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Save the Meniscus!

Have you torn the meniscus in your knee? Wondering whether to repair or remove it? Here are some findings that may help. Seventy-five people who had the lateral meniscus (the outside rim of cartilage in the knee) removed were examined between five and 15 years later. No other injury occurred in these knees. Only the torn or damaged part was removed (called a partial meniscectomy).

Most improvement was present around four months after the operation and lasted at least two years. Nearly 80 percent of the people reported "excellent" or "good" results at that time. Significantly, favorable results worsened to 65 percent by the end of the study.

The rest of the people in the study reported "poor" outcomes. In these cases, there was a major increase in pain and swelling and difficulty climbing stairs. Despite normal knees on examination, most of these patients described feelings of instability or unsteadiness in the operated knee.

Slightly more than half of the patients were able to return to pre-injury activity levels. The authors considered this a "good" result. However, the results could not be considered excellent because the other half didn't return to normal.

Over time, X-rays showed wear and tear at the joint for all knees with partial removal of the lateral meniscus. Interestingly, pain or problems weren't always present with this type of joint decline. Pain, swelling, knee locking, and difficulty with stair climbing were more common in older adults and those who were overweight. However, these results weren't accompanied by changes in the joint in early X-rays.

What do doctors make of these findings? Every torn meniscus should be saved whenever possible instead of being removed. Progressive joint deterioration is inevitable when part of the lateral meniscus is taken out. Although two-thirds of all cases have positive outcomes with partial meniscal removal, one-third does not. Eventually, almost everyone has changes in the joint as seen on X-rays.

The authors questioned whether a torn meniscus be should always be surgically treated. Maybe a torn but unrepaired lateral meniscus will have the same long-term result as a "naturally aged" knee. Stay tuned!

References: Gerhard Scheller, MD, et al. Arthroscopic Partial Lateral Meniscectomy in an Otherwise Normal Knee: Clinical, Functional, and Radiographic Results of a Long-term Follow-up Study. In Arthroscopy. November/December 2001. Vol. 17. No. 9. Pp. 946-952.

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