Frayed or Torn Meniscus: When Surgery May Be Necessary

The meniscus is a c-shaped piece of cartilage that's attached to the knee joint from the shinbone and cushions your joint. Meniscus tears are a common knee condition, especially as we age. There are a number of treatments for a torn meniscus, but often people hear that the only cure is surgery. Here's how the pain from a meniscus tear can improve on its own, and when surgery may be needed.

A man with a knee injury
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The Truth About Meniscus Tears

Not all meniscus tears require surgery. That said, very few meniscus tears will heal completely without surgery. It's important to understand that not all meniscus tears cause symptoms, and even if a meniscus tear occurs, the symptoms may subside without surgery. In fact, many people have meniscus tears and never even know it.

Degenerative Meniscus Tears vs. Normal Meniscus Tears

As we age, the strength of our tissue changes. Just as skin gets wrinkles and hairs turn gray, a meniscus changes over time and gets weaker and more brittle. When people over 40 sustain a torn meniscus, the meniscus tissue tends to be less healthy and less likely to heal, with or without surgery.

When meniscus tears occur due to age, they are called degenerative meniscus tears and symptoms typically occur without significant injury. The meniscus tissue shows signs of age and can look frayed. Trying to surgically repair this type of meniscus tear is like trying to sew together frayed fabric – the tissue simply won't hold together.

On the other hand, younger, healthier meniscus tissue, seen in people in their teens and 20s, tends to tear more cleanly and often occurs as a result of an injury. The tissue is rubbery and strong, and when it tears, it tends to do so without the frayed edges. It also tends to tear in a single line rather than in multiple directions. These types of tears may be responsive to surgical repair.

Tear Location Matters

Even though the meniscus tissue is healthy in younger people, a tear still may not have the ability to heal if it's along the inner edge of the meniscus. This is because the blood supply to the meniscus at its outer attachment is good, but little blood gets to the inner edge. Tears that extend into this area of the meniscus have a poor ability to heal, with or without surgery.

Stability of a Meniscus Tear

The last important factor to determine if a meniscus tear becomes symptomatic is if the tear is stable. A partial tear of the meniscus, meaning it doesn't go all the way through the meniscus, is stable. A deeper tear that extends all the way through the meniscus is unstable, and even if there is healthy tissue and a good blood supply, it may be unable to heal. Unstable tears tend to pull apart or cause symptoms before any significant healing occurs.

Surgery can be used to stabilize some meniscus tears. If the torn meniscus is healthy tissue with a good blood supply, then surgery to stabilize the tear may allow for healing.

When Surgery Is Necessary

In order for a meniscus tear to heal, it must have the following attributes:

  • Healthy tissue
  • Good blood supply
  • Stability

If you are having surgery for a symptomatic torn meniscus, a repair is generally necessary only if the tear is unstable, you have healthy meniscus tissue, and the tear is in an area of good blood supply. Your healthcare provider will also take into account your age, your activity level, and any other health issues you may have.

During surgery, if the tear isn't a good candidate for repair, your healthcare provider may remove the torn portion of the meniscus, called a partial meniscectomy.

When Surgery Is a Last Resort

Many people have meniscus tears that will improve without surgery. Often, a degenerative meniscus tear will have symptoms that subside over time and never require surgery. Research has also shown that older patients respond well to physical therapy as the first line of treatment for symptoms related to a meniscus tear.

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Article Sources
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