Meniscus Tears: Arthroscopic Meniscal Repair
Continuing our look at meniscus tears and the available treatment options, today I will focus on arthroscopic meniscal repair:
Arthroscopic Meniscal Repair
If the meniscus tissue is torn in the peripheral 1/3 where there is blood supply, the meniscus can be repaired and preserved. Repairing the meniscus is always my preference. So called “bucket handle tears” where the meniscus tears longitudinally along the outer rim and then flips into the center of the knee like a bucket handle, are amenable to repair. The alternative to repairing these bucket handle tears is to remove 50% or more of the meniscus. Removing this amount of the meniscus, which is the “shock absorber” cartilage, is known to predispose the knee to early arthritis and this should be avoided if possible.
The gold standard for repairing the meniscus is to pass sutures “inside–out.” While viewing through the arthroscope, sutures are precisely passed through the meniscus and tied over the capsule of the knee joint. There are newer “all inside” meniscal repair devices where sutures don’t have to be passed through a small incision made outside the knee. I use these all inside devices for smaller tears or for hard to reach tears.
The rehabilitation after a meniscal repair is more entailed than after an arthroscopic menisectomy. For a repair, the patient is kept in a knee brace with their knee locked straight whenever up and walking for 6–8 weeks, depending on the size of the tear. However, immediately after surgery, we encourage you to unlock the brace or remove it when sitting down and start gentle knee range of motion exercises. After 6–8 weeks, the brace is discontinued, but no squatting is allowed for up to 12 weeks as this places high shear stresses on the repaired meniscus, and we want to be sure it has been given every opportunity to heal.
Unfortunately, not all meniscus repairs heal despite our best efforts. This is again due to the poor blood supply and compromised healing potential of the meniscus. A MRI is somewhat helpful to see if the meniscus has not healed but more importantly, we look for symptoms of a meniscus which did not heal which are very similar to the symptoms patients had before surgery (catching, locking, well localized pain over the meniscus).