Should I have a meniscal repair or a meniscectomy?

Meniscal tears are generally treated with non-operative treatment or surgery. If non-operative treatment is unsuccessful or not appropriate, the torn meniscus can either be sutured back together (repair) or the torn part can be removed (meniscectomy). The best option for a given patient depends on many factors including the type of tear, the quality of the meniscal tissue, the patient’s age, and associated knee injuries. If the entire meniscus is removed, early arthritic changes are typically noted at 15 years on average, but symptoms can occur earlier in rare cases or much later in others.

The meniscus is well vascularized (good blood supply) at its periphery, while the inner aspect of the meniscus has limited blood supply. Therefore, tears at the periphery have a higher chance of healing if repaired while tears at the inner aspect are very unlikely to heal if sutured. Fortunately, tears at the inner aspect generally require little meniscal removal, while the peripheral tears that would require a lot of tissue to be removed have a greater capacity for healing with repair. The tissue quality is an important factor because during surgery it can become obvious that the tissue is too poor for repair, or that the tissue quality is excellent and repair should be undertaken. Often this can be predicted based on the MRI, but the definitive decision is made at the time of surgery when the meniscus itself can be evaluated.

Younger patients have better healing rates and also have more years ahead of them, so repair is especially desirable in the setting of a younger person. The lateral meniscus has a better vascularity than the medial, so repairs of the lateral meniscus heal better in general.

Lastly, associated injuries have an impact on the treatment decision making. Meniscal tears have higher healing rates in patients who have ACL reconstruction at the same time. This may be because the ACL reconstruction leads to increased blood within the knee and therefore improved healing. Another factor may be that meniscal tears that occur with ACL injuries involve normal meniscal tissue that tears because of trauma, rather than a degenerative meniscus that tears due to poor quality tissue which will also have poor healing capacity.

The decision to perform meniscal repair or meniscectomy is ultimately an intra-operative decision made by the surgeon based on the variables described above.

Click here to see Dr. Marx discuss the meniscal tear of Derrick Rose, the star basketball player for the Chicago Bulls, in an article for the New York Times.

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