If you are having symptoms which interfere with your ability to work or which have been going on for more than 6-8 weeks, despite rehabilitation with a physiotherapist, a referral to an orthopaedic surgeon is advised.
What operations are done for a meniscal tear?
If the tear causes persistent troublesome symptoms, particularly painful locking, then an operation may be advised - although evidence for the benefit of surgery is variable. Several studies have been done that suggest that surgical treatment for people who have a meniscal tear due to wear and tear (degeneration) is no better than following a standard exercise regime.
Most operations are done by arthroscopy (see below). The types of operations which may be considered include the following:
- The torn meniscus may be able to be repaired and stitched back into place. However, in many cases this is not possible.
- In some cases where repair is not possible, a small portion of the meniscus may be trimmed or cut out to even up the surface.
- Sometimes, the entire meniscus is removed but this is rarely done as long-term results are not good.
- Meniscal transplants have recently been introduced. The missing meniscal cartilage is replaced with donor tissue, which is screened and sterilised much in the same way as for other donor tissues such as for kidney transplants. These are more commonly performed in America than in Europe.
- There is a new operation in which collagen meniscal implants are inserted. The implants are made from a natural substance and allow your cells to grow into it so that the missing meniscal tissue regrows. It is not yet known whether this is any better than other treatments.
What operations are done for damage to the articular cartilage?
The treatment of large injuries or those which cause persistent symptoms is by surgery. Surgery may involve a keyhole operation (arthroscopy - see below) to remove loose bits of cartilage or to transplant cartilage into the damaged area. Another method used to repair damaged knee cartilage is to make tiny holes (called microfractures) in the bone beneath the damaged cartilage. This releases bone marrow into the damaged cartilage. The bone marrow then helps to repair the cartilage. Unfortunately, the newly formed tissue can break down over time and long-term results may be disappointing. You may want to discuss the pros and cons of surgery and the type of surgery with your doctor.
If damaged articular cartilage that is bad enough to cause symptoms is left untreated, this may lead to early osteoarthritis.
What is an arthroscopy?
This is a procedure that allows a surgeon to look inside a joint by using an arthroscope. An arthroscope is like a thin telescope with a light source. It is used to light up and magnify the structures inside a joint. Two or three small (less than 1 cm) cuts are made at the front of the knee. The knee joint is filled up with fluid and the arthroscope is introduced into the knee. Probes and specially designed tiny tools and instruments can then be introduced into the knee through the other small cuts. These instruments are used to cut, trim, take samples (biopsies), grab, etc, inside the joint. Arthroscopy can be used to treat meniscal tears and damaged articular cartilage. There are some risks from arthroscopy. See separate leaflet called Arthroscopy and Arthroscopic Surgery for more details.
Following surgery, you will have physiotherapy to keep the knee joint active (which encourages healing) and to strengthen the surrounding muscles to give support and strength to the knee.
Further reading and references
Englund M, Guermazi A, Gale D, et al; Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008 Sep 11359(11):1108-15.
McDermott ID, Amis AA; The consequences of meniscectomy. J Bone Joint Surg Br. 2006 Dec88(12):1549-56.
Sihvonen R, Paavola M, Malmivaara A, et al; Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013 Dec 26369(26):2515-24. doi: 10.1056/NEJMoa1305189.
Knee pain - assessment; NICE CKS, March 2011 (UK access only)
Bark S, Piontek T, Behrens P, et al; Enhanced microfracture techniques in cartilage knee surgery: Fact or fiction? World J Orthop. 2014 Sep 185(4):444-9. doi: 10.5312/wjo.v5.i4.444. eCollection 2014 Sep 18.
van den Bekerom MP, Struijs PA, Blankevoort L, et al; What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults? J Athl Train. 2012 Jul-Aug47(4):435-43. doi: 10.4085/1062-6050-47.4.14.
Holzer LA, Leithner A, Holzer G; Surgery versus physical therapy for meniscal tear and osteoarthritis. N Engl J Med. 2013 Aug 15369(7):677. doi: 10.1056/NEJMc1307177#SA1.
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