MENISCAL REPAIR

The menisci of the knee sit inside the joint on both the inside and outside. They aid stability by transmitting stress . A meniscal tear can occur through a sudden twisting injury such as during pivoting sports, or through degenerative conditions.

When the meniscus tears, it can be in a variety of different orientations and locations. The treatment is via an arthroscopy: key-hole surgery. Examples of the different tears and my specific techniques for each include:

– Bucket handle tear. The entire meniscus on one side of the knee tears and can flip as it remains attached at the front and back. It can cause the knee to lock. Treatment involves reducing it back in position and using multiple different key-hole stitching techniques to hold it securely in place

– Radial tear. The meniscus tears from the joint towards the capsule lining of the knee. Treatment involves a skilled mattress stitching technique to pull the two sides together without splitting the tissue

– Horizontal tear. The meniscus splits in two but often remains in place. Treatment involves stitching or sealing the two ‘leaves’ of meniscus together 

– Parrot-beak tear. Usually a thin bucket-handle that has then split. A minimal resection of the trapped tissue can give immediate resolution of pain without delay to rehabilitation

– Ramp tear. The meniscus splits at the very back near the capsule. Often associated with an ACL rupture. Stitches with permanent tiny plastic buttons into the capsule are deployed. This can ensure that the meniscus heals back in place

– Root tear. A strong bony anchor point for the meniscus is pulled off. Without surgical treatment the meniscus will drift out of the joint. This is called extrusion and rapidly leads to destructive arthritis. The meniscus is stitched and pulled back down to the tibial bone to perfectly recreates the meniscal structure. The stitches pass through a bone tunnel and are secured with a tiny internal metal button on the outside of the bone

The treatment that is offered to you will depend on my expert evaluation of your MRI. I have analysed hundreds of scans and written scientific research articles on their appearance.

To aid a meniscal repair I take a bone marrow aspirate from the knee during the key-hole procedure and inject this behind the tear; creating a better biological environment for healing.

Key points:

• Meniscal tears can heal if given the right environment
• The environment for healing is a combination of multiple biological and mechanical factors. All aspects of both of these elements will be reviewed to maximise success
• The meniscus used to be resected in everyone – which is wrong! Many centres still adopt this outdated approach. Our research has shown how important the menisci are to protect your knee
• The menisci should to preserved whenever possible and if surgery is required then a meniscal repair will provide this
• Non-operative treatment is an option for some tears especially if associated with underlying degenerative arthritis
• In some cases, the meniscus has sustained significant damage and cannot be repaired and needs to be resected. In some occasions following this the knee can be under stress. Options then include further surgery with realignment osteotomy, a meniscal scaffold, or a meniscal transplant. These options alleviate pain and protect the cartilage from arthritis.