part or whole and does not preserve the normal size of the meniscus. Although meniscectomy is a common procedure, many doctors are now choosing to repair the meniscus when possible to preserve long-term knee health.

A number of clinical studies have compared the treatment options showing strong support for meniscus repair and reporting long-term consequences of meniscus tissue removal.

Meniscus Repair

VS

Meniscus Removal
Tear is stitched together and natural meniscus shape maintained   Meniscus tissue is removed in part or whole
Preserves tissue and may return normal knee joint pressure4   Potential of accelerated advanced arthritis5 and higher risk for knee replacement in less than 9 years1,6
Along with rehabilitation, repair can facilitate the return to near normal activity levels   May lead to diminished long-term sports performance, mobility, and total knee health7

The primary concern for most patients following knee surgery is the development of osteoarthritis and future surgery.8 Most patients prefer meniscus repair when undergoing surgery for a torn meniscus to help reduce these risks.8

What to Expect During Recovery9

Following meniscus repair surgery, patients typically wear a brace for 4-6 weeks, and may need the support of crutches. Heavy lifting may be restricted during this time. Regular rehabilitation exercises are commonly prescribed to restore knee mobility and strength. Generally, patients return to near normal active lifestyles after surgery and rehabilitation.

References

  1. Chung KS, Ha JK, Yeom CH, et al. Comparison of Clinical and Radiologic Results Between Partial Meniscectomy and Refixation of Medial Meniscus Posterior Root Tears: A Minimum 5-Year Follow-up. Arthroscopy. 2015;31(10):1941-50.
  2. American Academy of Orthopaedic Surgeons. Meniscus Tears. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/meniscus-tears Accessed 22 Feb 2019.
  3. Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in Outpatient Knee Arthroscopy in the United States: A Comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am. 2011;93:994-1000.
  4. Beamer B, Masoudi A, Walley K, et al. Analysis of a New All-Inside Versus Inside-Out Technique for Repairing Radial Meniscal Tears. Arthroscopy. 2015;31(2):293-8.
  5. Papalia R, Del Buono A, Osti L, Denaro V, Maffulli N. Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. British Medical Bulletin 2011;99:89-106.
  6. Beaufils P, Becker R, Kopf S, et. al. Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):335-346. Epub 2017 Feb 16.
  7. Chahla J, Cinque ME, Godin JA, et.al. Meniscectomy and Resultant Articular Cartilage Lesions of the Knee Among Prospective National Football League Players. AJSM. 2018;46(1):200-207.
  8. Brophy RH, Gefen AM, Matava MJ, Write RW, Smith MV. Understanding of Meniscus Injury and expectations of Meniscus Surgery in Patients Presenting for Orthopaedic Care. Arthroscopy. 2015 Dec; 31(12):2295-2300.
  9. Noyes F, Barber-Westin S. Arthroscopic Repair of Meniscus Tears Extending Into the Avascular Zone With or Without Anterior Cruciate Ligament Reconstruction in Patients 40 Years of Age and Older. Arthroscopy. 2000;16(8):822-9.

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

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