What Exactly is the Meniscus
A meniscus is a fibrocartilage structure that is situated between the femur bone and the tibia bone (photo below). The meniscus is a flexible rubbery structure intended act as a shock absorber of the knee. There are two distinct menisci structures in the knee, the medial meniscus is located on the inner aspect of the knee and the lateral meniscus is located on the outer aspect of the knee. The menisci both have front and back portions that are typically referred to as the anterior and posterior horns. For example, if an athlete injured the back portion of the outer meniscus, that would be considered a tear of the posterior horn of the lateral meniscus. A tear of the meniscus typically occurs as a non-contact injury with a planted foot on the ground. Many times the athlete is twisting or shifting directions, where the body is moving in one direction and the knee is moving in the opposite direction. A meniscal tear will cause pain due to the femur flexing and extending across the tear rather than a smooth surface of the normal meniscus.
Treatment Plan
In general, the recommendation for a meniscus tear varies depending upon the type of tear, location of the tear and the age of the patient. If the tear is large and the patient is younger, the surgeon will likely attempt to repair the meniscus and allow it to heal. Younger patients have a much better chance of the meniscus healing after a repair than older patients. On the other hand, if the tear is small or the patient is older, then the surgeon will likely remove the torn part of the meniscus. The procedure for removal of the torn portion of the meniscus is called a meniscectomy. On rare occasions, if the tear is very small and on the edge of the meniscus, a conservative non-operative approach can be considered.
Meniscal Tear
Meniscectomy Surgery
Source: Randy Clark (YouTube)
Here is a short clip depicting a tear of the anterior horn of the medial meniscus being trimmed and smoothed which is referred to as a meniscectomy.
Return To Play
An athlete who is treated with meniscectomy surgery is expected to be able to return back to full activity in about 4 to 6 weeks. At the professional and college level, an aggressive protocol may return an athlete even sooner. The rapid return can be tolerated due to the fact that the torn portion has been removed so there is not substantial meniscal tissue needing to heal.
Sports Considerations
The current data demonstrates that the more meniscus that is removed, the higher the risk for developing arthritis in the future. Although it may sound tempting to opt for the meniscectomy in order to significantly reduce down time, it may not be the best choice. If repair of the meniscus is possible and appropriate for the situation, it should definitely be considered to protect the long term health of the knee.