Physiotherapy in Toronto for Knee

If you enjoy participating in sports but need surgery to repair or remove a damaged meniscus, this report may interest you. Experts in the surgical treatment of meniscal tears compared the effect of arthroscopic repair versus (partial) removal of the meniscus. The main area of interest was the effect of these two procedures on sports activity after surgery.

The meniscus is a C-shaped piece of thick cartilage in the knee. It has several main functions. One is to provide optimal weight-bearing through the knee. Another purpose is to absorb shock. The meniscus also helps stabilize the joint and help the joint slide and glide smoothly during movement.
There are two menisci: one on each side of the knee. Most often, the medial meniscus (side closest to the other knee) is damaged when athletes and sports players plant the foot on the ground and rotate or pivot the leg to change directions suddenly.

Over the years, it has been discovered that removing the meniscus entirely is not a good idea. Too many people developed early osteoarthritis after a meniscectomy. So, the standard procedure has gradually changed from complete removal to repair of the torn meniscus whenever possible. And when it has to be removed, as little as possible is taken out whenever possible.

So, now the question is: over time (i.e., the long-term or eight to 10 years later), what's the effect of these two procedures (repair versus partial removal) on sports activity? To find out, the authors of this study reviewed the records of 81 patients treated with one or the other of these two surgical techniques.

Records were kept of the patients' activity level before the injury and also of their age when the surgery was done. At the same time, an effort was made to see how much osteoarthritis developed and how quickly it progressed (that is, got worse over time).

The type of surgery that was done was determined by the type of rupture. Those patients with a full (all the way through the full thickness of the meniscus) but small (less than one centimeter long) tear had the repair done. The partial removal (meniscectomy) was done on ruptures located where the blood supply was poor or when the tear was too large to repair.

Patients in both groups went into a rehab program after surgery. The specific protocol used depended on whether the procedure was a repair or a partial meniscectomy. For example, the repair group was more limited in the amount of knee motion that was allowed compared to the meniscectomy group.
A brace was used for the patients who had the repair done, whereas the patients in the meniscal removal group had physiotherapy right away. Exercises were started without any bracing. Sports activities were allowed four weeks after the partial meniscectomy. Similar activity level wasn't allowed in the repair group until at least six weeks after surgery.

The success rate was much higher in the repair group compared with the partial meniscectomy group.

The more cartilage removed, the worse the osteoarthritis (narrow joint space, bone spurs) later. More professional and recreational athletes were able to resume full sports activity after repair (again compared with the removal group).

Loss of sports activity and obvious osteoarthritic degeneration were clearly more evident in the meniscus removal group. Even though it was only a partial meniscectomy, the negative effects were still greater than with a meniscal repair. Of note is also the fact that there were some failures among the repair group. A lack of healing response leading to new trauma and another tear were seen in a couple of patients. The surgeons were unable to predict when this would happen (i.e., which patients would have a nonhealing response).

The results of this study support the idea that meniscal repair is better than removal -- even over a partial meniscectomy. General knee function, level of sports activity, and joint health all measured higher in the repair group. Both clinical tests and X-rays confirmed these findings. And since the type of surgery that can be done depends on the location and size of the tear, return to sports activity really depends on the initial type of tear that is present.

Reference: Thomas Stein, MD, et al. Long-Term Outcome After Arthroscopic Meniscal Repair Versus Arthroscopic Partial Meniscectomy for Traumatic Meniscal Tears. In The Journal of Sports Medicine. August 2010. Vol. 38. No. 8. Pp. 1542-1548.