Deciding When to Repair or Remove a Torn MeniscusIt used to be that torn cartilage (meniscus) in the knee was removed. Doctors know better now. For the past 50 years, researchers have studied the meniscus. We now have a much better idea what this C-shaped piece of cartilage does in the knee. As it turns out, it's very important to the long-term health of the knee. Taking out the meniscus affects the joint's ability to bear loads, hold steady, and absorb shock.
Whenever possible, doctors try to save a torn meniscus. The cartilage is still removed when it's crushed or damaged beyond repair. The surgery to remove a torn meniscus is called a meniscectomy. In this study, doctors at a sports medicine center looked at the results of the worst tears ever repaired. They wanted to see if repair or removal had a better long-term outcome.
The patients studied were young and athletically active. Each patient had at least half of the meniscus torn. Each patient also had a tear of the anterior cruciate ligament (ACL) in the knee. All patients had an ACL reconstruction. The first group also had a meniscal repair. The second group had a meniscectomy. Each patient was followed on a yearly basis for an average of six to eight years.
The rehab program after surgery varied over time, depending on the latest research. For example, in the early 1980s, patients were told to limit how much weight they put on that leg for two to four weeks. In the late 1980s, patients were told to put as much weight on the foot and leg as they could handle. In the 1990s, activity was limited for the first week to keep the swelling down.
The researchers were expecting to see better results in the patients who had a meniscal repair. What they found was no difference between the two groups. When they looked a little closer they also found less patient satisfaction for athletes with degenerative tears. A degenerative tear in the meniscus usually goes in two directions: up and down and from side to side. These types of tears heal but don't seem to work the same after repair. They often tear again.
The authors conclude that degenerative meniscal tears can heal, but they don't always function. The current trend to repair all meniscal tears may need to be restudied. A larger study over a longer period of time is advised to confirm this new finding.
K. Donald Shelbourne, MD, and Donald R. Carr, LCDR, MC, USN. Meniscal Repair Compared with Meniscectomy for Bucket-Handle Medial Meniscal Tears in Anterior Cruciate Ligament-Reconstructed Knees. In The American Journal of Sports Medicine. September/October 2003. Vol. 31. No. 5. Pp. 718-722.
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