Is it necessary for a patient with a meniscus tear to undergo surgery to repair it right away? Or can he wait several months before the surgeon repairs it? My latest Ask Dr. Geier column addresses a question about surgery for one of the most common musculoskeletal injuries – timing of meniscus repair.
Is there a chance to repair a meniscus tear in a 43 year old during knee reconstruction 4 months after injury? My understanding is that the tear needs to be repaired within 2 weeks of injury.
Surgery to repair a meniscus tear
When a surgeon performs meniscal repair surgery, he essentially uses sutures and/or anchors to sew the edges of the tear back together. This procedure differs from the much more common partial meniscectomy, where the surgeon basically trims out the torn portion of meniscus.
The main factors that a surgeon uses to determine if a meniscus tear can be repaired or must be trimmed out are the tear’s location and its orientation. Typically only tears close to the blood supply of the meniscus – toward the capsule and away from the free edge – have the necessary blood supply to help repair heal. Vertical tears are among the only types of tears that sutures can effectively hold together as well.
Timing of meniscus repair surgery
Frequently surgeons perform meniscal repair surgeries within a few weeks of a patient’s injury. One, these tears often occur concurrently with ACL tears, so surgeons perform meniscal repair at the same time as the ACL reconstruction. Second, a younger patient might have a bucket-handle tear that blocks knee motion. Early surgery to get the meniscus back in place and sew it together is necessary.
In theory at least, surgeons often perform meniscal repairs earlier to prevent further damage. With continued impact through the knee, a patient could propagate the tear further or damage it in such a way that the surgeon can no longer repair it. Having said that, if a surgeon looks in the knee arthroscopically and finds a tear in a location with good blood supply and finds a tear pattern amenable to repair, he will usually try to repair it, even months out from injury.
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