What exactly is a meniscus tear? Does it always have to be fixed?

Meniscal injuries are among the most common sports injuries. The meniscus is a cartilage shock absorber that cushions the knee and is susceptible to injury especially as an athlete ages.

Patients often complain of a twisting injury that leads to swelling, pain, and locking. Degenerative meniscal tears (elderly patients) tend to lead to swelling, while large, displaced tears tend to lead to locking. The patients often also have a ligamentous injury such as the ACL. X-rays are important in ruling out arthritis, while the MRI is the most useful test in verifying a meniscal injury.

Treatment includes a wide spectrum of options including non-operative treatment, partial menisectomy, and meniscal repair. This depends on patient age, activity level, duration of symptoms, type of meniscal tear, and associated ligament pathology. Not all meniscal tears cause symptoms and, therefore, not all tears require surgical treatment. Short, longitudinal tears may spontaneously heal and may be observed. Degenerative tears associated with arthritis may become asymptomatic and require no further treatment.

However, there are several situations where surgery is recommended. Patients who have symptoms for longer than 6 weeks usually will not improve and undergo surgery. Young patients, athletes, or laborers who are not able to return to work or sport undergo early surgical treatment. Patients with locked knees (inability to straighten) usually undergo urgent surgical treatment. Finally, knees with associated ligamentous injuries (e.g. an ACL tear in a high school athlete) will have the meniscus addressed at the time of ligamentous repair/reconstruction.

The basic tenet of surgery is to save as much meniscus as possible and repair only tears in the peripheral, vascular region of the meniscus. The majority of meniscal tears are not reparable and are simply debrided. The results are good to excellent in the majority of patients undergoing surgery for this condition. The one exception is patients noted to have arthritic changes at the time of surgery, as the arthritis will generally progress and continue to be symptomatic.