Meniscal tears are surprisingly common. In younger people, they tend to happen during sport: a sudden twist or pivot that puts those cushioning pads of tissue under just too much pressure.
In older people, it’s often due to the natural weakening that comes with age. Estimates suggest as many as 40% of people over 65 may be carrying a cartilage tear of this kind.
So, if it does happen to you – what next? That really depends on a number of factors. Let’s look at some of the options.
Where is the tear?
On a medical diagram, the two crescent-shaped menisci in our knees look like solid white cushions. “Cushion” is a good word, because their main function is to act as shock absorbers. In reality, though, they’re a bit more complex. Each meniscus is actually comprised of two “zones”:
“Red zone” – this is the outer third of the crescent, which has a good supply of blood vessels
“White zone” – this is the inner portion of the meniscus, which lacks a good blood supply
This is important to bear in mind. If the tear is in the red zone, it may be able to heal on its own – thanks to that blood supply. Rest and some conservative care (such as ice treatment and elevation) will encourage that to happen. If the tear is in the white zone, however, it’s unlikely to heal on its own.
What kind of tear is it?
Location isn’t the only factor here. The size of the tear is important (bigger tears are more complicated to treat). And there are several different types. These include horizontal “flap tears”; radial tears (running from the inner to the outer edge); degenerative tears (a worn and frayed meniscus); and “bucket-handle tears” (a portion of tissue pulls away from the meniscus). These aspects – as well as your age and activity levels – will have a bearing on whether we recommend surgery. Also, because of where the meniscus is, assessing tears can be tricky even after scanning. It often has to be done during a keyhole operation, at which point the surgeon will decide how to proceed.
Two types of surgery
So let’s say you were going to have surgery on your meniscus. What would it look like? There are two main options:
Partial meniscectomy – if the tear is small and in the white zone, the surgeon can gently trim away the torn portion of cartilage, leaving the rest of the meniscus in place
Meniscal repair – if the tear is larger or more complicated, and in the red zone, the surgeon can reattach the loose cartilage to the rest of the meniscus using sutures
Both types of surgery can be done arthroscopically (ie with keyhole surgery) and as day cases.
What’s the key difference?
A meniscal repair is more complex. Depending on the tear, it will probably involve placing tiny anchors in the meniscus. These are then linked together using special stitches, which draw the tissues together (this is known as an “all-inside repair”). Then it’s a case of waiting for the body’s healing mechanisms to kick in. While this happens in around 8 out of 10 cases, it’s not guaranteed; sometimes further surgery is required.
A meniscal repair also takes longer to heal than a partial meniscectomy. You may need to wear a knee brace for some weeks afterwards. And you’ll need to avoid bearing weight on the knee for between two and six weeks. You have to be quite careful with the activities you do for the first three months after surgery, too. After that point, though, if the knee responds well, the outlook is very good. Patients are often able to return to the activities they enjoyed before the injury – not just the low-impact sports like cycling and swimming but, all being well, running and contact sports too.
For more on meniscal tears, visit our website…
Learn more about meniscus tears in our Conditions section
Find out how to prepare for an arthroscopy operation
Discover how the different parts of the knee work