Expert Commentary: Thomas Murray, Jr., M.D. 3/25/2010

Posted by Admin on March 25, 2010
A tear of a cartilage cushion or meniscus is one of the most common musculoskeletal injuries, and removal of the torn fragments, or menisectomy, is one of the most common orthopaedic procedures done in the United States every day. The two menisci (plural) are semi-circular structures in the knee that help the relatively round femur or thigh bone conform to the flatter tibia or leg bone below.

Because the meniscus has minimal blood supply, its ability to heal when torn is limited.  In younger patients and in certain tear patterns, suture repair of the tear may be possible.  However, for the great majority of tears in adults, tears are not likely to heal even if repair is attempted, and therefore simple partial removal is appropriate.

As part of the discussion regarding menisectomy, patients will frequently ask, “but don’t I need that cushion.”  Excellent question.  While we know from past experience that removing more meniscus than necessary is no longer advisable, as total menisectomy frequently leads to rapid onset of arthritic changes, it has been unclear to what extent leaving a meniscus tear in place might harm a knee. 

Doctors have long suspected that leaving a torn meniscus in place would do more damage than removing only the torn portion.  Fortunately a recent study published in Arthritis and Rheumatism shed some light on that exact question.  Martin Englund and his co-authors monitored patients between the ages of 50 and 79.  The group found that 54 % of patients with untreated meniscus tears went on to develop significant knee arthritis.  Those patients with meniscus tears were almost 6 times more likely to develop knee arthritis than their peers. 

So to put it simply, a torn meniscus is no longer working for you and may be working against you.  Certainly many other variables need to be considered, but if your health allows, removal of a meniscus tear may be advisable.  Most importantly, you should consult with your doctor.

Thomas F. Murray, Jr., MD

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