I have a torn meniscus in my left knee. I've been to see my orthopedic surgeon who recommended surgery to remove part of the cartilage. But from what I've been reading on-line, it sounds like the current treatment is to preserve (not remove) the meniscus. Is my surgeon steering me in the wrong direction?

The meniscus is a moon or crescent-shaped fibrocartilaginous structure present on both sides of the knee (medial and lateral). Both menisci provide structural integrity and support to the knee when it undergoes tension and torsion. Athletes involved in pivoting, cutting, or sudden changes in direction are most likely to sustain an ACL/medial meniscus tear. This commonly includes soccer and basketball players and skiers.

As you have discovered, treatment of meniscal tears has indeed changed over the years from removal to preservation. Surgeons use arthroscopic methods to check the meniscus for damage. Any frayed edges are smoothed. Holes may be drilled with a tiny meniscus repair needle to stimulate bleeding and speed up recovery. The process of putting holes in the cartilage is called trephination.

The focus today is more on finding the best way to repair this structure. But at the same time, studies show that some menisci have very poor healing potential and may be better removed. The biggest factor in surgical success to preserve the meniscus appears to be location of the meniscal tear.

There are three zones in the meniscus that correspond to blood supply to the area. The outermost zone is the red-red zone. Here there is the greatest amount of blood flow and the best chance for success. The middle zone (between the red-red and white zones) is the red-white zone. The inner zone is called the red-white zone. Healing potential is the poorest for tears in this central zone.

Patients with less than normal meniscal tissue who are active may benefit first from a rehab program to strengthen the muscles around the knee. This approach helps increase knee stability and protect you from future injuries. If this treatment method doesn't resolve your pain and other symptoms, then surgery may be the next step. If the tear cannot be preserved through surgical repair, then it may be necessary to remove the damaged area. Surgeons rarely remove the entire meniscus anymore.