Meniscus Root Repair
What is the Meniscus?
A meniscus is a C-shaped cartilage disk that is found on the inner and outer aspect of the knee. These menisci function as a shock absorber in the knee so that heavy weight bearing forces can be evenly distributed across the knee. This avoids point-loading of the other type of cartilage in the knee called articular cartilage, which forms a smooth lining on the ends of our bones.
What is a Meniscus Root tear?
When a meniscus tears, it results in increased contact pressures on the bone and cartilage within the joint. In recent years we have become increasingly aware of tears that occur at the root of the meniscus, close to where it attaches to the bone. Complete tears in this location allow the meniscus to extrude out of the joint resulting in almost complete loss of shock absorption. These lesions seem to be a particularly potent source of pain and may even lead to stress fractures occurring in the bone.
Root tears to the inner meniscus tend to occur between ages 45-65 and are more common in female patients. The pain is often felt at the back of the knee. Symptoms are often worse when getting of bed, standing from a chair or going up stairs. Full range flexion of the knee also tends to produce pain. Data from recent studies indicate that rapid progression of osteoarthritis may occur following this type of tear if left untreated.
Treatment options available
Recently, techniques have emerged to repair the root of the meniscus back to the bone, bringing the meniscus back into the joint to aid shock absorption and load distribution. This is done arthroscopically with sutures passed through the root of meniscus and then pulled out through carefully placed bone tunnels in the tibia. This procedure is only possible if there is no significant arthritis in the knee and the patient can completely limit weight bearing after the surgery for 6 weeks.
Early results indicate that root repairs can reduce pain and can slow the progression of arthritis caused from joint overload. In many cases this procedure can prevent or delay the need for a knee replacement.
In patients where a meniscus root repair is unlikely to be successful, treatment initially consists of simple non-operative measures such as physiotherapy and injection therapy. If the arthritis is advanced, then knee arthroplasty may be more appropriate than meniscus repair.
