Torn Meniscus: Remove or Repair?

Is repairing a torn meniscus better than just removing it? Doctors at the Shelbourne Clinic in Indianapolis reviewed 91 cases treated between 1982 and 1995 to find out. They were looking for the best treatment for an unstable bucket-handle meniscal tear.

A bucket-handle tear is the most common injury to the meniscus. The cartilage tears in a crescent-moon shape, like a bucket handle. The inner part of the cartilage often dislocates. It shifts into the notch where the knee ligaments cross each other.

This type of tear used to be treated by taking the entire meniscus out. But studies show that damage to the knee joint can occur when the meniscus is gone. Finding a way to repair rather than remove the cartilage is the new focus of research.

This study only included patients with a tear on the lateral side (outer edge) of the meniscus. The lateral meniscus isn't attached as tightly as the medial (inner) meniscus. This means it moves and shifts easier during joint motion. The lateral meniscus is also larger than the medial meniscus. These factors make tear patterns and healing different for lateral meniscus tears.

In this group all 91 patients had a torn anterior cruciate ligament (ACL) and a torn lateral meniscus. All ACLs were repaired. Of all the patients, 67 had the meniscus repaired, while 24 had the meniscus removed. Everyone had the same rehab program after the operation.

Results showed no difference between the two groups in swelling, stability, or activity level. The group who had the meniscus removed had more pain than the repair group. The authors think this difference may be an early sign of joint damage. X-rays won't show any changes until years later.

Reference: 

K. Donald Shelbourne, MD, and Michael D. Dersam, MD. Comparison of Partial Meniscectomy Versus Meniscus Repair for Bucket-Handle Lateral Meniscus Tears in Anterior Cruciate Ligament Reconstructed Knees. In Arthroscopy. July/August 2004. Vol. 20. No. 6. Pp. 581-585.

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