When a torn meniscus won’t heal, surgery may be needed

An orthopedic surgeon explains why you may be better off with a partial meniscectomy rather than trying to fix the tear.

If you’ve been struggling with a stiff and swollen knee that may be difficult to straighten or is sometimes painful when twisting, you may have a torn meniscus.

Your physician can diagnose it and will likely prescribe rest, ice and medication to relieve the pain and allow the injury to heal.

However, some meniscus tears will not heal. In those cases, you may need minimally invasive arthroscopic surgery. The next question will be what kind of surgery.

You don’t have to be an athlete to experience a meniscus tear. The C-shaped discs of cartilage connect your thighbones to your shinbones. They act as shock absorbers and help keep your knees stable.

You can tear a meniscus by kneeling, squatting or lifting. As you get older, the bones and tissues around the knee begin to wear down, increasing the risk of injury.

Meniscus repair or meniscectomy

If your meniscus is torn and simply won’t heal, the question is whether a surgeon should fix it or take part of it out.

“Most meniscus tears are not repairable because of the pattern of the tear. Only the outer third of the meniscus has a blood supply and will heal reliably,” said Joshua J. Christensen, M.D., orthopedic surgeon with Norton Orthopedic Institute.

But if the tear is vertical, more than 10 millimeters long (a little more than three-eighths of an inch) and on that outer part that has a blood supply, Dr. Christensen said he and his colleagues would repair it in a patient under 60 years old who does not have arthritis.

In other cases, the torn portion of the meniscus would be removed in a meniscectomy.

Removing all or part of the damaged knee cartilage is intended to relieve pain and allow the knee to move more freely.

“I do far more partial meniscectomies than repairs. It’s the most common orthopedic surgery,” said Dr. Christensen, who also operates on shoulders.

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Typically, a light general anesthetic is used for meniscus repair or meniscectomy. Spinal block may also be an option if the patient has a strong preference, according to Dr. Christensen.

“Both procedures are arthroscopic, meaning the incisions are small. In each procedure, two incisions are made that together measure 1 centimeter — just large enough to get the scope and instrument in,” Dr. Christensen said. “Meniscus repair has better long-term outcomes, because removing a large portion of the meniscus increases the chance of osteoarthritis several years down the road. Recovery for meniscectomy in patients who don’t have arthritis is four to six weeks including two to three days on crutches.

“Meniscus repair recovery is quite a bit longer because you have to wait for the area to heal,” Dr. Christensen said. “Patients often stay on crutches for six weeks and have to wait three to four months before returning to all previous activities.”

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