Meniscectomy vs Meniscal Repair
What is a Meniscus?
The meniscus is a shock-absorbing pad of cartilage in the knee that lubricates, supports and protects the bones in the knee joint. There are two menisci in the knee, one on the inner edge and the other on the outer edge of the knee. They function to stabilize the knee, equally distribute one’s weight on the knee bones for balance, and allow for smooth movement in many directions.
What is a Meniscus tear?
A Meniscus tear is when there is a tear or damage to this particular type of cartilage. A tear can lead to catching and locking of the knee during movement. In addition, the forces in a knee joint may be altered and lead to arthritis.
Types of Meniscus tears
- Acute/traumatic tears due to injury. Traumatic tears may be large or unstable which can cause ongoing discomfort if not fixed. Unstable tears include radial tears, flap tears and bucket handle tears.
- Degenerative tears are caused by wear and tear over time. These tears may result in pain, which eventually improves or disappears, allowing one to return to an active lifestyle without the need for surgery.
Meniscus tears most often result from an athletic injury and/or aging, which causes the cartilage to dry out and become brittle. Tears are usually a direct result of twisting or over flexing the knee joint. A tear can also result from heavy lifting.
A popping sound may be heard when the meniscus is torn. Depending on the type of tear, its size and location, a patient may be able to walk but have pain when seated or going up or down stairs. Many athletes continue to play with a meniscus tear, only realizing the injury when the knee stiffens and swells.
If the tear is large, the knee may buckle. If it is minor, one may feel a small degree of pain that dissipates within a few weeks. A moderate tear may make the knee feel stiff. If a piece of the meniscus becomes loose and moves around inside the knee, it can cause the knee to slip, pop or lock.
More specific symptoms include:
- Knee pain
- Swelling and stiffness
- Limited motion
- A sensation that the knee is giving way
- A sense of the knee catching or locking, which means the knee is unstable.
During your consultation with orthopedic surgeon Dr. Walter Thomas, you will discuss your symptoms and medical history. During the physical exam, Dr. Thomas will check for tenderness, which helps diagnose a tear. The McMurray test is often used to diagnose meniscus tears. During this test Dr. Thomas will bend and straighten the knee, and rotate it. If a tear exists, these movements will cause a clicking sound.
Imaging tests may be ordered to confirm the diagnosis since the symptoms of a meniscus tear are also symptoms of other common knee problems. X-rays can show other causes of knee pain, while an MRI will show soft tissue damage and can confirm the diagnosis.
Treatment depends on the type of tear, its size and location.
Tears that are small and on the outer edge of the meniscus may heal on their own.
The initial use of the RICE treatment method is effective for many meniscus tears. The RICE method consists of: Rest, Ice, Compression, and Elevation. Aspirin and NSAIDs will also help reduce pain.
If the symptoms resolve and the knee is stable, nonsurgical treatment may be sufficient. However, if symptoms persist, injection therapy is another treatment option. Injection therapy consists of a cortisone injection to reduce inflammation. Injection therapy may be especially helpful for degenerative tears in arthritic patients.
If symptoms persist after the aforementioned treatments, arthroscopic surgery may be the most effective option.
This is a commonly performed procedure to repair a tear, trim and remove the torn and loose pieces in the joint, or remove the entire meniscus.
Meniscus repair is a delicate surgery that sutures the tear and anchors the meniscus in place. Recovery from this procedure is longer than in a meniscectomy. Often a meniscus tear occurs with an injury to the ACL ligament. In this case, the surgery will repair the ligament and the meniscus.
A meniscectomy is an arthroscopic procedure that removes the meniscus or trims the damaged meniscus tissue (also called a debridement). Removal of the entire meniscus is called a total meniscectomy. Removal of damaged parts is called a partial meniscectomy.
In arthroscopic surgery a small, thin tube that contains a camera is inserted into the knee joint to examine and repair the meniscus. Small tools are inserted into small incisions for repair. This less invasive surgery will limit damage from the procedure, and help promote complete recovery. It is usually done in an out-patient surgery center under general or local anesthesia. Physical therapy will be recommended. Most patients are able to fully recover and return to normal activity within 2-4 weeks.
In Thousand Oaks, California, Dr. Walter A. Thomas offers patients the most comprehensive orthopedic care available. Our state-of-the-art facilities and dedicated staff are here to serve the north Los Angeles, CA community.