A torn meniscus is a common injury often caused by forcefully twisting or rotating the knee. It can also be a result of degenerative changes in older adults. A meniscus tear typically requires treatment with arthroscopic surgery.
The menisci are C-shaped pieces of tough cartilage that rest on either side of the knee, between the thigh bone and shin bone. They help to distribute body weight across the knee so it can be properly supported by the bones in the leg, and also provide stability to the knee joint. A meniscus tear is common after a traumatic injury, and most frequently occurs when the knee joint is bent and the knee is then twisted. Torn menisci most often occur in athletes and older adults whose cartilage may have worn away.
A torn meniscus causes pain and swelling, and may also be accompanied by a frequently locking joint and the inability to completely straighten the knee. Some people experience a popping or clicking sensation within the knee as well.
Treatment for a meniscus tear often begins with conservative methods such as rest, ice or over-the-counter medication. If these measures are not effective and symptoms continue, patients may benefit from meniscal repair or debridement surgery. A repair procedure, as its name suggests, has a goal of stitching together the tear in the meniscus in order to maintain its functionality. In contrast, a debridement procedure focuses on removing the damaged portion of the meniscus to alleviate symptoms and help the remainder of the meniscus to heal and function optimally. In many cases, the surgeon will not be able to determine which technique is needed until the meniscus is visualized during the surgery.
Meniscal repair is an arthroscopic procedure in which the torn edges of the meniscus are sutured together, which helps the cartilage heal properly. This allows the preservation of the meniscus in its full size, making it a desirable option under the right circumstances. The determination to make a repair to the meniscus will often depend on whether enough of a blood supply is available at the torn area to enable it to heal and function correctly. This may be the case for those patients in their early 20s and younger if the location of the tear has a sufficient vascular network to support the repair.
The meniscal debridement procedure is performed arthroscopically, with tiny surgical instruments inserted through very small incisions. This technique is more commonly used than repair due to the limited blood supply in the meniscus, which makes healing difficult. A debridement procedure involves removing the torn section of the meniscus, resulting in a smaller, but fully healthy, piece of cartilage that remains.
Recovery from meniscal repair surgery generally takes much longer than recovery from debridement. The repair requires additional time to heal, so patients must wear a supportive brace on the affected knee for four to six weeks post surgery to restrict movement. Physical therapy is recommended for several weeks to two months in order to restore flexibility and strength to the knee. Full recovery, including a resumption of athletic pursuits, may take approximately four months.
Following a meniscal debridement procedure, patients typically require the use of an assistive device such as crutches for the first few days to prevent bearing too much weight on the healing leg. Most patients can return to typical daily activities after a week and resume sports activities within two months. Physical therapy may be beneficial as well in promoting healing and helping the knee to regain complete function once again.
Surgery on a torn meniscus is common and considered very safe. However, all forms of surgery carry some risk. The risks typically associated with either a meniscal repair or debridement procedure may include infection, bleeding, injury to the meniscus or ligaments in the knee, formation of a blood clot, nerve or blood vessel damage and stiffness in the knee.