Spontaneous repair of the meniscus, unless the lesion is peripheral, is unlikely to occur. This is because the meniscus is avascular.
Treatment of meniscal tears depends on several factors e.g. - type, location, and size of the tear. Treatment options include:
- conservative treatment without meniscal surgery
- considered initially in all patients regardless of whether surgery is being considered
- RICE (Rest with weight bearing as tolerated or with crutches, Ice, Compression bandaging, Elevation of the affected limb to minimise acute swelling and inflammation) regimen should be followed
- activity modification, NSAID’s (if contraindicated or poorly tolerated consider paracetamol) and physiotherapy should be included in long term management (1)
- complete meniscectomy
- not a common procedure at present
- has been shown to be associated with accelerated cartilage loss and development of osteoarthritis
- partial meniscectomy
- is indicated when meniscal repair is not possible (3)
- only the unstable tissue is removed while preserving as much of the meniscus as possible (especially the outer third)
- causes less damage to the joint when compared with complete menisectomy
- is the preferred treatment method in patients with unstable tears (when primary meniscal repair is not possible) (2)
- meniscal repair
- aim is to maintain meniscal integrity and prevent long-term degenerative changes seen after meniscectomy
- usually carried out in tears in the vascularised outer third of the meniscus (termed the ‘red-red zone’ signifying the area of vascularity) while repair of tears in red-white zone’ (watershed area between vascular and avascular meniscus) is controversial. ‘White-white zone’ (avascular zone) tears are repaired rarely
- techniques include - open repair, arthroscopic inside out repair, arthroscopic outside in repair, arthroscopic all inside repair (3)
- patients are kept on non or partially weight bearing for several weeks
- healing takes around 4 months after which the patients are usually asymptomatic
- a favourable repair outcome is seen in
- surgery done within 8 weeks of injury
- patient age under 30 years
- tear length less than 2.5 cm
- a peripheral tear
- a lateral meniscus tear
- concomitant ACL reconstruction
- meniscal transplant
- could be considered for selected patients who have undergone previous complete or near-complete menisectomy
In the case of bucket-handle tears, excision of the meniscus may be enough to reduce any risk of secondary osteoarthritis.
An important feature of treatment is postoperative physiotherapy.
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