The meniscus is a vital part of the knee. It acts as a shock absorber between the femur (thigh bone) and Tibia (shin bone). It helps spread the load when an impact or force goes through the knee. It also helps in stability and nutrition of the knee. There are 2 menisci on each side of the knee. The medial and the lateral meniscus. They are semi-circular in shape.
We know from many studies that the more meniscus that is damaged or removed in surgery the more likely a patient is to develop arthritis in the knee at a later date.
It is therefore very important that the meniscus is repaired and not removed with surgery whenever possible. A specialist knee surgeon will be well versed in the technique of meniscal repair whereas some more generalist surgeons will only be able to remove part of a torn meniscus.
When a meniscus is repaired the edges of the tear have to be opposed. In some tears the meniscus has stretched and this is not possible or the meniscus is too damaged for repair. The meniscus is repaired by placing stitches across it to hold it in place whilst it heals. This is performed via an arthroscopy (key hole surgery), usually performed as a day case procedure. In order for the repair to be successful in the long term the meniscus has to heal itself. The ability of the meniscus to heal is dependent on several factors:
- How long the tear has been present. The sooner after the injury it is repaired the better.
- The age of the patient. Younger the better
- The position of the tear. The repair needs a blood supply, the closer the tear is to the attachment to the lining of the joint the better.
- Stability of the knee. The knee needs to be stable so any ligament injuries need to be repaired to enhance the healing.
After the surgery the knee is usually protected in a hinged brace that allows some bending of the knee. This is worn for between 6 and 12 weeks following the surgery. Usually the patient is able to put weight through the leg but will usually require crutches for 6 weeks. The exact regime will be dependent on the stability of the repair and will be individualized by the surgeon. The meniscus usually takes at least 3 months to heal so full sporting activity will not be resumed until 4 months from surgery at the earliest.
Unfortunately not all repaired menisci heal and they go on to cause further problems. In this situation the torn part of the meniscus usually has to be removed in a further arthroscopy.