There’s no mistaking the negative effects a tear in the knee’s meniscus – the C-shape of cartilage cushioning the space between the thighbone and shinbone – can wreak on patients’ daily lives. But a swirl of myths surround surgery to repair or remove the meniscus, can blur patients’ ability to decide whether this treatment may be right for them, says orthopaedic surgeon Kevin D. Plancher, MD, founder of Plancher Orthopaedics & Sports Medicine.
More than 400,000 surgeries to remove or repair a torn meniscus took place in the United States between 2005 and 2011, according to a 2013 study in the American Journal of Sports Medicine. Meniscus tears are common for good reason: There’s double the opportunity to injure the meniscus, since two such cartilage pads are located in each knee joint, Dr. Plancher says. Tears stem from several causes, including sports injuries involving squatting and twisting motions, such as a football tackle or sudden basketball pivot; trauma such as car crashes; excess body weight, which strains the entire knee; and aging, which weakens and thins knee cartilage over decades due to less lubrication in the knee.
Symptom severity ranges from patient to patient, but typical signs of a torn meniscus include pain, stiffness or swelling in the knee that gradually worsens over days. Some patients feel a slipping or “popping” sensation in the knee, notes Dr. Plancher, also a Clinical Professor in Orthopaedics at Albert Einstein College of Medicine in New York.
Conservative treatments are almost always tried first after a meniscus tear — including rest, ice, compression or physical therapy – but if a patient doesn’t experience symptom or pain improvement or can’t straighten the knee, surgery may be considered to either repair or remove part of the meniscus.
Tips on Truth vs. Fiction about Meniscus Surgery
In addition to normal concerns about surgery, those facing a meniscus operation often aren’t privy to correct information about the surgery itself and whether meniscus repair or removal is advised. Dr. Plancher, who lectures globally on issues related to orthopaedic procedures and sports injury management, offers these myths and facts about meniscus surgery:
Myth: The surgeon always knows before meniscus surgery whether the meniscus needs to be repaired.
Fact: Sometimes surgeons must visualize the inner knee at the start of the procedure before a final determination can be made whether repair is possible or a piece of the meniscus must be removed. Among other factors, the decision is also based on the patient’s age, activity level and overall health along with where the meniscus tear is located, its size and pattern. Saving the meniscus is important and when possible should be performed.
Myth: Removing the entire meniscus is always preferable to leaving any piece behind.
Fact: The lack of any meniscus tissue to cushion the knee joint may eventually lead to degenerative arthritis in the knee, which may necessitate an artificial knee joint down the road. So whenever possible – and especially in younger patients – preserving and if possible repairing the meniscus is preferable to removing it completely. In fact, studies have demonstrated that the more meniscal tissue removed from the knee, the more likely you will be to develop knee osteoarthritis.
Myth: Meniscus repair surgery involves large incisions.
Fact: In the past, larger incisions were needed during meniscus surgery. Advances in surgical equipment now enable tiny incisions or small poke holes to be used. Surgeons insert tools and a camera through these slits to either repair the meniscus or trim away damaged areas, a procedure lasting about an hour.
Myth: Failure rates for meniscus repair surgery are high.
Fact: 2013 research in the American Journal of Sports Medicine notes that many prior studies suggested between 20% and 40% of meniscus tears repaired surgically later re-tear with higher re-tear rates in medial (or the inside of your knee) versus lateral (or the outside of your knee) meniscal repair. But the 2013 research indicated those numbers were inflated, with less than 10% of meniscus patients experiencing a re-tear. Patient selection and the pre- and postoperative rehab program is essential.
Myth: Meniscus surgery will require patients to keep the knee immobilized for an extended period.
Fact: After the same-day procedure, patients can bear weight on the knee within a day or two but must wear a brace to keep the leg straight for 4 weeks. Physical therapy exercises are begun within days and the patient must bend the knee to 90º to avoid any long-term stiffness. While meniscus repair surgery generally takes longer to recover from because some of the meniscus has been preferred, this is still a more optimal result. Most patients that undergo meniscus repair will fully recover within about 6 weeks after wearing a knee brace and/or using crutches during that period. Patients with a small portion of their meniscus removed can expect to recover in 5 weeks.
Fact: All patients who require meniscus surgery must insist upon a plain, standing x-ray even if they have an MRI to avoid worsening symptoms.
Kevin D. Plancher, MD, is a board-certified orthopaedic surgeon and the founder of Plancher Orthopaedics & Sports Medicine. Plancher Orthopaedics & Sports Medicine is a group of fellowship-trained surgeons with expertise in knee, hip, and shoulder arthroplasty, sports medicine, hand and microvascular surgery, foot and ankle and cartilage specialty procedures. Offices are located in NYC and Greenwich, CT with office hours 6 days a week.