Meniscus Repair For Root Tears Is Most Economical

A cost effectiveness study of meniscus repair, meniscectomy, or nonoperative management for a meniscus root tear in a 55 year old person without arthritis showed repair with the lowest longitudinal costs. This approach decreased knee replacement needs long term. Read details HERE

Meniscus Repair in the Setting of a Revision ACL Reconstruction: ISAKOS Presentation Shanghai

Revision ACL Reconstruction Predictors of Outcome: Meniscus and Cartilage

Adrian Peterson Returns From Meniscus Repair: What is the Likelihood of Success?

Adrian Peterson, the outstanding running back for the Vikings is returning from what was apparently a meniscus repair.
While many people think they undergo meniscus repair the most common treatment for meniscus injuries is to trim out the torn portion. Only in ~10% can you actually stitch the meniscus together. We have researched meniscus repair results extensively in my Sports Medicine practice and have found that when indicated the results can be excellent. In our minimum 5 year results for all inside arthroscopic meniscus repair we found that 88% were still intact at 5 years when meniscus repair was the only procedure. If combined with an ACL reconstruction the results were slightly worse with a success of 82% at 5 years. To read more detail find the study HERE

 Torn meniscus requiring trimming on the left and a meniscus undergoing all-inside arthroscopic repair on the right

Meniscal and Chondral Predictors of ACL Revision Reconstruction Outcomes

Revision ACL reconstruction is known to result in worse outcomes. Meniscus and cartilage damage may contribute to these worse outcomes. With the MARS (Multi-center ACL Revision Study) Group we looked 1215 revision ACL reconstructions to analyze the impact of meniscus and articular cartilage damage on patient results We found that a previous lateral meniscectomy and femoral groove/trochlear groove cartilage damage most strongly contributed to worse patient outcomes. Read further details HERE

Patient Expectations Regarding Meniscus Injuries and Treatments

In a recently published study we anlyzed patient expectations and knowledge regarding meniscus injuries and treatments. Patients that had previously undergone meniscus treatment were much more knowledgable regarding meniscus issues. Only 28% of patients understood that meniscus resection is actually more common than repair. The most common concern regarding meniscus treatment was the risk of arthritis. You can read further details HERE

Frequently MRI Not Needed for Diagnosing Knee Conditions

In this study performed at Washington University we found that screening x-rays frequently prevented the need for ordering the more expensive MRI. When patients showed up with MRIs already obtained they frequently did not add any needed information. This is especially true when arthritis was noted on the x-ray. Read a synopsis and further details HERE

Meniscus Repair 2

The role of the meniscus in cushioning the joint and protecting the articular cartilage makes preserving them a key part of knee health. For a meniscus tear unfortunately meniscectomy (removing the torn portion) is the appropriate treatment 90% of the time. This is because in most situations a repair will not be successful. The reasons repair is not attempted is due to the lack of blood supply in 1/3-1/2 of the meniscus that precludes healing of a repair. Additionally, if the configuration of the tear is not appropriate then repair is not possible. In the 10% of situations when repair is possible it is typically highly successful in the short term with > 90% success without reoperation within the first 2 years. Our ability to predict ahead of time whether or not repair will be possible has been evaluated. In a study performed in conjunction with my partners and published in  the American Journal of Sports medicine we found we were able to predict the chance to repair a meniscus 74% of the time. This makes it easier to tell patients what to expect after surgery regarding recovery and rehabilitation. Read the Abstract HERE.

We evaluated the MOON meniscus repair results at 2 years in a study published in the American Journal of Sports Medicine and found that in 82 tears of which we were able to obtain follow up on 77 (94%) there was a success rate of 96% with no further surgery required for the meniscus within the first 2 years following repair in 74 of the 77 repairs. Read the full study HERE. In future blogs I will discuss the longer results we have noted at 5 years or more following meniscus repair.

Meniscus Repair

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.

Meniscus Tears

The meniscus is the soft rubbery bumper cushion that sits between the thigh bone and the leg bone. There are two menisci in the knee; a medial (inside) and a lateral (outside) meniscus. These structures act as shock absorbers that decrease the stress seen by the articular cartilage found on the end of the thigh bone and leg bone. Meniscus injuries are quite common and occur in patients of all ages. Arthroscopic surgical treatment of a meniscus injury is the most common orthopaedic surgical procedure done in this country. An injury can occur as a result of squatting, turning or twisting during almost any activity.

Once the meniscus is torn, symptoms like locking, clicking, and catching may occur. In addition, patients will frequently notice swelling in the knee. The pain will be localized along the joint line on the inside or the outside of the knee depending on the tear. The diagnosis is made based upon a history and physical exam and frequently special tests. X-rays are usually normal. If there is some question regarding the diagnosis, an MRI can be obtained to confirm a tear. Most tears remain symptomatic and will ultimately require treatment if they interfere with activities of daily living or sports and recreation activities.

90% of the time, the appropriate treatment is arthroscopy to remove the torn fragments rather than

repair. Often the meniscus cannot be repaired due to the lack of blood supply, which prevents healing factors from getting to the area of injury even when repaired by stitches. Arthroscopic meniscal debridement is one of the most common procedures performed in orthopedics. It is typically very successful in decreasing symptoms and allowing patients to return to their normal activities. The fact that the patient has torn the meniscus increases their risk of arthritis over the next 15 to 20 years. Removing the torn fragments does not increase this risk, but merely decreases the symptoms from the tear.

Recovery from an arthroscopy to remove the torn meniscus is relatively short. It is a minimally invasive outpatient surgery with typically 2 to 3 small puncture wounds to perform the surgery. The patient will typically be weight bearing as tolerated, but he/she may need to use crutches for a few days following the surgery. Swelling typically improves during the first week. Patients with sedentary jobs can return within one to two days. More physical laborers may take longer to recover. Patients typically return to sports or exercise by 4 to 6 weeks following a short period of physical therapy. Future blogs will describe meniscus repair and review the research we are currently involved with at Washington University Sports Medicine regarding meniscus repair.