Meniscal Repair Versus Removal
Preserving Meniscus Cartilage is Important for Knee Health
Meniscus cartilage is a dense fibrocartilage that is attached to the tibial plateau by coronary ligaments and the joint capsule. Meniscus play an important role in the health of the knee including dissipation of compressive loads from the weight of the body, improved stability, and joint lubrication.
There is a medial and lateral meniscus cartilage located within each knee. The meniscus is constructed thicker on the outside and tapered towards the inside. This thicker outside contributes to stabilizing the femur on the tibia.
Mechanism of Meniscus Injury
Meniscus cartilage can be torn in a number of ways, but the most common is a loading of the meniscus combined with a twisting motion on a planted foot. The tibia is stabilized by the planted foot while the femur continues to rotate tearing a portion of the meniscus. The medial meniscus is the meniscus most commonly torn in sports.
The location and type of tear are important when considering treatment. Mild cases with no associated ligament tears can be managed conservatively through rest, ice, and rehabilitation. Moderate and severe cases need to be assessed for surgical repair.
Historically, meniscus cartilage was removed (partial or total menisectomy) if there was a tear. However, research has revealed that removing the meniscus can lead to degenerative disease within the knee joint including osteoarthritis.
Meniscus Repair Study and Long Term Outcome
Logan, M., Watts, M., Owen, J., & Myers, P. (American Journal of Sports Medicine, June, 2009) reviewed the outcome of 45 meniscus repairs in elite athletes during a five year follow-up. The purpose of their study was to review the medium to long term outcome of repairing meniscus tears that might not traditionally be repaired (but removed) to determine the effectiveness of the repair.
Forty-two athletes underwent 45 arthroscopic meniscus repairs. A large percentage of the athletes (83%) also underwent ACL reconstruction at the same time. Failure was considered patients who had joint line pain, locking, and/or swelling and had to undergo subsequent partial menisectomy (removal of meniscus).
Eighty-one percent of the athletes returned to play within ten months (length due to associated ACL reconstruction). The authors identified 11 failures (10 medial and 1 lateral). However 7 of the 11 failures were associated with a new traumatic injury. Their conclusion was that meniscal repair and healing was possible as evidenced by the high rate of return to play for these elite athletes.
Not All Meniscus Tears can be Repaired
However, as noted in the article by Turman, K., and Diduch, D. (Journal of Knee Surgery, April, 2008), not all patients with meniscus tears are good candidates for repair. Each patient must be assessed on a case-by-case basis. Co-conditions are also a consideration as there has been documentation of better outcomes of meniscus repair with concurrent ACL reconstruction.
The ideal outcome is to preserve as much meniscus as possible when there has been a meniscus tear. Preserving the meniscus can improve overall joint health and reduce the incidence of long term degenerative disease.
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