Indications for Surgery Surgery is indicated for people who have symptomatic tears of the meniscus. Meniscal tears can cause pain in the knee as well as mechanical symptoms including locking, catching, intermittent sharp pains, and sometimes even giving way.
Only the outer 10 to 30 percent of the meniscus has a blood supply that is required to allow tissues to heal. Because of this limited blood supply and limited ability to heal and repair itself, the meniscus tends to develop degenerative tears (from “wear and tear”) over time. The majority of meniscal tears are generally degenerative but sometimes a single injury can suddenly extend a developing tear, causing it to become symptomatic (painful). Unfortunately, because of the instability (movement) of the torn fragment of the meniscus and its limited blood supply, meniscal tears generally do not heal or regenerate themselves. Also, because of this limited blood supply and the fact that a majority of tears are degenerative in nature (beat- up” without clean edges that can be sewn together), most meniscal tears cannot be repaired and require an arthroscopic partial menisectomy (removal of the torn and damaged portion of the meniscus) to relieve symptoms. A small number of meniscal tears that occur after an injury (especially an ACL injury) are simple vertical (clean) tears in the outer area of the meniscus which has a good blood supply. This type of tear may heal if surgically repaired (sewn back together). Meniscus repairs are performed arthroscopically (using a small camera that allows Dr. Chudik to look inside the knee through small incisions), but often requires a small open incision to protect nerves and blood vessels around the knee as the needles and suture are passed through the tissues to repair the meniscus.
The success of meniscus repair (healing of the tear) is significantly higher in stable knees with an intact anterior cruciate ligament (ACL). Thus, it is advisable to reconstruct an ACL tear in patients with combined ACL tear and a reparable meniscus tear to increase the chances for the meniscus to heal. The age of the patient appears to have little effect on the healing rate of a repair.
Because the meniscus is a part of the weight-bearing surface of the knee joint, a meniscus tear often represents an early but significant sign that the knee is wearing and tearing. It is often one of the first steps in the development of arthritis, the clinical scenario when the weight- bearing surface of the joint (cartilage and meniscus) is worn out and causing pain, swelling and stiffness. The meniscus is important to help distribute forces across the knee joint. Injury or loss of functioning meniscus (whether removed or not) is associated with increased loading of the…