Knee Meniscus Surgery

author : AMSSM

comments : 3

I have a torn meniscus and am torn between doing the arthroscopic surgery. I have heard many positive outcomes from folks who had it done. But I am 49 and I wonder if my outcome will be the same.

Member Question

I have a torn meniscus and am torn between doing the arthroscopic surgery on it.  I have heard man positive outcomes from folks who had it done.  But I am 49 and I wonder if my outcome will be the same.  Have you heard of a person my age getting done and doing well afterwards (running etc)?  My knees arent locking, and the pain is not present all the time, only when I run.  Cycling and swimming don't bother it at all.  But it's bothersome to run in pain...and I'm afraid I'm making it worse.

Answer from Chris Nelson, MD
Member AMSSM 

Thanks for the question and it may be hard to say yes or no because it has a lot to do with your specific type of meniscal injury. In each knee you have two “C” shaped menisci. They each function as shock absorbers for your knee, help protect the cartilage covering your tibia and femur that would otherwise be in direct contact with each other and they even help circulate the joint fluid in your knee. The meniscus doesn’t have the greatest blood supply which is what makes it tricky to heal properly after injuring it or repairing it. The outside part of each “C” is closest to the edge of your knee and has the best blood supply. As you go farther towards the center of your knee joint the blood supply gets worse making healing much more difficult. When torn, the meniscus can fold in on itself and cause a lot of pain especially with dynamic weight bearing like running. This is also why you can feel a catch in your knee or the reason you cannot fully extend it. There are several different ways to injure your meniscus such as a degenerative type of tear which is not a great candidate for repair or a bucket handle tear. Since the bucket handle type of tear is near the edge of your meniscus it has a better chance of healing well after repair.

As far as surgical options go the two main possibilities would be to partially remove the injured part of the meniscus (partial meniscectomy) or actually repair the meniscus and try to preserve its function in your knee. We have little blood supply to the meniscus after the age of 16 so this method can be difficult.

Repairing the meniscus gives you a better long term outcome as far getting back to doing what you want to do like running. However this also gives you a higher chance of needing a repeat surgery compared to removing the damaged part of the menisci.

Keep in mind that the meniscus are your cushion in your knee and also when undergoing surgery you are essentially cutting out some of this cushion, predisposing you to possible earlier progression of arthritis. Unless you are having mechanical problems with your knee – locking, catching, instability I would keep my own meniscus, and avoid surgery. I would be more likely to recommend you see a surgeon if you are having these mechanical symptoms because you could have a flap that is flipped up and tearing further and that would cause further damage. However, if you have no mechanical symptoms you would be better to do physical therapy and strengthen your knee.

To rehab a meniscus tear I would focus on your biking and swimming for now and gradually return to running as the pain diminishes.  Start with strengthening your gluteus muscles and core muscles. My favorite recommended exercises are side leg lifts, mule kicks and fire hydrants. This will help with your knee mechanics and ultimately cause less pain.

I would recommend you talk with your doctor about what type of tear you have and whether surgery seems like a good option based on your type of tear. But keep in mind if you are not having mechanical symptoms non-operative treatment is likely the best option for you.

Chris Nelson, MD
Oregon Health Science University

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date: December 7, 2012