If you’ve ever torn a meniscus – one of the two shock-absorbing pads of cartilage within your knees – you may be familiar with some of the unpleasant symptoms. Stiffness. Swelling. Pain (though not always). Sometimes a “catching” sensation. Perhaps even instability around the joint.
Meniscus tears are pretty common. Younger people tend to suffer them in sport, after a sudden twist or pivot. Older people can be susceptible as their knee tissues weaken with age.
How do you fix a torn meniscus? Well, that really comes down to the type and severity of damage. There are different kinds of tear: horizontal, vertical, anterior, posterior, or all the way around the edge (a so-called “bucket handle” tear).
Minor tears can heal by themselves, so the treatment process may simply be time, rest, painkillers if necessary, and possibly some physiotherapy. More serious tears, however, can require surgery.
Two surgical approaches to meniscal damage
There are two main avenues here. If the tear is relatively small and doesn’t extend into the blood supply around the meniscus, we can aim to trim away the loose fragment of cartilage. This should leave a smoother and less ragged surface. It’s known as a partial meniscectomy, and it can be done as a day case with keyhole surgery (arthroscopy). But if the tear is more complicated – for instance, if it runs into nearby blood vessels – we may recommend a meniscal repair instead. Here the approach involves not removing but reattaching loose cartilage, using medical stitches that remain in the knee after surgery. Meniscal repairs are also performed arthroscopically.
Why it’s best to preserve cartilage
Cartilage is essential for joints. It absorbs impact and reduces friction as the bones move against each other. When it wears away, either by sudden injury or longer-term degeneration, that protection disappears. We call this arthritis, or “bone-on-bone” arthritis if the damage is acute. This problem applies to meniscus operations as well. If the loose fragment is quite small, it’s possible to remove it. But taking away a large chunk of cartilage (or even all of it: a “total meniscectomy”) raises the chance of the knee developing arthritis in time. That’s why preserving the meniscus, where possible, is usually the best course of action.
New technology that’s helping us do that
The good news is that we’ve seen some encouraging advances in meniscus repair recently. Getting access to a tear in order to place the sutures can be tricky, especially if the damage extends to the side or front of the menisci. But new devices have come onto the market to help with that; they curve at almost any angle around the meniscus, and have an inbuilt system for setting the precise penetration of the instrument. That flexibility allows us to fix more of the tiny “anchors”, or “tabs”, which hold the stitches in place. The strength of these fixations has improved too. All these things are helping us to optimise the chance of a successful repair, and thus the chances of a good long-term outcome for the knee after injury. Best of all, they’re protecting natural cartilage wherever we can.
Read on…
- 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
