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Meniscus Repair
The meniscus is the soft rubbery bumper cushion that sits between the thigh bone and the leg bone. There are two menisci in the knee; a medial (inside) and a lateral (outside) meniscus. These structures act as shock absorbers that decrease the stress seen by the articular cartilage found on the end of the thigh bone and leg bone. Meniscus injuries are quite common and occur in patients of all ages. An injury can occur as a result of squatting, turning or twisting during almost any activity. Once the meniscus is torn, symptoms like locking, clicking, and catching may occur due to the torn fragment. In addition, patients will frequently notice swelling in the knee. The pain will be localized along the joint line on the inside or the outside of the knee depending on the tear. The diagnosis is made based upon a history and physical exam and frequently special tests. X-rays are often normal. If there is some question regarding the diagnosis and MRI can be obtained to confirm a tear. Most tears remain symptomatic and will ultimately require treatment if they interfere with activities of daily living or sports and recreation activities. Click here to view a video and learn more about meniscus tears.
Since the meniscus helps protect the knee from wear and tear, surgeons try to repair the meniscus whenever possible. However, most meniscus tears are not considered repairable. The meniscus has a limited blood supply, and tears in areas of little or no blood flow have a high risk of not healing. The pattern of the tear is also important. It is not always possible to predict whether a meniscus tear is repairable prior to surgery.
If a meniscus tear is considered appropriate for an attempt at repair, a number of techniques can be used. The surgery is primarily arthroscopic (minimally invasive) although additional small incisions, or cuts, may be necessary to perform the repair. A variety of devices or sutures can be used to perform a repair. If a patient has an ACL reconstruction at the same time as the repair of the meniscus, there is more blood present in the knee joint. As a result, the success rates of meniscus repair are higher when an ACL reconstruction is performed at the same time. Other methods can be used to improve the blood supply to a meniscus repair, for example using a portion of the patient’s own blood with a technique called platelet rich plasma (PRP).
The physical therapy following meniscal repair varies depending on a number of factors. Most patients can put weight on the knee soon after surgery, although a brace may be used. Running is usually delayed until 3-4 months after surgery while a full return to sports and squatting typically occurs after 4-6 months.