Meniscus Repair

Surgery Overview

A meniscus tear is a common injury to the cartilage that stabilizes and cushions the knee joint. The type of the tear can determine whether your tear can be repaired. Radial tears sometimes can be repaired, depending on where they are located. Horizontal, flap, long-standing, and degenerative tears—those caused by years of wear and tear—generally cannot be repaired.

Your doctor will likely suggest the treatment that he or she thinks will work best for you based on the zone where the tear is, the pattern of the tear, and how big it is. Your age, your health, and your activity level may also affect your treatment options. In some cases, the surgeon makes the final decision during surgery, when he or she can see the how strong the meniscus is, where the tear is, and how big the tear is.

  • If you have a small tear at the outer edge of the meniscus (in what doctors call the red zone), you may want to try home treatment. These tears often heal with rest.
  • If you have a moderate to large tear at the outer edge of the meniscus (red zone), you may want to think about surgery. These kinds of tears tend to heal well after surgery.
  • If you have a tear that spreads from the red zone into the inner two-thirds of the meniscus (called the white zone), your decision is harder. Surgery to repair these kinds of tears may not work.
  • If you have a tear in the white zone of the meniscus, repair surgery usually isn't done, because the meniscus may not heal. But partial meniscectomy may be done if torn pieces of meniscus are causing pain and swelling.

Surgical repair may be done by open surgery, in which a small incision is made and the knee is opened up so that the surgeon can see inside the knee and the meniscus can be repaired. Increasingly, surgeons use arthroscopic surgery to repair the meniscus. The surgeon inserts a thin tube (arthroscope) containing a camera and a light through small incisions near the knee and is able to see inside the knee without making a large incision. Surgical instruments can be inserted through other small incisions. The surgeon repairs the meniscus using sutures (stitches) or anchors.

Other knee injuries—most commonly to the anterior cruciate ligament (ACL)—may occur at the same time as a torn meniscus. In these cases, the treatment plan is altered. Typically, your orthopedist will repair your torn meniscus, if needed, at the same time ACL surgery is done. In this case, the ACL rehabilitation plan is followed. To learn more, see the topic Anterior Cruciate Ligament (ACL) Injuries.

What To Expect After Surgery

Your surgeon may recommend that you do not move your knee more than absolutely necessary (immobilization) for 2 weeks after surgery. This may be followed by 2 weeks of limited motion before you are able to resume daily activities. Physical therapy should begin right after surgery. But heavy stresses, such as running and squats, should be postponed for some months. You must follow your doctor's rehabilitation (rehab) plan for optimum healing. Afterwards, you may still continue to have pain and require more physical therapy or, sometimes, additional surgery.

The timetable for returning to walking, driving, and more vigorous activities will depend on your success in rehab.

For some exercises you can do at home (with your doctor's approval), see:

Click here to view an Actionset.Meniscus Tear: Rehabilitation Exercises.

Why It Is Done

How your doctor treats a meniscus tear depends upon the size and location of the tear, your age, your health and activity level, and when the injury occurred. Treatment options include nonsurgical treatment with rest, ice, compression, elevation, and physical therapy; surgical repair; surgical removal of the torn section (partial meniscectomy); and surgical removal of the entire meniscus (total meniscectomy). In general, surgical repair is favored over partial or total meniscectomy. If the meniscus can be repaired successfully, saving the injured meniscus by doing a meniscal repair—rather than partial or total removal—reduces the occurrence of knee-joint degeneration.

Small tears located at the outer edge of the meniscus often heal on their own. Larger tears located toward the center of the meniscus may not heal well, because blood supply to that area is poor. In a young person, surgery to repair the tear may be the first choice, because it may restore function.

How Well It Works

Surgical repair may result in less pain and a return to normal knee function. Also, you may be able to prevent long-term complications (such as osteoarthritis) with successful surgical repair of your tear. The success rate of repair in the red zone is 85%.1

Successful repair of meniscus tears depends to a large degree on where the tear is located. Tears at the outer edge of the meniscus (the red zone) tend to heal well. Blood supply to tears that extend into the center of the meniscus (white zone) is questionable, and surgical repair of a tear in this zone may not heal well.

Risks

Risks of the surgery itself are uncommon but may include:

  • Infection.
  • Damage to nerves or blood vessels around the knee.
  • Blood clots in the leg.
  • Risks due to anesthesia.

What To Think About

If surgical meniscus repair is indicated, the procedure should be done as soon as possible after the injury. But if the tear is in the red zone and you choose to put off a surgery to see if the meniscus tear heals on its own, a later repair may still heal the meniscus properly.

You may be able to prevent long-term complications such as osteoarthritis with successful surgical repair of your tear. Although no long-term studies have proved this, successful meniscus repair may save meniscal cartilage and reduce the stress put on the knee joint, thereby lowering the risk of osteoarthritis.

Complete the surgery information form (PDF)surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

References

Citations

  1. Beynnon BD, et al. (2010). Meniscal injuries. In JC DeLee et al., eds., DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice, 3rd ed., vol. 2, pp. 1596–1623. Philadelphia: Saunders Elsevier.

Credits

By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Specialist Medical Reviewer Patrick J. McMahon, MD - Orthopedic Surgery
Current as of June 4, 2014

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