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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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I'm 66-years old and in good health but I've got a bum knee from an old meniscus tear. I've tried to avoid surgery but the dang thing hurts so much, I can't walk more than two blocks. Should I go ahead and have it taken out?

When deciding on the best plan of care for a meniscus problem, the surgeon considers the age and activity level of the patient. The surgeon looks at how long the patient has had this problem (acute versus chronic). The chances of healing in a long-term injury (one that occurred months to years ago) are less than in a more recent injury. The surgeon will also consider the condition of the joint. How bad is the tear? Could it heal on its own? Small tears along the edges of the cartilage have a better chance of healing because there is a better blood supply there. An MRI will help show how much blood supply there is and give the surgeon an additional tool when predicting who might get better with nonoperative versus surgical care. Tears on the inner aspect of the meniscus (especially large tears in multiple directions) don't heal well and often need a little surgical help. Sometimes patients are advised to try a conservative (rehab) program first. Older adults who aren't very active may do just fine with a rehab program of modified activity and strengthening exercises. If symptoms are resolved and activities can be resumed, then great -- surgery won't be needed. But if after a trial of rehab lasting up to three months, there's no improvement or pain persists with activities, then it's time to think about surgery. The most successful operations are performed within the first 10 to 12 weeks after the injury first occurs. When it comes to surgery, the goal is to save the meniscus but also stabilize the knee. It may be possible to repair the tear and/or reattach the torn edges. The surgeon shaves down any ragged edges in a procedure called debridement. Debridement may be all that's needed to stimulate a healing response. In some cases, the surgeon may opt to suture loose edges back in place or even remove part of the damaged meniscus. By taking a look at the cartilage using an arthroscope, it's possible to see what condition the meniscus is in and how much degeneration has occurred. Too much degeneration and the meniscus won't heal itself and can't be saved. Likewise, if the tear is too long, too deep, or too displaced, then it might be necessary to actually remove part (or all) of the cartilage. This procedure is called a meniscectomy. No matter what, the surgeon always tries to preserve tissue and knee function.


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