The meniscus is critical for
protecting and cushioning the joint. When the meniscus is torn and unable to be
repaired then a meniscectomy is performed. Meniscectomy means removal of the
torn tissue. When this occurs it increases the risk of arthritis. Even when
performed arthroscopically the risk of developing arthritis in the future
remains high. 50-75% of people that lose a moderate portion of their meniscus
will develop symptomatic arthritis over the next 15 years. Since the meniscus
helps protect the knee from wear and tear, surgeons try to repair the meniscus
whenever possible. However, most meniscus tears are not considered repairable.
Approximately only 10% are reapairable. The meniscus has a limited blood
supply, and tears in areas of little or no blood flow have a high risk of not
healing. The pattern of the tear is also important. It is not always possible
to predict whether a meniscus tear is repairable prior to surgery.
If a meniscus tear is considered
appropriate for an attempt at repair, a number of techniques can be used. The
surgery is primarily arthroscopic (minimally invasive). It can involve small
devices that utilize a technique completely inside the knee or small incisions,
or cuts, may be necessary to perform the repair. A variety of devices or
sutures can be used to perform a repair. If a patient has an ACL reconstruction
at the same time as the repair of the meniscus, there is more blood present in
the knee joint. Other methods can be used to improve the blood supply to a
meniscus repair, for example using a portion of the patient’s own blood with a
technique called platelet rich plasma (PRP).
The physical therapy following
meniscal repair varies depending on a number of factors. Most patients can put
weight on the knee soon after surgery, although a brace may be used. Running is
usually delayed until 3-4 months after surgery while a full return to sports
and squatting typically occurs after 4-6 months. The results are good following
repair. In future blogs we will delve into some of the research we have
performed at Washington University regarding meniscus repair, but in general
90% of repairs last a minimum of 2 years and 75-90% will last 5 years without
retear.
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