Red Zone Tear White Zone Tear When Non
This illustration demonstrates the reasoning often given to patients that meniscus surgery is the only way. Menisci have two zones. The red zone is the meniscus outside zone the white zone is the inside zone. A red zone tear lies within the blood-rich portion of the meniscus. Where there is a blood supply to the meniscus, there is the opportunity to stimulate healing or repair. The white zone meniscal tear is thought to be non-healing because there is no direct blood supply. Many doctors do not believe the white zone meniscus tear can be repaired because of this. This is typically the part of the meniscus removed in meniscus surgery.
Surgery For Meniscus Tears
NYU Langone orthopedic surgeons are specially trained to offer a range of surgical options, including minimally invasive outpatient approaches, for treating meniscus tears. The type of surgery that your doctor may recommend typically depends on where in the meniscus the tear is located, its severity, and the tear patternall of which your doctor assesses with physical exams and imaging tests.
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Surgeons try to preserve as much of the meniscus as possible because of the important role it plays in absorbing shock and weight in the knee and in your mobility.
Your doctor considers whether you are a good candidate for one of our outpatient surgical procedures and whether it is likely to preserve the meniscus. Younger people who are athletic may be good candidates for surgery to repair or replace the meniscus, while older adults who have degenerative tissue in the meniscus may benefit from more conservative, nonsurgical approaches. Regardless of age, if you have a tear that causes symptoms such as knee locking you may be better served with arthroscopic surgery.
When Is Surgery Needed
Some meniscus tears require surgery to heal the meniscus and restore the knees range of motion. For example:
- A tear on the inner two-thirds of the meniscus that wont heal on its own because the area lacks blood flow to stimulate the immune system response.
- A tear that gives you a lot of pain or impairs use of your knee may require surgery to remove or repair the torn part of the meniscus.
- Complex tears usually require surgery to trim the damaged part of the meniscus.
Surgery may be a meniscus repair or a trimming of the meniscus tissue, which is called a partial meniscectomy. Note that meniscectomy may cause osteoarthritis in the long term.
Meniscus tear surgery is very common, with about
Its best to see a doctor as soon as possible:
- if you have sudden pain from a knee injury
- if you have trouble using your knee
- if your pain persists
Untreated meniscus tears can get worse, or pieces of the meniscus can shed into the joint. For an athlete, playing through knee pain can cause greater problems later.
A doctor can do physical and imaging tests, such as an X-ray or MRI, to determine what kind of damage you have and discuss possible treatment options with you.
Also consult a doctor if you continue to have pain after a course of conservative treatment.
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Another Procedure Knee Microfracture Surgery And Cartilage Implant Surgery
The notion that replacing dead meniscus tissue, with a dead persons meniscus or with synthetic meniscus is going to prevent osteoarthritis, as discussed in our article Alternatives to knee microfracture surgery and cartilage implant surgery is not realistic. By the time a person has a damaged meniscus, many other tissues in their joints are also affected including ligaments and tendons that provide stability when strong or provide instability when compromised. The whole knee joint needs to be treated not just the meniscus tear. The human meniscus is mobile, movable, stretchable, and made up of fibrocartilage, and has many functions including joint stabilization and the manufacturing of specific mediators of healing that go into the synovial fluid. None of these functions can truly be reproduced by any other type of meniscus besides the persons own meniscus.
Although there is some short-term improvement after these surgeries in aspects such as pain control, the long-term effects of meniscectomy, meniscal repair, and meniscal allograft transplantation reveal that symptoms, such as pain and instability, will persist for years afterward.
Meniscus Tear Of The Knee: Causes Symptoms And Diagnosis
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Overview of a meniscus tear
The meniscus is a piece of cartilage that provides a cushion between your femur and tibia . There are two menisci in each knee joint.
They can be damaged or torn during activities that put pressure on or rotate the knee joint. Taking a hard tackle on the football field or a sudden pivot on the basketball court can result in a meniscus tear.
You dont have to be an athlete to get a meniscus tear, though. Simply getting up too quickly from a squatting position can also cause a meniscal tear. According to Boston Childrens Hospital, more than 500,000 meniscal tears take place in the United States each year.
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Goal Of Arthroscopic Meniscus Repair
The goal of meniscus surgery is to preserve healthy meniscus tissue. A meniscus tear requires a blood supply to heal. Only the outer third portion of the meniscus has blood supply to enable healing of a tear. Repairs are generally limited to this peripheral region of the meniscus.
Many types of meniscus tears occur in the region of the meniscus without adequate blood supply for healing. Meniscus removal is generally recommended for tears to regions of the meniscus without blood supply. Please see arthroscopic meniscectomy for more information.
Now Lets Get Back To The Reasons Why You May Still Be Recommended For Meniscus Surgery Surgeons Strongly Argue That There Is Validity To Meniscectomy
Doctors in Germany say that many of the studies critical of arthroscopic meniscus surgery are not 100% reflective of the patients they see. Medical research is broken up into levels of evidence. Level 1 is based on evidence which means a researcher took existing research and combined it into a review of the literature. Doctors and researchers grade this at the lowest level of accredited research.
The German doctors say too much level 1 evidence is being offered as a generalization of meniscus surgery. The complaint is some surgeries will help some patients and that every meniscus surgery is not a bad surgery and this research is not reflective of that.
- They also cite that according to the consensus statement of ESSKA the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy, meniscus surgery is still recommended.
- So European surgeons have not yet embraced the idea of totally moving away from meniscectomies.
The treatment of degenerative meniscal lesions should start with conservative management.
The ESSKA guidelines also say the treatment of degenerative meniscal lesions should start with conservative management. In the case of persistent symptoms, surgery should be considered after 3 months. In the case of mechanical symptoms, arthroscopy might be indicated earlier.
They do say arthroscopy in advanced osteoarthritic knees is not indicated due to inferior clinical outcomes.
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Why Meniscus Repair Surgery Is Needed
Surgical treatments include meniscectomy or a repair of the tear.
Meniscus tears that cause mechanical symptoms tend to respond well to surgical treatment. A mechanical symptom is caused by the torn meniscus physically impeding the normal movement of the knee.
Common mechanical symptoms include:
- A popping or clicking sound or sensation
These injuries are surgically treated either with a partial meniscectomy or a meniscus repair to place the edges together with sutures or tacks.
Why Is It Important To Treat A Torn Meniscus
Anytime you experience knee pain or the symptoms of a torn meniscus, its important to seek a prompt diagnosis and expert care. A meniscus tear that goes untreated can lead to prolonged pain and stiffness, possibly an even larger tear, or progression to an arthritic knee.
Luckily, many non-traumatic meniscus tears often become pain-free with conservative measures like rest, ice, compression, and elevation therapy, knee orthotics, and physical therapy.
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Can A Meniscus Heal Itself
Yes, a meniscus can heal itself as long as symptoms do not persist and the knee is stable. In this case, non-surgical treatment can be utilized. Torn meniscus treatment depends on the type of tear, its size, and location. The outer third of each meniscus has a rich blood supply so blood cells can regenerate to create new meniscus tissue and can sometimes heal on its own.
Does Meniscus Surgery Lead To Knee Replacement
There is no definitive answer to this question as each individuals case is unique. While meniscus surgery may lead to knee replacement in some cases, this is not always the case. Some individuals may experience successful results from meniscus surgery and never require knee replacement. The best way to determine if meniscus surgery will lead to knee replacement is to consult with a doctor or orthopedic surgeon.
A partial meniscectomy, which involves the removal of part of the knee rather than just repairing the joint, is the most common meniscectomy procedure, according to the American Society of Plastic Surgeons. Cartilage tears and pain can occur after an implant is removed, and it is unable to function. Arthritis is prevalent in 60% of knees treated with surgery 18 months after the procedure, as opposed to 33% who only received physical therapy. Surgery is not required for the repair of the knee joint. As a result, your knee will only get weaker and your arthritis will only get worse. Second, consider the efficacy of PRP or stem cells, both of which have been shown to be very effective in multiple trials.
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The Patient With Many Meniscus Surgeries And A Prognosis Of Eventual Knee Replacement
Removing tissue from your knee can only make your knee weaker in the long run and prone to arthritis. This is why many have numerous surgeries on their knees, trying to correct problems in part caused by tissue removal. Removal of the meniscus decreases the shock absorption that protects the knee. Why shave it then? Because some physicians believe that the meniscus does not have the ability to be repaired, either by regular body repair mechanisms or surgery. So it is shaved, smoothed, or partially removed. Years ago, when a meniscus was injured, the standard protocol was complete removal and resultant boneonbone arthritis in the future. Many of these poor patients were forced to have knee replacements years later because of the severe pain from the meniscus removal.
Like many in our field, we see patients who have had numerous arthroscopic surgeries. Sometimes these patients even brag about how many surgeries they had. Most will stop bragging once they learn that they will ultimately need a knee replacement and that the activities or work they did/do that accelerated their meniscus problems will most likely come to an end because the knee replacement will not allow them the range of motion needed to continue on.
How Does A Meniscus Tear Happen
Like an insole in your shoe, menisci help absorb shock by providing a cushion between the upper and lower leg bones where they meet in the knee area. There are two of these crescent-shaped pieces of cartilage in each knee.
Meniscus tears often originate from a sudden twisting movement. The condition also can be caused by degenerative diseases like osteoarthritis. The injuries are sometimes sports-related, but they can also happen when youre simply going about your everyday activities.
This is true especially as you get older. Menisci start to get weaker around age 30, which means your risk of a tear increases as you age, says Dr. Parker.
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Treatment For A Meniscus Tear
Specific treatment for a meniscus tear will be determined by your doctor based on:
Your overall health and medical history
How bad your injury is
How well you can tolerate specific medications, procedures, and therapies
The length of time it will take to heal
Your opinion or preference
What Is The Recovery Time
Specific recovery time varies depending on the type of surgery you have. Recovery from arthroscopic meniscal tear surgery is relatively quick, and most patients are able to resume normal activities within a few weeks. If you have a meniscal repair, the recovery time and rehabilitation period may be longer up to six weeks in a knee brace or with crutches.
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The Role Of The Meniscus In The Knee Joint
Located in the space between the distal femur and the tibial plateau, the elastic crescent-shaped menisci play a number of important roles in the proper functioning of the knee. Their remarkable physical properties enable them to function as shock absorbers between the weight bearing surfaces of the knee and distribute compressive forces from the femur more evenly across the tibial plateau.
The role of the menisci is so important, as without this distribution of weight, the knee joint would be exposed to loads of up to six times greater.
The menisci also help to lubricate the sensitive cartilage surfaces between the tibia and femur. In addition, due to the firm attachment of their thicker outer portions to the joint capsule, they play an important part in overall joint stability.
The most common meniscus injuries are tears, including incomplete and complete tears. The cause of these tears may be either acute or degenerative .
Given that meniscus injuries can impede joint function and lead to potentially irreversible joint damage such as osteoarthritis, it is essential to consult a doctor immediately in cases of suspected injury. Only an experienced orthopedic specialist is able to determine if a meniscal tear is likely to heal on its own, or requires surgery.
If You Have Been Given The Meniscus Injury Surgical Recommendation You Have Been Told That You Will Get One Of These Three Procedures
- An Arthroscopic meniscus repair. In this procedure, there is a small tear that the suture can sew up. In some instances, surgeons are taking bone marrow from the iliac crest and using stem cell therapy to accelerate this repair.
- An Arthroscopic partial meniscectomy. In this procedure, there is a piece of a meniscus that is more badly torn or macerated and considered non-repairable. There is basically nothing to stitch up. This piece of the meniscus is recommended for removal because of its condition.
- An Arthroscopic total meniscectomy. The whole meniscus is considered damaged beyond repair and the entire meniscus will be recommended for removal.
One of the primary reasons for a meniscal operation is to improve joint stability, yet meniscectomy often appears to have the opposite effect, as it elicits even more instability, crepitation, and degeneration than the meniscus injury produced prior to operation. This is why reoperation rates after meniscectomy can be as high as documented in the research below.
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Different Types Of Meniscus Tears
There are six different types of meniscus tears. Each type requires a different treatment.
The six different types of meniscus tears are:
Return To Work After Meniscal Surgery
Return to work will vary depending on the procedure performed and type of work you do. Most patients can return to office work within a few days. Labour intensive work however, may require up to 3 weeks or longer before returning to full duties.
During this period you should try to avoid the following activities:
- Prolonged standing
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When Does A Torn Meniscus Require Surgery
If diagnostic imaging reveals a moderate to severe tear in the outer edge of your meniscus, sewing the tear together may be the most effective solution. Minimally invasive surgical repair of red zone meniscus tears has a high success rate.
Our team may recommend surgical repair if you:
- Still have pain, weakness, or instability after conservative care
- Are relatively young and would like to remain highly active
- Would like to reduce your risk of future joint issues
If the tear spreads from the red zone to the inner portion of your meniscus, your decision may be more difficult.
You could try a surgical repair, although white zone repairs dont always heal, or you may opt for a different type of surgical treatment called a partial meniscectomy, which removes the torn section of the meniscus.
Whether your meniscus injury is mild, moderate, or severe, our goal is to help you heal and if possible regain full functionality so you can continue to be fully active. In many cases, surgery is the best way to attain that goal in many others, conservative care is all it takes.
If you have a painful knee injury, we can help. your nearest OrthoTeam Clinic location, in Madison or Stoughton, Wisconsin, today, or use the easy online booking feature to schedule a visit with one of our sports medicine experts.