Meniscal Tears & their Treatment: The menisci are C-shaped shock-absorbing semi-circular rings of Type 1 Fibrocartilage that serve to protect the Type 2 hyaline articular cartilage that covers the ends of the femur and tibia. The coefficient of friction of articular cartilage is approximately 1/5 to 1/7 that of ice sliding on ice. With time, sports activities, life and age our cartilage gradually accumulates injury and begins to deteriorate. The menisci play a critical role in preserving the structure and function of the articular cartilage in our knees. Meniscal tears are typically incapable of healing because they have a poor blood supply which comes in from the periphery and an avascular zone in the central third.
Meniscal Tears and meniscal surgery is often misunderstood and mischaracterized. Traumatic tears in young individuals will not heal and can be a source of persistent pain, mechanical symptoms, swelling and dysfunction. With time, life, and age the prevalence of meniscal tears increases and therefore they become an increasingly more common finding over age 45-50. If they are asymptomatic, they are an incidental finding best left alone. If they are responsible for pain and mechanical symptoms, then oral anti-inflammatories, ice, activity modification and physical therapy are the preferred conservative treatment.
For traumatic tears in young athletes or persistently symptomatic tears that fail to respond to conservative treatment, surgical intervention is appropriate and can be of significant benefit to patients. A great deal of research from the work of Drs. Russell Warren and Stephen Arnoczky at Hospital for Special Surgery to that of Dr. Ashesh Bedi of the University of Michigan has helped us to better understand the indications for when these tears should be repaired and when the irreparable meniscal tissue should be resected. Of key importance in understanding these surgeries, is the principle that only torn/irreparable/dysfunctional tissue is removed and only when appropriately indicated.
The following is case example of a bucket-handle meniscal tear with a rare opportunity for a second-look to confirm healing at the time of a staged ACL reconstruction in a young female athlete.