meniscus tear: should i have surgery?

a meniscus tear is a common knee injury. the meniscus is a rubbery, c-shaped disc that cushions your knee. each knee has two menisci (plural of meniscus)—one at the outer edge of the knee and one at the inner edge. the menisci keep your knee steady by balancing your weight across the knee. a torn meniscus can prevent your knee from working right.

a meniscus tear is usually caused by twisting or turning, often with the foot planted while the knee is bent. these tears can occur when you lift something heavy or play sports. as you get older, your meniscus gets worn. this can make it tear more easily.

if you are older, you may not know what you did to cause the tear. or you may only remember feeling pain after you got up from a squatting position, for example. pain and slight swelling are often the only symptoms.

what happens depends on the size of the tear, its location, and your symptoms. it also depends on whether your knee was healthy when the tear happened or if your knee already had age-related changes.

tears caused by an injury in younger people may heal over time with rest and physiotherapy. surgery is often used for large tears. that's because they can lead to long-term problems if they aren't repaired.

when the tear is in a knee that has age-related changes, symptoms may be helped by rest, physiotherapy, and time. in some cases, a doctor may suggest surgery.

there are two basic types of treatment for a torn meniscus—non-surgical treatment and surgery.

• with non-surgical treatment, you use rest, ice, compression, and elevation, and you have physiotherapy. you may wear a knee brace for a short time.
• with surgery, you can have one of the following:
  • surgical repair to sew the tear together.
  • partial meniscectomy, which is surgery to remove the torn section of the meniscus.
  • total meniscectomy, which is surgery to remove the entire meniscus.

your doctor will likely suggest the treatment that they think will work best for you based on where the tear is, what the pattern of the tear is, how big it is, and how old you are. your health and activity level may also affect your treatment options.

when possible, meniscus surgery is done using arthroscopy instead of open surgery. during arthroscopy, your doctor puts a lighted tube with a tiny camera—called an arthroscope, or scope—and surgical tools through small incisions.

surgery has risks, including infection, a blood clot in the leg, damage to nerves or blood vessels, and the risks of anesthesia. after surgery you may still have pain and joint stiffness.

surgery to repair a tear in the meniscus can relieve pain and improve knee function. surgery may also help prevent long-term complications, such as osteoarthritis.^{footnote 2}

meniscus repair may be most successful:^{footnote 2}

• in younger people.
• if the tear is near the outer edge of the meniscus, where there is better blood supply.
• if the tear is small.
• if the tear was caused by sudden trauma and not by wear and tear.
• if the repair is done soon after the injury.

surgery to remove part of the meniscus (meniscectomy) is better at keeping your knee stable than surgery to remove all of the meniscus. partial removal also allows a quicker and more complete recovery than total removal.

removing the whole meniscus typically reduces some symptoms. but losing the meniscus reduces the cushioning and stability of the joint. most people, especially if they are young or active, are not satisfied with a total meniscectomy. this is why surgeons try to remove as little of the meniscus as possible.

studies have shown that a partial meniscectomy may improve knee pain in people who don't have arthritis in their knee. this surgery is not likely to help if you already have arthritis.^{footnote 1}

instead of surgery, you may try rest, ice, compression, and elevation. you may wear a knee brace. you can try over-the-counter medicine such as ibuprofen or naproxen to help with pain and to reduce swelling.

if you have ongoing pain after trying these non-surgical treatments, you can work with your doctor to plan a rehab program that helps you regain as much strength and flexibility in your knee as possible. your rehab program probably will include physiotherapy and home exercises.

your doctor may recommend surgery because:

• you still have pain after trying other treatment, such as rest and physiotherapy.
• your knee "locks up" instead of working normally.
• you may be able to reduce the risk of future joint problems (osteoarthritis).
• you are an active person.
• your knee has a good chance of healing with surgery.