Should I have surgery for my torn meniscus?

Introduction

This information will help you understand your choices, whether you choose to share in the decision-making process or to rely on your health professional's recommendation.

Key points in making your decision

How you and your health professional treat your meniscus tear, an injury to the cartilage that protects the knee joint, depends on several things, including your health professional's preferences, your age, health, and activity level, and when your injury occurred. Consider the following when making your decision:

The location of the tear in the red and/or white zone of the meniscus is one of the most important factors in deciding whether surgery is indicated and, if so, which procedure is best. See an illustration of the meniscus zones.
- If you have a minor tear at the outer edge of the meniscus (red zone), you may want to choose nonsurgical treatment, because often these tears heal with rest.
- If you have a moderate to large tear at the outer edge of the meniscus (red zone), you may want to consider surgical repair (sewing the edges together), because this zone has a good blood supply, and this kind of tear tends to heal well after surgery.
- If you have a tear that extends from the red zone into the white zone, the decision is more difficult. Surgery repair for these kinds of tears has varying results.
- If you have a tear within the inner two-thirds (white zone) of the meniscus, surgical repair is usually not done because there is insufficient blood supply for healing. When these tears cause symptoms, the torn pieces are usually removed (partial meniscectomy). In rare cases, the entire meniscus is removed (total meniscectomy).
You may be able to prevent long-term complications, such as osteoarthritis, with successful surgical repair of your tear. Although no long-term studies have proven this, health professionals believe that successful meniscus repair helps to evenly distribute the forces on the knee joint. If the knee is protected from uneven force, there is a lower risk of joint degeneration.
The pattern of the tear can determine whether your tear can be repaired. Radial tears sometimes can be repaired, depending on where they are located. Horizontal, flap, long-standing, and degenerative tears—those caused by years of wear and tear—generally cannot be repaired.

Medical Information

What is a meniscus tear?

A meniscus tear is a common knee joint injury. This rubbery tissue acts as a shock absorber between the upper and lower leg bones. Each knee has two C-shaped menisci (plural of meniscus): a lateral meniscus at the outer side of the knee and a medial meniscus at the inner side of the knee. A meniscus tear can limit your knee function.

How is the meniscus injured or torn?

A meniscus tear usually occurs with a twisting or pivoting motion and often with the foot planted and the knee partially flexed (for example, when lifting or playing tennis). Other knee injuries, such as a torn ligament, can happen at the same time. As you age, your meniscus becomes worn and may tear more easily. Meniscus tears are rare in young children.

What are the symptoms of a meniscus tear?

The symptoms of a meniscus tear often vary. In a typical minor tear, there may be pain and slight swelling at first. These symptoms usually go away in 2 to 3 weeks.

In a typical moderate tear, you may feel pain at the side or center of the knee, depending on where the tear is located. Often, you are still able to walk. Swelling increases gradually over 2 to 3 days and may make your knee feel stiff and limit bending. There's often sharp pain with twisting or squatting. These symptoms go away but tend to recur with minor twisting or overuse.

In severe tears, pieces of the torn meniscus can dislocate into the joint space. This can make the knee catch, pop, or lock. You may not be able to straighten your knee. It can also feel "wobbly" or unstable, or give way without warning. The knee may swell and become stiff right after the injury, or over 2 to 3 days.

Older people whose menisci are worn may not be able to think of a specific event that caused the tear or may recall symptoms developing after a minor incident such as rising from a squatting position. Pain and minimal swelling are often the only symptoms.

How will my health professional diagnose a meniscus tear?

Your health professional will do a physical examination of both knees to evaluate tenderness, range of motion, and knee stability. He or she will ask how the injury occurred and whether you have ever had any other knee injuries. X-rays are usually done. Your health professional may suggest that you follow up with an orthopedic surgeon.

How is a meniscus tear treated?

Your treatment decisions depend on your health professional's preference; when the tear occurred; the location of the tear; and your age, health status, and activity level. Treatment options include:

Nonsurgical treatment with rest, ice, compression, elevation, and physical therapy. This may include temporarily wearing a knee brace.
Surgical repair.
Surgical removal of the torn section (meniscectomy). In rare cases, the entire meniscus is removed.

In general, surgical repair is favored over a partial or total removal. If the meniscus can be repaired successfully, saving the injured meniscus by doing a meniscal repair—rather than a partial or total meniscectomy—reduces the occurrence of knee joint degeneration.

Small tears located at the outer edge of the meniscus often heal with rest. Larger tears located toward the center of the meniscus may not heal well because blood supply to that area is poor. In a young person, surgery to repair the tear may be the first choice because it may restore function. See an illustration of common meniscus tears.

Your age and activity level will also determine whether surgery is a good option for you. In a young person, surgery to repair a tear may be the first choice because it has a greater chance of healing and restoring a more normal function to the knee. It is generally believed that there is a poorer potential for healing in older patients, but successful repair of tears in people older than age 50 has been reported.

The most common risks of surgery include infection, a blood clot in the leg, damage to nerves or blood vessels, and the risks of anesthesia.

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