The treatment of a meniscal tear depends on a number of factors. It depends on:
The most worrying symptoms in meniscal injury are locking and giving way of the knee and in any age group these symptoms are usually best addressed with meniscal surgery. If a patient presents only with pain and no symptoms of locking or giving way, then a trial of conservative therapy for at least three months with physiotherapy is first indicated. If pain continues for more than three months then a further discussion would be required around the best form of treatment which may be meniscal surgery.
In the past all meniscal tears were treated with excision of the torn meniscus and this was a perfectly acceptable treatment for all meniscal tears. Through decades of research and biomechanical studies, we now know that preserving this precious tissue is extremely important to protect the joint surfaces within the knee so assessment of the meniscal tear and its potential for repair should always now be considered.
Meniscal repair is carried out on meniscal tears such as peripheral and bucket handle tears and vertical tears where there is a high probability of success of healing of the meniscal tissue. The meniscus can be divided into various zones. There is a red zone, red/white zone and a white zone. The red zone represents the highest vascularity with the highest chance of success of healing of the repair that has been carried out. A white zone repair has the lowest biology and potential for healing but with modern techniques and application of biological therapy as well as repairing the meniscus, the success of white zone tears has also been made possible.
There are various repair techniques that can be employed. There are inside-out repairs, outside-in repairs as well as all-inside meniscal repairs using different types of suture material and hardware.
Arthroscopic meniscectomy is a commonly performed procedure where the torn meniscus is excised or removed or resected using keyhole surgery. This is a tried and tested method of treating meniscal tears that are not repairable. The knee is accessed through small incisions with a camera and instruments and the unstable torn bit of meniscal cartilage is removed under a general anaesthetic. This usually results in a good outcome in terms of pain relief and restoration of function, however the more meniscus that is removed, the higher the risk of osteoarthritis in that part of the knee joint.
There are pros and cons to both of these techniques.
Meniscal repair is a superior form of treating meniscal tears due to the long-term benefit of joint protection in the knee. However, following the meniscal repair, the repair must be protected with protected weight bearing, bracing and crutches and the patient will not be allowed to drive and walk properly for around six weeks following which there is a further six to twelve weeks of rehabilitation associated with meniscal repair.
In contrast the arthroscopic meniscectomy is a smaller procedure and the recovery is usually shorter, around two to six weeks.