Meniscal Repair versus Menisectomy for Traumatic Knee Injuries

June 23, 2015 | Blog

Injuries to the meniscus are very common. While many with meniscal tears can be treated nonoperatively, some do require surgery. The two common options include meniscal repair or meniscectomy.

The menisci serve a vital role in allowing compressive loads to be dissipated across the knee while reducing the forces on articular cartilage. The outer 20-30% of the medial meniscus and the outer 10-25% of the lateral meniscus are considered the vascular zones. The other areas of the menisci are considered avascular and are nourished by synovial fluid diffusion. An understanding of the blood supply to the menisci are the key to the healing tears. When a tear occurs to the meniscus, it can be described as a horizontal, vertical or a combination type tear. Tears along the avascular region of the meniscus are usually not amendable to meniscal repair, as blood supply is required for healing.

Upwards of 700,000 meniscal surgeries are performed in the U.S. annually. When a meniscectomy is performed, meniscal tissue is excised. The more tissue that is excised, the greater the loss of contact surface area which leads to greater stress within the knee. This can lead to loss of articular cartilage and eventual osteophyte formation. A successful meniscal repair is able to preserve the structure and load capabilities of the meniscus within the knee. A meniscal repair can be considered when the tear is located along the outer one third border of the meniscus, the patient has good tissue quality, is relatively healthy, is active, and the treating surgeon is experienced in meniscal repair.

A study by Stein et al who evaluated eighty-one patients with an isolated medial meniscal tear and underwent either meniscectomy or repair showed that over 80% of those who had a meniscal repair had no significant osteoarthritic progress after nearly 9 years. This is compared to only 40% of those who underwent a meniscectomy. A systematic literature review performed by Paxton et al also concluded that meniscal repairs have better long term outcomes. Less radiologic degeneration was seen versus partial meniscectomy. Meniscal repairs are associated with a longer return to activity versus meniscectomy. Additionally a meniscus repair should be performed within the first 2 months following injury to maximize healing.

References: Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jager A. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial menisectomy for traumatic meniscal tears. American Journal of Sports Medicine. 2010 Aug; 38(8): 1542-1548. Paxton ES, tock MV, Brophy RH. Meniscal repair versus partial menisectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy. 2011 Sept; 27(9): 1275-1288.

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