Best Treatment For Meniscal TearsTreatment of meniscal tears has changed over the years. It was once thought that the meniscus wasn't really important. The cartilage was removed if it developed a tear. Now surgeons try to save as much of the tissue as possible.
The operation has also changed from an open incision to arthroscopic repair. Arthroscopic repair or partial meniscectomy is now defined as today's standard of care.
In this article, the authors reviewed past studies done on arthroscopic repair of meniscal tears. The goal was to find trends in results. Factors linked with good and bad results were of particular interest. Each study was evaluated for proper research and statistical methods.
Results of their analysis showed that the type of patient (age, sex) wasn't strongly linked with results. The type of tear is far more important to the final outcome. For example, flap tears take longer to heal compared with bucket handle tears. Athletes with flap tears return to sports much slower than those with other types of tears.
It doesn't seem to matter which side of the joint the meniscus is torn on. There was no difference in results for medial (side closest to the other knee) versus lateral (outside half of knee) meniscal tears. The natural anatomical knee alignment and angle may improve the results for some patients.
Measures used to determine results can also yield differences in outcomes. X-rays may show a good outcome but patient satisfaction may be low. And the results of the surgeon's findings after the operation may not match up with the patient's symptoms. In other words, exam results can be considered normal when patients are having significant pain or loss of motion.
Overall, arthroscopic partial meniscectomy is a successful procedure for both medial and lateral tears of the meniscus. The results are better if less than half the meniscus is removed. Patients with both a torn anterior cruciate ligament (ACL) and a torn meniscus have the worst results.
These results are based on studies extending as far as 15 years after the surgery. Researchers will continue to follow these patients for 20 years or more to see the long-term effects.
Peter D. Fabricant, and Peter Jokl, MD. Surgical Outcomes After Arthroscopic Partial Meniscectomy. In Journal of the American Academy of Orthopaedic Surgeons. November 2007. Vol. 15. No. 11. Pp. 647-653.
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