Meniscus Repair Surgery for Torn Knee Cartilage

Surgery is one of the options that is sometimes considered for the treatment of a meniscus tear. A meniscal tear is an injury of the meniscus—a strong, supportive, and flexible tissue in your knee, and it can often be treated non-operatively.

Non-surgical treatments for meniscus tear may include:

• Physical therapy
• Strengthening exercises
• Anti-inflammatory medications
• Cortisone injections

Why Meniscus Repair Surgery Is Needed

Surgical treatments include meniscectomy (partial or complete removal of the meniscus) or a repair of the tear.

Meniscus tears that cause mechanical symptoms tend to respond well to surgical treatment. A mechanical symptom is caused by the torn meniscus physically impeding the normal movement of the knee.

Common mechanical symptoms include:

• Locking of the knee (unable to bend)
• Inability to fully straighten the knee
• A popping or clicking sound or sensation

These injuries are surgically treated either with a partial meniscectomy or a meniscus repair to place the edges together with sutures or tacks.

Meniscectomy

When the entire meniscus is surgically removed, the results are usually very good. But, over time, the cartilage on the ends of the bone may wear away. This is thought to be due to a loss of cushioning and the diminished stability of the knee joint that occurs after a meniscus is removed.

A partial meniscectomy, which is partial meniscus removal, is usually done with a minimally invasive arthroscopic surgery. A partial meniscectomy is the removal of only the torn segment of the meniscus. This works very well over the short and long-term if the meniscus tear is relatively small. But for some large meniscus tears, a sufficient portion of the meniscus is removed and problems can again creep up down the road.

Is Meniscus Repair Better?

Your surgeon may offer a meniscus repair as a possible treatment option. Studies suggest that if a meniscus repair is possible, the long-term outcome is better because of a decreased risk of arthritis later in life. But not every meniscus tear can be surgically repaired.

Nutrients provided by blood flow are necessary for healing. The meniscus is a circular piece of cartilage with blood supply coming from its outer rim. This rim is the red-white region of the meniscus because it has a vascular and a non-vascular portion.

Healing differs by location of the tear:

• In order for the meniscus repair to heal, the tear must be near the outer edge in an area of good blood supply.
• Tears in the central portion of the meniscus will not heal after a meniscus repair because this part of the meniscus does not have a good blood supply.

Tears in the white-white non-vascular zone of the meniscus are not typically repaired because the lack of blood supply doesn't promote healing. When surgery is done for a central tear, the torn tissue has to be removed.

During the Surgery

A repair involves reapproximating the torn edges of the meniscus to allow them to heal in their proper position so they won't get caught in the knee or cause mechanical symptoms.

Techniques of meniscus repair include:

• Arthroscopic placement of tacks
• Suturing the torn edges

Postoperative rehabilitation is an important part of healing after a meniscus repair.

If the meniscus repair doesn't heal, which happens 20 to 40% of the time, a second surgery may be necessary to remove the re-torn meniscus.

Rehab After Repair

Rehabilitation following meniscus repair surgery is more extensive than rehabilitation after a partial meniscectomy. Because you have to allow your torn meniscus to heal, certain activities must be restricted to avoid placing excessive pressure on your healing meniscus.

In particular, deep flexion (bending) of the knee must be avoided because movement places pressure on the repaired meniscus. A brace can be placed for several months following your procedure to prevent this type of motion.