Surgical Meniscus Repair Works…only if You’re Very Young
Is there such a thing as meniscus repair? The concept that surgeons repair meniscus tears in most patients is a big misconception. The vast majority of patients with meniscus tears in fact have the torn portion of the meniscus removed, which then places more forces on the remaining piece, leading it to fail. There is no meniscus repair. The failure of the remaining meniscus happens with almost clock work precision, you get a bit more time if you’re younger and less if you’re older. This smaller meniscus which no longer protects the joint then leads to more knee arthritis. Like the woman I saw yesterday who had a torn piece of the inside of her lateral meniscus taken out which then caused the remaining meniscus tissue to promptly spit out the joint (like a pea squeezed between your fingers), leading her lateral compartment to collapse and her leg to begin to go crooked. So can any type of meniscus tear be fixed? This week a lower level long-term case series was published where the surgeon tried to sew meniscus tears back together in younger patients (ages 16-44 years) instead of whacking out the torn piece. The good news is that in some patients this worked, the bad news was that it only worked in patients under 30 years of age. A prior study had shown knee meniscus tear healing in only about 6 in 10 younger patients. Why? For the same reason that micro fracture works better in patients under 40. Younger patients have more stem cells in their joints capable of assisting meniscus and cartilage repair. This number declines in older patients. This is why we supplement older joints with their own stem cells. The upshot? Getting a torn meniscus operated on may be a good idea if you’re young, but based on the published literature is almost always not a good idea if you’re older.
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