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| Meniscus Repair | |
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Fixing, instead of removing the torn cartilage
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By: Jonathan Cluett, M.D.
02/2002
Once diagnosed with a tear of the meniscus, a decision needs to be made regarding the treatment of this problem. Many meniscal tears, particularly chronic tears, can be treated non-operatively. Treatments in this case may include physical therapy, strengthening, and medications. However, meniscal tears may also require surgical treatment.
Tears of the meniscus that cause so-called "mechanical symptoms" tend to respond best to surgical treatment. A mechanical symptom is caused by the meniscus physically impeding the normal movement of the knee. Common symptoms include locking or catching of the knee. People often complain that they feel as though their knee 'locks up.' In the operating room, the surgeon has two primary options, either remove the torn piece of meniscus (a partial menisectomy) or repair the edges together.
The meniscus is circular piece of cartilage with the blood supply coming from its outer rim. In order for the meniscus to heal from a repair the tear must be near the outer edge in an area of good blood supply (nutrients from the blood vessels are necessary for healing); this is the so-called red (vascular)-white (non-vascular) region of the meniscus. Tears in the central portion of the meniscus will not heal well even if repaired-these tears with be removed by your surgeon. However, studies seem to show that if a repair is possible, the long-term outcome is better for the patient because of a decreased the risk of arthritis later in life.
Techniques of meniscus repair include using arthroscopically placed arrows or suturing the torn edges. Both procedures function by reapproximating the torn edges of cartilage to allow them to heal in their proper place and not get caught in the knee causing the symptoms described above.
Rehabilitation following a meniscus repair is more significant than if the torn piece of meniscus is simply removed. If removed, the patient is usually up and walking within a day or two, and back to normal activities within a few weeks. Following a repair, patients may need to keep weight off the knee for days or weeks. Physical therapy is often necessary, and full activities may not be resumed for months. The exact protocol will depend on the individual situation, but is invariably more involved than following a partial menisectomy. Furthermore, if the repair fails (i.e. the repair falls apart), which happens between 20 to 40% of the time, a second surgery may be necessary to remove the damaged cartilage. The advantage of a repair is that the patient retains their meniscus, and likely has a lower risk of developing arthritis later in life.
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