New Evidence Supports Meniscal Repair in People Who Are 40-SomethingOver 40 with a meniscus tear in your knee? Nowadays, doctors will probably choose to repair--rather than remove--your injured tissue. Repair is now possible even when the tear is in the avascular zone, the part of the meniscus without blood supply. In the past, doctors hesitated to do repairs in the avascular zone, for fear that lack of blood would keep it from healing.
The meniscus is a crescent-shaped piece of cartilage in the knee. The meniscus acts like a shock absorber to help spread out the forces that press on the knee joint. Without a meniscus, the forces are concentrated onto a smaller area. The meniscus is very important to the long-term health of the knee. Doctors have become aware that surgically removing the meniscus can lead to early arthritis in the knee joint.
This study was designed to test the long-term affect of surgically repairing the avascular zone of the meniscus in a group of 30 patients who were 40 years and older. Rehabilitation treatments after the surgery proceeded cautiously. Patients started out with treatments to help get the knee moving again, but only in a limited zone of movement. They had to wait up to six weeks to work the full amount of knee bend. They were also limited for up to six weeks in the amount of weight they could bear when walking. To further protect the repaired meniscus, they were not allowed to squat down for four months and had to wait at least six months before running, jumping, or twisting the knee.
Researchers followed up on all but one of the patients an average of 33 months after surgery. Six patients needed additional arthroscopic knee surgery for various reasons, so the researchers were able to actually look at the repaired meniscus with the arthroscope. All patients filled out surveys about their sports, work, and general activities, their symptoms, and how they felt about their knee's recovery.
Fears about poor surgical results in the avascular zone appear to have been unfounded. An astounding 87% of the repairs were symptom-free at follow-up. And 76% of the patients reported that their overall knee condition was "normal to very good." The authors attribute this success to new advances in knee surgery and the precautions taken during rehabilitation.
Frank R. Noyes, MD, and Sue D. Barber-Westin, BS. Arthroscopic Repair of Meniscus Tears Extending Into the Avascular Zone With or Without Anterior Cruciate Ligament Reconstruction in Patients 40 Years of Age and Older. In Arthroscopy. November/December 2000. Vol. 26. No. 8. Pp. 822-829.
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