Meniscus repair

Recovery after a meniscus repair is deliberately slower than after trimming a torn piece away. The reason is simple: the repaired meniscus needs time to heal.

Your recovery plan may include:

• Early recovery: crutches, protection of the repair and control of swelling.
• Movement: gradually restoring the knee’s range of movement according to the repair.
• Strength: progressive physiotherapy as the knee allows.
• Everyday activity: returning gradually to work, driving and normal walking.
• Sport: running, cutting and pivoting are introduced only when the knee has regained the required strength and control.

Your exact milestones depend on the type and location of the tear, the repair performed and how the knee responds to rehabilitation. We will discuss them with you and put your individual recovery plan in writing.

If your recovery is progressing differently from what we expect, we would rather you tell us early than wait for the next appointment.

The meniscus is a tough, flexible cartilage cushion between the thigh bone and shin bone. There are two in each knee. It helps distribute load and contributes to the stability and function of the joint.

When the meniscus tears, some people notice pain or swelling. Others experience catching, locking or a feeling that the knee is not moving normally.

There are two broad ways of dealing with a torn meniscus when surgery is required.

The damaged portion can be trimmed, allowing quicker recovery but leaving less meniscal tissue.

Or the tear can be repaired, using sutures to preserve the meniscus and give it an opportunity to heal.

When the tear is suitable for repair, preserving the meniscus is generally preferred. Not every tear can be repaired. The decision depends on the tear pattern, location, tissue quality, blood supply and condition of the rest of the knee.

The MRI is only part of the decision.

We look at:

• where the tear is and what type of tear it is
• the condition of the meniscus and the rest of the knee
• your age and activity level
• your symptoms
• whether the knee is locking, catching or giving way
• what you need the knee to do

Tears closer to the outer edge of the meniscus have a better blood supply and a greater potential to heal after repair. Tears further towards the centre have less blood supply and may be less suitable for repair.

Sometimes imaging gives us a very good idea of what we will find. Sometimes the final assessment of whether a tear is repairable can only be made when we see the tissue directly during arthroscopy.

A younger patient with a repairable tear may benefit greatly from preserving the meniscus, even though the recovery is longer.

A patient with a degenerative meniscal tear and established arthritis may gain little from surgery, particularly if the knee is not locking or mechanically obstructed.

The diagnosis matters. But so does the person attached to the diagnosis.

Many meniscus tears do not require an operation.

If there is no significant locking or instability, a structured rehabilitation program, appropriate activity modification and time may be a sensible first step. Some people improve enough that surgery never becomes necessary.

The calculation changes when the knee repeatedly locks, catches or gives way, or when there is a specific tear that is unlikely to settle with non-surgical treatment.

The important point is not simply whether the MRI shows a tear. It is whether that tear is responsible for the problem you are experiencing.

Trimming a damaged portion of the meniscus generally allows a faster recovery.

Repair takes longer because the tissue has to heal.

But repair preserves more of your natural meniscus.

That is the trade-off we discuss honestly before deciding. The right choice depends on the tear, the condition of your knee, your age, your activity and what you want your knee to do in the years ahead.

Meniscus repair is usually performed through small keyhole incisions.

An arthroscope gives us a magnified view inside the knee. The tear is assessed directly, and if it is suitable for repair, sutures or repair devices are used to secure the meniscus while it heals.

Most patients go home the same day or after a short hospital stay, depending on the procedure and individual circumstances.

You may need crutches and a brace for a period of time. The amount of protection depends on the tear and the repair performed.

The restriction is not an inconvenience added to recovery. It is part of protecting the repair while it heals.