What is the meniscus and what purpose does it serve?
“The meniscus is a fibrocartilaginous structure in your knee. It acts to distribute force across the knee and is involved in nutrition of the knee. It has many functions that we likely don’t even recognize, but the meniscus is a material that distributes force and creates some level of stability in the knee.”
What are common ways the meniscus is torn?
“In younger people, a meniscus tear is typically an acute event or a traumatic event. A loading situation where you plant your foot on the ground and twist on your knee – that is typically one of the ways that you can tear your meniscus. Hyperflexion is another way. I’ve taken care of kids in the past who turn their meniscus wrestling when their knee is deeply bent and under force, that’s certainly a way that a meniscus can tear. In older patients though, it doesn’t take that kind of force to tear the meniscus. The meniscus is not well vascularized, so it doesn’t really have a capacity to heal itself, at least not one that we recognize. So, I tell people in my age group that if your meniscus tears, it’s an accumulation of events. It’s a lifetime of stress that can come in the form of bending down to get a can of soup out of a kitchen drawer or working in the garden after having your knee bent all day. Those are the types of mechanisms that we see. Typically, in younger people – injuries are more traumatic. In an older person they are less traumatic.”
How do you go about determining to remove or repair a torn meniscus?
“In a younger person, every effort is made to try and repair the meniscus. We do think that maintaining meniscal material helps decrease a younger patient’s risk of developing arthritis. I would say most meniscus tears in young people are repaired. As you get older, the meniscus really doesn’t maintain the level of vigor that you would expect a material to maintain as you get older. It tends to get beat up a little bit. I give the analogy that if you’ve got a magazine material that’s very tough and thick, it’s very tough to tear that that magazine. But as time goes on if you were to crinkle that magazine up a thousand times and then attempt to tear it, it becomes much easier. In older people, the material just doesn’t hold up. It doesn’t have the capacity to heal. As you get older, the preference would actually be to remove the meniscal material when it’s torn and symptomatic but maintain as much normal meniscal material as possible to help distribute force throughout the life of the patient.”
How is a meniscus tear repaired surgically?
“Typically, what we do is use an arthroscopic technique that allows us to suture the sides of the torn pieces together. The meniscus in a younger person does have a blood supply – but as you get peripherally out towards the edge of the meniscus, the blood supply is more robust. Attempts are made to maintain that level of bleeding or create some bleeding in the torn area, and then place sutures across that area with the hope that the bleeding in that area can provide immature cells that ultimately mature into fibroblasts, cells and tissue that allows the two sides to heal back together.”
How long does it take for a meniscus tear to heal?
“In a younger person, a meniscus tear takes a while to heal because we are looking for the sides to heal together. So, there’s a period of time where we limit activity. There’s a period of time where we limit range of motion and then slowly, but progressively, introduce more activity. In an older person that has had a meniscectomy (where we just resect the torn tissue), the recovery is much quicker. We would typically say that someone has a surgery, let’s say on a Monday or Tuesday – return to work is a day or two after the surgery in most instances (depending on the job), but usually people are feeling pretty well two to three weeks after the procedure. Again, in that setting, we’re not asking for the meniscal material to heal back together. We’ve resected the torn pieces and we’re just looking for the skin to heal after we’ve made an incision to do the surgery.”