Frayed or Torn Meniscus: When Surgery May Be Necessary

Your meniscus may be able to heal itself

Knee injury. yenwen/ GettyImages

The meniscus is a c-shaped piece of cartilage that's attached to the knee joint from the shinbone and cushions your joint. Meniscus tears are a common knee condition, especially as we age. There are a number of treatments for a torn meniscus, but often people hear that the only cure is surgery. Here's how the meniscus heals and when surgery may be needed.

The Truth About Meniscus Tears

Not all meniscus tears require surgery.

That said, very few meniscus tears will heal completely without surgery. It's important to understand that not all meniscus tears cause symptoms, and even if a meniscus tear occurs, the symptoms may subside without surgery. In fact, many people have meniscus tears and never even know it.

Degenerative Meniscus Tears vs. Normal Meniscus Tears

As we age, the strength of our tissue changes. Just as skin gets wrinkles and hairs turn gray, a meniscus changes over time and gets stiffer and weaker. When people in their forties, fifties, and older sustain a torn meniscus, the meniscus tissue tends to be less healthy and less likely to heal, with or without surgery.

When meniscus tears occur due to age, they are called degenerative meniscus tears and they look frayed. The meniscus tissue shows signs of age. Trying to surgically repair this type of meniscus tear is like trying to sew together frayed fabric—the tissue simply won't hold together.

On the other hand, younger, healthier meniscus tissue, seen in people in their teens and 20s, tends to tear more cleanly. The tissue is rubbery and strong, and when it tears, it tends to do so without the frayed edges. It also tends to tear in a single line rather than in multiple directions. These types of tears may be responsive to a surgical repair.

Tear Location Matters

Even though the meniscus tissue is healthy in younger people, a tear still may not have the ability to heal if it's in the center of the meniscus. This is because the blood supply to the outer edge of the meniscus is good, but little blood gets to the central part. Tears that extend into the center of the meniscus have a poor ability to heal, with or without surgery.

Stability of a Meniscus Tear

The last important factor to determine if a meniscus tear can heal is if the tear is stable. A partial tear of the meniscus, meaning it doesn't go all the way through the meniscus, is stable. A deeper tear that extends all the way through the meniscus is unstable, and even if there is healthy tissue and a good blood supply, it will be unable to heal. Unstable tears tend to pull apart before any significant healing occurs.

Surgery can be used to stabilize some meniscus tears. If the torn meniscus is healthy tissue with a good blood supply, then surgery to stabilize the tear may allow for healing.

When Surgery Is Necessary

In order for a meniscus tear to heal, it must have the following attributes:

  • Healthy tissue
  • Good blood supply
  • Stability

Surgery is generally necessary to repair a torn meniscus only if the tear is unstable, you have healthy meniscus tissue, and the tear is in an area of good blood supply.

Your doctor will also take into account your age, your activity level, and any other health issues you may have.

If the tear isn't a good candidate for repair, your doctor may remove the torn portion of the meniscus, called a partial meniscectomy. Less often, a total menisectomy may be performed, in which the entire meniscus is removed.

When Surgery Is a Last Resort

Many people have meniscus tears that will improve with some simpler treatments. Often, a degenerative meniscus tear will have symptoms that subside over time and never require surgery. Research has also shown that older patients respond well to physical therapy as the first line of treatment for a meniscus tear.

If surgery is needed later, the knee will function similarly to how it would have if surgery had been done to begin with.

Sources:

Labbe, C. Physical Therapy to Treat Torn Meniscus Comparable to Surgery for Many Patients. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Published August 1, 2013.

Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. Treatment of meniscal tears: An evidence based approach.  World Journal of Orthopedics. 2014;5(3):233-241. doi:10.5312/wjo.v5.i3.233.

Repairing Torn Meniscus. Cedars-Sinai. 

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