The meniscus is a C-shaped piece of cartilage located between the femur (thighbone) and the tibia (shinbone) in each knee. It acts as a shock absorber, providing stability and cushioning during movements.
Meniscus repair is often preferred over meniscectomy (removal of the torn part) whenever possible because preserving the meniscus is essential for maintaining the knee’s stability and reducing the risk of long-term complications like arthritis. Repair is an option based on the type of tear, and the overall condition of the meniscus. Not all meniscus tears can be repaired.
Meniscus repair is a minimally invasive procedure which involves stitching together the torn pieces of the meniscus. Dr. Reynolds will make two or three small incisions in the knee. Then he will insert an arthroscope, a small, thin tube that contains a camera to examine and repair the meniscus. Using tiny instruments, Dr. Reynolds will suture or reattach the torn edges of the meniscus together to promote healing.
This less invasive surgery will limit damage from the procedure and help promote faster recovery. It is usually performed in an outpatient surgery center under general or local anesthesia. Physical therapy will be recommended. Most patients are able to fully recover and return to normal activity within 2-4 weeks.
Various factors have been identified that influence the success of meniscus repair, these include joint stability, associated ACL reconstruction, age, tear shape, type and location.
- Small tears at the outer edge of the meniscus, in the red zone may heal on their own with conservative management including RICE: Rest, Icing, Compression and Elevation with NSAIDs to reduce pain. If symptoms persist, corticosteroid injections can reduce inflammation, and are especially helpful for degenerative tears. When symptoms persist, arthroscopic surgery is the most effective option.
- Tears in the inner two-thirds of the meniscus (the white zone) have limited ability to heal due to the limited blood supply and the nutrients needed for healing. In this case, surgical trimming or repairing the damaged parts will be necessary.
- Complex tears may not be amenable to repair.
- Degenerative tears may be less amenable to repair as the tissue quality if poorer and the healing capacity is reduced.
Partial meniscectomy is a different surgical procedure that involves the removal of a portion of the torn meniscus. Unlike meniscus repair, where the goal is to preserve the meniscus, partial meniscectomy aims to address the symptoms and mechanical issues caused by the torn portion of the meniscus. During the procedure, Dr. Reynolds trims and removes the damaged part of the meniscus, leaving behind the healthy and stable portions. This helps reduce pain and improve knee function but may potentially lead to long-term complications, such as an increased risk of osteoarthritis in the affected knee.
The choice between meniscus repair and partial meniscectomy depends on several factors, including the type, location, and size of the meniscus tear, the patient’s age, activity level, and overall knee health. Meniscus repair is preferred whenever possible, especially for younger patients and certain types of tears that have a higher chance of successful healing. Partial meniscectomy is typically considered when the tear is in an area with limited blood supply or if the tear is complex and not amenable to repair.