Only the outer 10 to 30 percent of the meniscus has a blood supply that is required to allow tissues to heal. Because of this limited blood supply and limited ability to heal and repair itself, the meniscus tends to develop degenerative tears (from “wear and tear”) over time. The majority of meniscal tears are generally degenerative but sometimes a single injury can suddenly extend a developing tear, causing it to become symptomatic (painful). Unfortunately, because of the instability (movement) of the torn fragment of the meniscus and its limited blood supply, meniscal tears generally do not heal or regenerate themselves. Also, because of this limited blood supply and the fact that a majority of tears are degenerative in nature (“beat-up” without clean edges that can be sewn together), most meniscal tears cannot be repaired and require an arthroscopic partial meniscectomy (removal of the torn and damaged portion of the meniscus) to relieve symptoms. A small number of meniscal tears that occur after an injury (especially an ACL injury) are simple vertical (clean) tears in the outer area of the meniscus which has a good blood supply. This type of tear may heal if surgically repaired (sewn back together).
Dr. Steven Chudik, arthoscopic knee specialist, performs meniscus repairs arthroscopically with the assistance of an arthroscope (small camera that allows him to look inside the knee through small incisions). Small shavers and cutting instruments are used to remove and contour the torn portion of meniscus if it is not repairable. For tears that are reparable, the edges of the tear are freshened; then sutures (stitches) are used to hold the torn edges together while the meniscus heals.
Physical therapy should begin two to three days after surgery and continue for approximately six weeks for a partial meniscectomy and three to four months for meniscal repair. The success of meniscal surgery is dependent on the post-operative rehabilitation. It is crucial to follow through on and maintain a proper therapy schedule.