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Advances in Meniscus Repair Technology

thutBy David Thut, MD

There are two types of cartilage in the knee.  The first is the articular cartilage which is the smooth surface on the ends of the bones that allows the joint to glide without friction.  Meniscus cartilages are soft tissues that act as a cushion to protect the articular cartilage from wearing out.  Unfortunately, the meniscus is prone to injury; the soft tissue can tear and cause pain and catching in the knee.

Years ago, the standard treatment for meniscus tears involved a large incision around the knee and removal of the entire meniscus.  Surgeons quickly learned, however, that while the procedure took care of the pain associated with the tear, removal of the entire meniscus doomed the patient to severe arthritis in the following two decades.  With widespread adoption of knee arthroscopy about 30 years ago, orthopaedic surgeons learned that if they removed only the torn area of the meniscus and left as much of the normal meniscus behind as possible, the progression to arthritis was slowed.  Today, arthroscopic surgery for a meniscus tear is one of the most common surgical procedures performed in the US.  As many as 1 in 300 people per year undergo knee arthroscopy, and many of those will develop arthritis despite efforts to preserve good tissue.

Wouldn’t it be great if we could repair the torn meniscus and allow it to remain fully functional? There have been techniques to put stitches in the meniscus for years, and when the tear heals, studies have shown that the meniscus protects the knee nearly normally.   Sadly, the success rate in getting the tissue to actually heal has been poor.  We have always thought that this is related to the lack of blood supply to the majority of the meniscus, so we have traditionally only attempted repairs in young patients with very specific tear patterns.

Recent advances in technology now allow us to place stitches in meniscus tears in ways that we never could before.  And the evidence now suggests that even when the blood supply is poor or the patient middle aged, many tears (about 70%) can heal if the knee does not have preexisting arthritis.  We have started using an instrument called Ceterix Novostitch and the results are promising.

The post operative course changes if you are lucky enough to have a repairable meniscus.  If we just remove the tear, then a patient may bear weight as soon as she is able and may progress to walking normally within a few days and usually to sports activity within a month or so.  If we are able to repair the meniscus, however, there will be weight bearing restrictions.  Some patients will not be allowed to put any weight on the leg for a month, while others will be asked to bear weight only with the leg completely straight for the first month.  There typically would be physical therapy involved after full weight bearing is allowed.

Repair of the meniscus, while not technically possible in all cases, is very beneficial to the knee in the long term, and we are excited that we can do it more often.  If you have knee pain, you may be a candidate for meniscus repair.  We are happy to discuss the risks and benefits on an individual basis with each patient.