Meniscus Tear

Treatment Overview

There are many things to consider when deciding how to treat your torn meniscus, including the extent and location of the tear, your pain level, your age and activity level, your doctor's preference, and when the injury occurred. Your treatment choices are:

• Nonsurgical treatment with rest, ice, compression, elevation, and physical therapy. This may include wearing a temporary knee brace.
• Surgical repair to sew the tear together.
• Partial meniscectomy, which is surgery to remove the torn section.
• Total meniscectomy, which is surgery to remove the entire meniscus. This is generally avoided, because this option increases the risk for osteoarthritis in the knee.

Whenever possible, meniscus surgery is done using arthroscopy, rather than through a large cut in the knee.

The location (zone) of the tear is one of the most important factors in determining treatment. See a picture of the meniscus zones .

• Tears at the outer edge of the meniscus (red zone) tend to heal well because there is good blood supply. Minor tears may heal on their own with a brace and a period of rest. If they do not heal or if repair is deemed necessary, the tear can be sewn together using dissolvable stitches. This is successful 90% to 95% of the time in this area.²
• The inner two-thirds (white zone) of the meniscus does not have a good blood supply and therefore does not heal well either on its own or after repair. If torn pieces float into the joint space, which may result in a "locked" knee or cause other symptoms, the torn portion is removed (partial meniscectomy) and the edges of the remaining meniscus are shaved to make the meniscus smooth.
• When the tear extends from the red zone into the white zone, there may be enough blood supply for healing. The tear may be repaired or removed. This is something the orthopedic surgeon decides during the surgery.

Also, the pattern of the tear may determine whether a tear can be repaired. Longitudinal tears are often reparable. Radial tears may be reparable depending on where they are located. Horizontal and flap (oblique) tears are generally not reparable. See a picture of different types of tears .

Another factor when considering treatment is that repairs to the lateral meniscus (on the outer side of knee) typically heal better than repairs to the medial meniscus (on the inner side of the knee). See a picture of the lateral and medial menisci .

It is preferable to preserve as much of the meniscus as possible. If the meniscus can be repaired successfully, saving the injured meniscus by doing a meniscal repair reduces the occurrence of knee joint degeneration compared with partial or total removal (meniscectomy). Meniscus repair is more successful in younger people (experts think people younger than 40 years old do best), in knees that have good stability from the ligaments, if the tear is in the red zone, and if the repair is done within the first few weeks after the injury (acute).³

Meniscal repair may prevent degenerative changes in the knee joint. But it has not been proved conclusively that repairing a tear prevents more long-term problems (such as osteoarthritis) than not repairing a tear. Many doctors believe that a successful meniscus repair lowers the risk of early-onset arthritis because it reduces the stress put on the knee joint.

Orthopedists most often perform meniscus surgery with arthroscopy, a procedure used both to examine and then to repair the inside of a joint by inserting a thin tube (arthroscope) containing a camera and a light through small incisions near the joint. Surgical instruments are inserted through other small incisions near the joint. Some tears require open knee surgery.

Should I have surgery for my torn meniscus?

Rehabilitation varies depending on the injury, the type of surgery, your orthopedic surgeon's preference, and your age, health status, and activity demands. Time periods often vary, although in general, meniscus surgery is usually followed by a period of rest, walking, and selected exercises. After you have full range of motion without pain and your knee strength is back to normal, you can return to your previous activity level.

For some exercises you can do at home (with your doctor's approval), see:

Meniscus tear: Rehabilitation exercises.

Other knee injuries, most commonly to the anterior cruciate ligament (ACL) and/or the medial collateral ligament, may occur at the same time as a meniscus tear. In these cases, the treatment plan is different. Typically, your orthopedist will repair your torn meniscus, if needed, at the same time that ACL surgery is done. In this case, the ACL rehabilitation plan is followed. For more information, see the topic Anterior Cruciate Ligament (ACL) Injuries.

Meniscal transplant is an experimental treatment for meniscal tears. It might be a good option for a meniscus that is already weakened or scarred due to previous injury or treatment. In this surgical procedure, a piece of meniscus cartilage from a donor (allograft) is transplanted into the knee.

To be eligible for meniscal transplantation:⁴

• You should be younger than age 40.
• You have pain and swelling in your knee that has not responded to other treatment.
• You have minimal or no arthritis in your knee joint.
• Your knee is well-aligned, meaning you are not bent outward at the knees (bowlegged) or bent inward at the knees (knock-kneed).

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Author:	Shannon Erstad, MBA/MPH	Last Updated: September 22, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Kenneth J. Koval, MD - Orthopedic Surgery, Orthopedic Trauma
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