Meniscus Tear
Treatments

Doctors base their treatment recommendations on a variety of factors: the type of meniscus tear, the size and location of the tear, the joint's stability and the knee's overall condition, as well as the patient's age and physical activity goals. Often, particularly with degenerative tears, physical therapy, bracing, ice applications, anti-inflammatory medications and various types of injections are enough to relieve symptoms, improve function and allow a safe return to activity over time.

Surgery is generally recommended for mechanical or structural meniscus tears that could compromise the protective and stabilizing effects of the meniscus. A minimally invasive procedure called an arthroscopy allows the surgeon to see inside your knee by passing fine instruments, including a tiny camera, through small incisions on the front of your knee. If indicated, the surgeon can perform either a meniscus repair to restore its shape and function or a meniscectomy to remove the damaged section of the meniscus (when repair isn't possible).

Meniscus repair

A repair attempts to restore the natural shape of the meniscus and preserve the tissue, so it can perform its normal function of protecting the knee joint. Surgeons can suture the torn parts together with a variety of possible devices. The procedure requires an extended rehabilitation period, with use of crutches and a brace, as well as physical therapy. Not all meniscus tears will heal when repaired, and some patients need a second surgery.

Post-operative protocols depend on the type of tear, the surgical techniques utilized and other factors specific to your situation. Generally, though, patients wear a brace for two to six weeks and need crutches for part or all of that time. Physical therapy exercises are commonly prescribed to restore mobility and strength. The majority of patients return to near-normal active lifestyles after surgery and completion of physical therapy.

Meniscectomy

A meniscectomy, or meniscus debridement, is permanent removal of the damaged tissue and thus does not preserve the normal shape or volume of the meniscus. In general, a meniscectomy is associated with decent short-term symptom improvement and a relatively rapid recovery from surgery, but also possibly with an increased potential for accelerated arthritis and a higher risk of eventually needing a knee replacement. In select cases, meniscectomy does provide good longer-term results.

The post-op plan with a meniscectomy is generally shorter and simpler than for meniscus repair. Patients can put weight on their leg immediately after surgery and often just need crutches to help with balance. Physical therapy will be prescribed to restore knee motion and strength. Most patients will be fully recovered two to three months after surgery.

For these reasons, the more common procedure at this time is a meniscectomy. But under the right circumstances, meniscus repair can still be a good choice, especially since repair techniques and outcomes are continuing to improve.

Deciding between meniscus repair and removal

In many cases, the best choice is clear from your medical history, physical exam and imaging tests. However, in some cases, the repair-versus-removal decision has to be made by the surgeon during the operation, when the nature and extent of the tear can be evaluated directly. If this is your situation, your surgeon will discuss both options – including the likelihood of each – with you in advance.

Repairing the meniscus rather than removing any part of it has obvious advantages, which is why most surgeons prefer it. Meniscus tissue, however, is somewhat unpredictable in its healing due to its variable blood supply and the forces it experiences in the knee, which is why repair failure rates remain fairly high (10 percent to 30 percent, depending on the tear). Also, meniscus repair surgery takes longer and is more expensive than a meniscectomy, and the post-op regimen is considerably longer and more difficult.