Meniscus Repair & Debridement

Meniscus repair involves sewing the torn pieces of cartilage back together. It is generally preferred for young, active individuals and when the tear is in the “red zone,” the most peripheral area of the meniscus which has good blood supply to enhance healing potential. The goal of repairing the meniscus is to preserve knee function and reduce the risk of developing osteoarthritis in the future. Importantly, not all tears are suitable for repair due to poor blood supply in more central areas of the meniscus.

Meniscus repair is indicated in situations where the torn meniscus can be sewn back together to preserve as much of the meniscus and its function as possible. The decision to proceed with meniscus repair depends on several factors, including:

1. Location of the tear: The meniscus is divided into different zones based on blood supply. The outer or peripheral area, known as the “red-red zone”, has a good blood supply and therefore has a better capacity for healing. Tears in this area are more likely to be repaired. In contrast, the inner two-thirds, known as the “red-white” and “white-white” zones has a poorer blood supply, making successful repair less likely.
2. Type of tear: Certain types of tears are more amenable to repair. These include longitudinal, bucket-handle, root, and certain radial tears. Complex, degenerative, or horizontal tears may not be suitable for repair.
3. Age and activity level of the patient: Younger patients and those with a high activity level are more likely to benefit from meniscus repair. This is due to the better healing capabilities and the desire to preserve knee function and reduce the risk of osteoarthritis in the future.
4. Symptoms and duration of the tear: Acute or recent tears are more likely to be able to be repaired than chronic or longstanding tears.
5. Post-operative rehabilitation: Meniscus repair requires a more extensive rehabilitation protocol than meniscectomy. Patients must be willing and able to adhere to post-operative restrictions such as several weeks on crutches and use of a brace, and engage in several months of physical therapy to ensure the success of the repair.

Meniscus debridement, also known as meniscectomy, involves the removal of the damaged portion of the meniscus. This procedure is typically recommended when the tear is not repairable, often due to its location in the red-white or white-white zone with poor meniscus blood supply or the pattern of the tear. Debridement can relieve pain and improve knee function.

Meniscectomy involves removing the smallest possible amount of meniscus necessary to relieve symptoms. Arthroscopic tools are used to trim the torn portion of the meniscus.

Meniscectomy is best for patients who do not already have knee osteoarthritis.

Debridement is indicated when repair is not feasible or likely to be successful. Indications for meniscectomy include:

1. Location of the tear: Torn meniscal segments located in the “red-white” or “white-white” zone, which has poorer blood supply, may not heal well even if repaired. In such cases, a meniscectomy may be indicated to alleviate symptoms.
2. Type of tear: Certain types of meniscal tears, such as complex, degenerative, or horizontal tears, are not amenable to repair due to their shape, size, and the quality of the meniscal tissue.
3. Chronic tears: Longstanding tears or tears deemed unlikely to heal even with repair might necessitate meniscectomy to relieve symptoms.
4. Patient symptoms and quality of life: For patients experiencing significant pain, swelling, and functional impairment that does not improve with non-surgical treatments (e.g., physical therapy, medication, activity modification), meniscectomy may be indicated to improve quality of life, alleviate symptoms, and allow return to activity.
5. Age and activity level of the patient: Depending on the individual patient, sometimes older patients or those with lower activity levels might be more likely to undergo meniscectomy rather than repair, especially if the tear is degenerative in nature.