Does a Torn Meniscus Require Surgery?
Not all patients with a meniscus tear require surgery. In older adults who have a degenerative meniscus tear, but who are minimally symptomatic, surgery is not recommended. Older adults with moderate to severe knee arthritis often have associated degenerative meniscus tears. In these patients, the arthritis is typically the main source of pain, not the meniscus tear. Given this, surgery is not typically recommended but rather non-surgical treatments can help control the pain and swelling due to the arthritis.
Nonsurgical treatments for a degenerative meniscus tear not needing surgery are:
- Resting the knee and limiting activities for a period of time
- A knee compression sleeve
- Ice therapy
- Anti-inflammatory medications
- Physical therapy for restoring full range of motion, strength, and knee biomechanics.
- Possibly injection therapy
Some older patients with degenerative tears, particularly those with large, displaced flaps of meniscus may come to an arthroscopic surgery even if there is also arthritis in the knee. In surgery, the torn flaps of meniscus that are catching are trimmed away. These flaps will not heal if they were sewn together as there is no blood supply to them. These meniscus flaps are also no longer serving as a shock absorber cartilage in the knee and are simply causing pain. These patients can expect to be fully recovered in 4-6 weeks from surgery.
Younger patients with acute meniscus tears are best treated surgically. Without surgery, the meniscus will not typically heal, and if a patient waits too long, the tear can progress, and the tissue then becomes more complexly torn until it is no longer amenable to repair and instead has to eventually be removed.
The outer third of the meniscus is called “the red zone.” This area has blood supply and the meniscus can heal if sutured together. The inner two thirds of the meniscus is called “the white zone.” This area has no blood supply and will not heal, even if sutured together. For tears in the red zone of the meniscus, Dr Cunningham always recommends meniscus repair, so that the entire meniscus can be preserved with no meniscus being removed. Removing a significant portion of the meniscus in a young person will predispose the patient to developing early arthritis in the knee.
Dr Cunningham performs meniscus repairs arthroscopically. Several small incisions are made around the knee and an arthroscope is introduced. Specialized instruments are used to place sutures across the meniscus in order to hold the tissue together so the meniscus can heal. Following surgery, patients go home the same day. They are placed in a knee brace and for most repairs, they are allowed to fully weight bear on the knee as long as the knee is held straight in a brace. When there no body weight being applied to the knee, the knee can be moved through a full range of motion. Patients are otherwise going to physical therapy. Full recovery following meniscus repair surgery can take 3 – 4 months. Dr. Cunningham is a knee specialist at Vail Summit Orthopaedics and Neurosurgery. He is an expert at diagnosing and treating meniscus tears for patients in Vail, Summit County, Aspen, and Denver, CO. Contact Dr. Cunningham today.