Meniscal surgery

The meniscus is a cushion in the knee. It helps to spread out the forces through the knee when doing activities. The menisci in the knee move as the knee bends to allow these forces to be effectively spread, whether you are running, jumping of squatting. If you have a tear in your meniscus, this function is reduced. This can cause pain, sometimes locking type symptoms, as well as increasing the risk of future osteoarthritis.

Meniscal repair

Traumatic meniscal tears occur in an otherwise healthy meniscus and are often caused by a sporting injury. These are often repairable. This can be determined more precisely with an MRI scan. Meniscal repair techniques and equipment have improved considerably over the last decade and now most tears can be repaired. One of the difficulties is that the meniscus has a relatively poor blood supply, especially in the central part of the meniscus (the so-called white zone). This can reduce the chance of a successful repair, and the pros and cons of repair surgery will be discussed with Nick Smith.

Meniscal root repair

If the meniscus tears within 1cm of its attachment into the bone, it is called a root tear. This distinction is important because the operation to repair it is different. It is best repaired by drilling a tunnel through the bone and passing a repair tape through this tunnel. Lateral root tears occur primarily with bigger injuries and may tear at the time of an ACL rupture. Lateral root tears can completely defunction the meniscus. Medial root tears can occur without trauma or with minimal trauma, usually in middle aged people. There is a high chance of progressive osteoarthritis associated with medial meniscal root tears.

Meniscal transplantation

Patients that have had a traumatic meniscal tear and subsequent removal of the meniscus (meniscectomy) are at risk of knee pain, particularly during activities and also progression of osteoarthritis. Some of these patients may be suitable for meniscal transplantation. The meniscus used in transplantation is donor tissue (allograft) and is fixed using the latest meniscal repair techniques. There are only a few surgeons in the UK performing this operation. Nick Smith has extensively researched this topic and has a high-volume clinical practice. He is therefore very well placed to discuss whether this surgery may be right for you or not.

Removal of part of the meniscus (partial meniscectomy)

A degenerative meniscal tear usually happens at the back of medial meniscus (posterior horn). Historically, most people would have been offered surgery. However, there have been a number of trials showing that non-operative treatment (physiotherapy or watch and wait approach) can be equally effective. Some trials had a high crossover rate for patients in the non-operative group (meaning that a high proportion did in fact go on to have surgery). There are now national consensus guidelines on who should be offered surgery and who should be offered non-operative treatment, which is based on the best current evidence. At UHCW NHS Trust, we are further studying these patients to see if we can identify who is likely to benefit from surgery and who is not. It is clear that there is not a one size fits all answer and it is up to the treating team to appropriately assess patients and give informed advice on the treatment options.

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  • Meniscal surgery

    The meniscus is a cushion in the knee. It helps to spread out the forces through the knee when doing activities.