Tuesday, April 12, 2016
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.