MENISCUS TEAR SURGERY: REPAIR VS. DEBRIDEMENT

The meniscus is a c-shaped piece of cartilage that acts as a shock absorber in the knee. Each knee has two menisci, the lateral (outer) and the medial (inside). When the meniscus tears, surgery is normally needed to relieve the pain, swelling, instability, and locking that most patients experience. There are two options for meniscus tear surgery: removing the torn piece of meniscus (debridement), and stitching the torn piece back together (repair).

Debridement

Because most of the meniscus has a poor blood supply and does not heal well, removing the torn piece by debridement is most commonly performed. Removing the torn, unhealthy meniscus generally relieves patient symptoms. Patients are sometimes concerned about their ability to function with less meniscus; while it is true that a smaller meniscus slightly raises the risk of developing osteoarthritis later in life, patients must remember that the torn piece is not able to effectively cushion the knee joint anyways, and keeping it will only prolong painful symptoms.

Repair

Because it is ideal to keep and preserve the entire meniscus, a meniscus tear repair is preferable when possible. For children, teens, and patients in their early twenties, the meniscus may have enough blood supply to heal. The reparability of the meniscus ultimately depends on vascularity of the tear location; tears that occur near the ends of the c-shaped meniscus have more blood supply and are better equipped to heal. When deciding if a tear should be repaired or cut out, a surgeon will consider the patient’s age and tear location, but the ultimate decision will most likely be made when the surgeon sees the actual tear during surgery, and can best judge its ability to heal. If the surgeon chooses to repair the meniscus, stitches will be placed arthroscopically to hold the tear together for healing.

Recovery Comparison

Meniscus tears that are cut out through debridement have a much shorter recovery time than those that are repaired with stitches. Patients use crutches for 1-2 days, and are able to return to their everyday activities within one week. At one month the average patient is 80% back to their pre-tear activities and sports, and 90-95% at two months. Physical therapy can also be used if a patient desires.

In contrast, a repair requires a longer recovery time because the meniscus needs time to heal back together. Patients wear a brace for 4-6 weeks to limit movement and flexion in order to protect the repair. Rehabilitation and physical therapy take an additional 6-8 weeks, and most patients return to sports activities at 4 months.

Los Angeles orthopedic surgeon Dr. Eric Millstein has extensive experience fixing all types meniscus tears. If you are suffering from a meniscus tear and want to discuss your surgical options, schedule a consultation with orthopedic surgeon Dr. Eric Millstein at (310) 595-1030.