Meniscus Repair

The success of a meniscal repair depends on several factors, with one of the most important being the location of the tear. Tears in the outer regions of the meniscus, known as zones 1 and 2, have a better chance of healing due to their higher blood supply. This enhanced vascularity supports tissue regeneration and repair.

Tears in the central region of the meniscus (zone 3) are more challenging to treat, as this area has limited blood flow and reduced healing potential. However, advancements in surgical techniques and research suggest that even these central tears can be repaired successfully under the right conditions. Other key factors influencing the success of a meniscal repair include the patient’s age, overall health, body mass index (BMI), and commitment to postoperative rehabilitation. Recent studies indicate that patients in their 50s and those with a BMI under 35 can achieve positive outcomes from meniscal repair.

Meniscal repair is conducted using arthroscopic surgery, a minimally invasive technique involving small incisions through which a camera (arthroscope) and specialized surgical tools are inserted into the knee joint. There are several methods for repairing the meniscus, including:

1. All-Inside Technique: This method uses implants that remain within the knee, providing internal stabilization for the meniscus.
2. Inside-Out Technique: This traditional approach involves sutures passed from the inside of the knee outwards, offering strong fixation.
3. Outside-In Technique: Sutures are placed from outside the knee and guided inward, which is ideal for repairing certain tear types.

Each of these techniques has its strengths, and the choice depends on factors such as the tear’s size, location, and complexity. Dr. Cinque carefully evaluates each case to determine the most effective method or combination of methods to achieve the best results for the patient’s specific condition.

Commitment to a structured rehabilitation program is essential for a successful outcome after meniscal repair. Unlike meniscectomies, where part of the meniscus is removed and recovery is quicker, meniscal repair requires a more conservative approach to protect the sutured tissue and ensure proper healing. 

Initial Phase (0-2 Weeks):

• Patients remain toe-touch weight-bearing and should use crutches.
• A knee brace is provided to stabilize the joint.
• Patients can perform gentle range-of-motion (ROM) exercises, limiting flexion to 0-90 degrees.

Intermediate Phase (2-4 Weeks):

• Active and passive ROM exercises are continued, with a gradual increase to full ROM.
• Weight-bearing is permitted as tolerated, but the knee brace remains in place.

Advanced Phase (4-8 Weeks):

• The knee brace can be unlocked, and patients may start bearing full weight.
• By the end of week 8, the brace is typically no longer needed.

Rehabilitation Milestones:

• Around 12 weeks, patients can begin jogging.
• Progressive exercise and strength training can be gradually introduced as tolerated.

Adherence to these rehabilitation guidelines is critical for minimizing stress on the repaired meniscus and ensuring long-term success. Failure to follow the prescribed rehabilitation plan can compromise the repair, leading to potential complications.

Before deciding on meniscal repair, it’s important for patients to have an open discussion with Dr. Cinque about their specific goals and expectations. Factors such as the patient’s age, activity level, and overall health, as well as the characteristics of the meniscal tear, play significant roles in determining the best treatment approach.

For many, meniscal repair offers the potential to preserve natural knee function and delay the onset of degenerative conditions like osteoarthritis. However, it’s not the optimal solution for every patient. Understanding the postoperative commitment and long-term implications is crucial in making an informed decision.