Tuesday, February 28, 2017

Does a Torn Meniscus Always Require Surgery?

“I tore my meniscus so I am probably going to need surgery”—it’s a common thought.  But, it’s also a misconception.

Non-operative treatment of meniscus tears exists and can be effective. An orthopedic surgeon’s treatment recommendation depends on a variety of factors.

How to Determine if a Torn Meniscus Can Be Treated Without Surgery

There are three things to look for:

1.     Blood supply. The meniscus is classified into two zones, the red zone and white zone.  A torn meniscus that has sufficient blood supply (red zone) can often heal without surgery. But, a torn meniscus with a poor blood supply (white zone) often requires surgical repair.
2.     Knee stability. If there is no ligament damage and the knee is stable, the tear can often heal and normal function can be maintained.
3.     Symptoms. Patients who suffer a tear but experience little to no symptoms should be treated non-operatively.

Once an orthopedic surgeon has made their diagnosis, a treatment plan can be put into place.

Non-Operative Treatment of a Torn Meniscus

The first step in treatment is to reduce pain and swelling and this only takes a few days. Then, physical therapy is prescribed with the goal being to strengthen the ligaments and muscles of the knee so the joint maintains stability and function. Depending on the severity of injury and symptoms, therapy can be short (2-3 weeks) or long-term (6-8 months).

Surgical Procedures for Meniscus Tears

As mentioned above, the meniscus is divided into the red zone and the white zone.  The type of procedure recommended is based on where the tear has occurred.

A Tear in the Red Zone
The Red Zone is the outer edge of the meniscus that does have some blood supply. Due to this blood supply, the healing potential is usually much greater and the cartilage can become strong and healthy again.

The most common procedure to treat the Red Zone tears is a Meniscus Repair. This procedure involves using a small puncture to access the meniscus. Once the incision is made, a small camera (arthroscope) is inserted into the knee and small surgical tools are used to stitch the meniscus back to its original position.

A Tear in the White Zone
The White Zone is the inner 2/3 of the meniscus that is avascular, meaning it has no direct blood supply. For this reason, tears in this area not stitched back together because they will not heal.

If surgery is needed for a tear in the White Zone, a procedure known as an Arthroscopic Meniscectomy is performed. This procedure involves using a small puncture to access the meniscus. Once the incision is made, a small camera (arthroscope) is inserted into the knee and the torn portions of the meniscus are trimmed. These torn pieces of meniscus have exposed nerve endings and will often cause the pain and inflammation associated with a meniscus tear.

 How to Determine If the Meniscus Has Healed

The meniscus has healed if the knee is stable and 
· No symptoms are present
· An MRI is negative
· An orthopedic surgeon’s physical exam is negative

Once cleared, patients can return to normal activities, including sports.

Contacting an Orthopedic Surgeon

Sometimes, surgery isn't needed, but the only one who can tell is an orthopedic surgeon. Please give us a call to schedule an appointment. One of our specialists will provide you with everything you need to know.

At Advanced Bone and Joint our Orthopedic and Sports Medicine physicians are experts in treating injuries of the bones, joints and soft tissue - including the meniscus.  Contact us today to learn more!

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