Knee Meniscus Repair: The Great White Whale
Most patients who I have spoken to believe that their meniscus surgery was a knee meniscus repair. So was it? Not so much. How do we know? A recent study confirms that, despite the term being used liberally, what’s frequently done is often chopping out pieces of the torn meniscus rather than repairing anything. First some background. The knee meniscus is a shock absorbing structure that’s often torn in sports or as we age. Recent research has shown that in middle aged and elderly patients, patients that hurt have no more meniscus tears than those who have no pain. So the concept that we can point to a MRI with a meniscus tear and assume that it’s causing pain is not a sound one. Despite this, knee meniscus repair surgery or it’s uglier cousin, knee debridement surgery are still very common. Debridement means chopping out pieces of the meniscus, a practice that has been associated with less protection for the joint and more knee joint arthritis. Finally, knee meniscus surgery has recently been determined to be no better than plain old physical therapy. So what about knee meniscus repair?
The group in the new study looked at a national database and pulled the billing records of almost two hundred thousand surgeries performed between 2004 and 2009. What did they find about knee meniscus repair? It’s about as common as good ole Moby Dick. 96% of all knee meniscus surgeries were debridements with only 4% being repairs! In fact, the number of medial knee meniscus repair surgeries dropped by almost half from 2004 to 2009. In addition, the most common age where meniscus tear repair was used was in patients aged 10 to 19 years old! Why so young? Surgical meniscus repair only works (60% of the time) in the very young. The conclusions of the authors says it all, “A high frequency of meniscus debridement can be expected in arthroscopic knee surgery. Despite advances in meniscus repair techniques and devices, no increase occurred in the performance of meniscus repair compared with meniscectomy.” The upshot? For more than 9 in 10 patients, despite conceptualizing their surgery as a meniscus repair, what they really had was a chunk of their meniscus chopped out, which is usually not a good idea. “Thar she blows me mateys…”