A Torn Meniscus — Again

Some tears of the meniscus in the knee don’t have to be removed. They can be repaired. Sometimes the same meniscus is torn and repaired more than once. This study reports the results of repeat repairs in 18 torn menisci.

Research has shown that removing the meniscus leads to increased force on the joint surface. Taking out as little as one-third of the inner meniscus increases contact stress on the joint by 65 percent. Scientists think the loss of cartilage and increased stress is what causes osteoarthritis in knees that have had part or all of the meniscus removed.

The meniscus is so important doctors still try and save it when it tears a second time. What are the results of a second (or third) meniscal repair? In these 18 cases, repeat meniscal repairs were 72 percent successful. The average follow-up was seven years. Range of motion, function, and X-rays of the joint space were measured in all cases.

Repeat tears often occur in the same place as the first tear. Sometimes the repeat repairs can’t be fixed a third time. If the tear is too long, too deep, or goes in too many directions, repair may not be possible. Removing part of the meniscus is the next step.

The authors conclude that repairing a torn meniscus a second time can give the patient relief from pain. Most patients can eventually return to strenuous levels of activity. Doctors aren’t sure if the repeat repair protects the meniscus as well as the first repair. More studies are needed to compare knee function and results after the first meniscus repair to results after the second meniscus repair.