Meniscal Repair Protocols

You have four menisci in your body, two in each knee joint. They form two c-shaped cushions between the thigh bone and the shin bone in your knee. Since the menisci absorb forces during exercise, sudden stops and pivoting turns may cause meniscal tears. Also, age-related degeneration of the meniscal fibrocartilage makes it prone to tearing during simple movements as you age.

Meniscal Evaluation

• Because your four menisci act as shock absorbers in your knees, torn or degraded menisci will allow contact between the bones within your joint. When bone moves against bone, the cartilage is damaged and you may develop osteoarthritis in your knee. An injured meniscus causes knee instability and persistent pain. Diagnosis can be made by a doctor with a complete history, a physical exam and other diagnostic tests. If it is determined that meniscal repair is an option for you, it can be done surgically as an open joint surgery, or arthroscopically through small incisions with a microscope.

Open Repair

• If the back of your medial meniscus is torn at least 5 mm, the surgeon will likely perform an open repair. Your medial meniscus lies on the inside region of your knees, where your knees touch between your legs. An evaluation of the size and quality of the tear is made with an arthroscope prior to surgery. When surgery is necessary, this type of tear is hard to reach surgically. Therefore, an incision to open the entire joint is required to ensure easy visualization and repair.

Arthroscopic Inside-Out Repair

• An inside-out repair method can be used on tears in either your medial or lateral menisci. Your lateral menisci lie on the outside sides of your knees. A surgeon uses this method to place sutures inside the tear within your knee to an area on the outside of the joint capsule. The sutures are placed at various angles and locations, depending on the tear. Because suture positioning places a needle from inside the joint to outside the joint, this method has higher potential for nerve injury.

Arthroscopic Outside-In Repair

• Outside-in meniscal repair occurs opposite of inside-out repair. This method is used on frontal tears in both your lateral and medial menisci. It has the advantage of placing sutures outside the joint to inside the joint, thus avoiding possible nerve damage. Its disadvantage is a less precise placement of sutures into your torn meniscus.

Arthroscopic All-Inside Repair

• Currently, all-inside meniscal repair is the most popular method. It avoids most other repair complications and has the shortest recovery time. This method is the most challenging to the surgeon because the entire repair is done within the small space of an enclosed joint. Improvements to this technique have introduced suture anchors to replace suture knots, thus eliminating complications due to the restrictive space during tying methods.

Alternatives

• Non-surgical repair allows your own body's repair mechanisms to take over. Many times, if a tear length is less than 3 mm or if the tear is too far away from the blood supply, surgery is not recommended. Sometimes, the meniscal damage is so complete that it cannot be repaired but has to be removed. Because cartilage damage is assured after removing the meniscal cushioning, meniscal implants or knee replacement surgery become the final options.