Treatment

Treatment of Meniscal Tears: Arthroscopic Surgery

Once a meniscal tear has been diagnosed it should be treated. This does not have to be done urgently although patients with a painful locked knee may want surgery as soon as possible. Arthroscopic surgery is the only way to treat the tear since there are currently no medications, braces, or physiotherapy treatments that have been shown to promote healing in the avascular tears.

Arthroscopic surgery is performed on an outpatient basis. The surgeon initially inspects the whole knee joint to see if there are any other problems (e.g. arthritic areas, ligament tears or tears of the other meniscus) and then evaluates the meniscal tear by inspecting it with a blunt probe. Based on the location and geometry of the tear the decision is made to either remove or repair the tear(s). Removing the tear (called ameniscectomy) is accomplished by using a variety of small instruments that cut and suck out only the torn portions of the meniscus. The remaining meniscal rim is then balanced and contoured to provide a gradually tapered transition into the area of the resection. The surgeon tries to leave as much normal meniscal cartilage as possible since this is an important shock-absorbing structure.

Most meniscal tears need to be removed because they involve areas of the tissue that do not have the ability to heal (even if sewn together). On the other hand, if there is a vertical tear at the peripheral rim of the meniscus, which is confined to the zone of meniscal blood supply, it is possible and desirable to repair the meniscus. A repair allows the entire meniscus to be saved and retained, whereas removing a peripheral tear would require resection of a very large portion of the meniscus. The key to a successful repair is that the meniscus must be able to heal itself; the repair serves only as a means of securely holding the tissue together long enough for this process to occur.

Post-Operative Treatment

Appropriate protection of the repaired meniscus is required since even the most secure repair will tear through the meniscal tissue if it is loaded too soon. The role of the repair is only to hold the meniscus together long enough that it can heal firmly.