Meniscus Injury Treatment Options
The tear type, size, and location as well as your age, health, and activity level are all considered when deciding the best treatment for you.
The location of the tear
The meniscus has three zones – the white zone, the red-white zone, and the red zone. The inner portion of the meniscus (white zone) has poor blood supply, which limits the body’s natural healing abilities. Tears in the white zone are generally treated by removing the torn portion (meniscectomy).
30% of the meniscus – the outer edges – has a good blood supply which is essential for the natural healing and repair process. Tears in the red zone may heal with conservative management or can be surgically repaired with confidence that these repairs will heal well.
Small and partial-thickness tears in the red zone of the meniscus may heal on their own with conservative management. Conservative management includes rest, ice, compression, elevation, anti-inflammatory medications, and physical therapy. If the symptoms resolve and the knee is stable, nonsurgical treatment may be sufficient.
If symptoms persist, injections are another treatment option. Injections typically consist of cortisone to reduce inflammation. Injection therapy may be especially helpful for degenerative tears in arthritic patients to relieve pain and symptoms. When symptoms of pain and swelling persist after the conservative treatment and injection therapy, arthroscopic surgery may be the most effective option.
The goal of arthroscopic knee surgery is to preserve the meniscus when possible. Knee arthroscopy is a commonly performed procedure to repair a tear, trim and remove the torn meniscus, remove loose pieces of cartilage in the joint, or even remove the entire meniscus.
In arthroscopic surgery, a small, thin tube containing a camera is inserted into the knee joint to examine the meniscus. Based on what is seen in the joint, Dr. Chahla will then either repair, trim, or remove part of the meniscus. Small tools are also inserted into small incisions for repair or trimming of the meniscus. This minimally invasive surgery limits damage, reduces bleeding, and helps promote a quicker recovery. It is usually performed in an outpatient surgery center under general or local anesthesia. Physical therapy will be recommended. Most patients are able to fully recover and return to normal activity.
Arthroscopic debridement is a procedure performed to remove frayed edges and clean up damaged tissue, including fragments of torn cartilage aimed at relieving pain and improving function. This is typically performed in tears involving the white zone of the meniscus to preserve a smaller healthy meniscus. Arthroscopy for debridement of degenerative meniscal tears can sometimes be indicated when other non-surgical approaches have failed. Recovery for these types of procedures is very short.
Partial or total meniscectomy
Partial or total meniscectomy is the removal of part of or the entire meniscus, respectively. However, complete removal of the meniscus can result in persistent and potentially progressive knee pain due to accelerated arthritis. Patients who do not yet have knee arthritis may consider a meniscus transplant for pain relief, and to delay the onset of arthritis.
Rehabilitation after surgery can restore range of motion. Physical therapy will be recommended to assist with healing and improve function. Crutches can be used to take weight off the operated knee. Patients can return to daily activities in a week, and sports within two months.
Arthroscopic meniscus repair
Arthroscopic meniscus repair is performed by suturing together the torn edges of the meniscus. This procedure is a good option to preserve the meniscus. This can be done depending on the state of your cartilage and underlying arthritis rather than on your age. If you are still active and willing to have the repair and then undergo rehabilitation, you should strongly consider it.
There are many different types of meniscus repairs. In the all-inside technique, the surgeon sutures the meniscus without having to make additional incisions. However, when large tears are identified, an inside out technique is usually utilized.
The inside-out technique places sutures into the meniscus by passing needles from inside the joint to outside the joint, and tying the sutures through an incision on the medial or lateral aspect of the joint. This technique is considered the gold standard because many more sutures can be used, it can be used to repair complex tears with a high rate of success. Its downside is that it does require additional incisions (which is a small price to pay to save one’s meniscus), and the surgeon must have knowledgeable assistants to be able to help pass the needles and tie the sutures.
Another less common technique is to make a small incision in the front of the knee and pass sutures from outside the knee to inside the knee. This technique is called the outside-in technique. This is especially important for repairing tears in the front of the meniscus where an inside-out or all-inside meniscus repair technique cannot be used.
Isolated meniscus repairs (meaning there are no other injuries such as an ACL tear) commonly require patients to be non–weight bearing for up to six weeks and to avoid any significant stress on the knee like squatting, lifting, or sitting cross-legged for several months. This is to protect the meniscus and allow it to heal after it has been repaired. When you have a meniscus tear with an ACL reconstruction, the drilling of the tunnels of the reconstruction releases many of your body’s healing growth factors and stem cells from the bone, and often you can start bearing weight right away. The exception would be complex meniscus tears, such as a root repair or radial repair of the meniscus. In these circumstances, the meniscus repair is still quite fragile, and one needs to be non–weight-bearing for up to six weeks. In meniscal root tears, the meniscus is detached from the bone and floats around the knee. This is equivalent to not having a meniscus, so it’s crucial to repair this type of tear.
Meniscus transplant surgery is the replacement of a damaged meniscus with a donor meniscus. It may be recommended for young, active patients who have previously had their meniscus removed, develop knee pain, and may be too young for a knee replacement. A transplant can relieve pain and prevent knee arthritis in patients who do not already have knee arthritis.