Running repairs: when to mend a meniscal tear and when not

meniscal tearThere’s been a fascinating debate in Orthopedics Today about the thorny problem of how to treat a meniscal tear, and the conversation – conducted by a five experts in the field – is something worth commentating on.

Before we get into it, a brief overview. The meniscus is a rubbery, crescent-shaped disc, and their job is to cushion the stress that your knees endure as you walk or run, and help steady the knee by balancing the weight you put on it. Each knee has two of them: one at the outer edge of the knee, and one at the inner edge.

A meniscal tear can be caused by many factors: it can happen when you twist or turn your knee, usually when the foot is planted while the knee is bent. It can happen when you lift a heavy item, or during the rigours or sports participation. Sometimes, amongst older people, it happens while you’re going about your day-to-day routine, as your menisci start to wear over time.

Meniscal tear: one ailment, many symptoms

The symptoms of a meniscus tear can vary depending on the severity of the ailment. A minor tear results in slight pain and swelling, which lasts for a couple of weeks. A moderate tear causes worse pain and swelling, along with knee stiffness and difficulty in bending, but the symptoms will go away and reoccur if the knee is left untreated. A severe tear can result in pieces of the meniscus getting caught in the joint space, leading to the knee locking and catching. Furthermore, the knee can give way without warning on occasion.

To sum up, then, it’s a particularly problematic ailment for a very important part of the knee. As the debate points out, however, making a diagnosis is tricky. Unless it’s a severe tear, the typical symptoms – locking, catching and giving way – aren’t happening. It’s also difficult to pin down what the patient actually did in order to cause the tear, especially when that patient is over 40, overweight, or both.

Meniscal tear: to treat or not to treat?

So why the debate over whether to treat the ailment or not? Because, according to the report; “there is no evidence to support that repairing (degenerative) medial meniscal root tears, knee degeneration will be postponed or stopped”. Past the age of 40, the tears in the menisci tend to be a failure of the cartilage – that is to say, a fragmentation of the cartilage due to repeated trauma. In the case of younger people, the tear is essentially healthy cartilage torn by a single trauma episode. These are more likely to be able to repaired, whereas the failed cartilage is only amenable to being trimmed back to healthy tissue.

It’s worth bearing in mind that meniscal root repairs are a relatively uncommon specific type of tear of the cartilage – the main damage in that area will more usually stem from a tear of the body of the meniscus.

As with any injury to the knee, surgery is not always the automatic option. Knee specialist Mr Jonathan Webb will always take into account the nature of your injury and your personal circumstances and expectations and then advise you on whether surgery is the best solution.