Should I have surgery for my torn meniscus?

Introduction

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This information will help you understand your choices, whether you choose to share in the decision-making process or to rely on your health professional's recommendation.

Key points in making your decision

How you and your health professional treat your meniscus tear, an injury to the cartilage that protects the knee joint, depends on several things, including your health professional's preferences, your age, health, and activity level, and when your injury occurred. Consider the following when making your decision:

• The location of the tear in the red and/or white zone of the meniscus is one of the most important factors in deciding whether surgery is indicated and, if so, which procedure is best. See an illustration of the meniscus zones .
  • If you have a minor tear at the outer edge of the meniscus (red zone), you may want to choose nonsurgical treatment, because often these tears heal with rest.
  • If you have a moderate to large tear at the outer edge of the meniscus (red zone), you may want to consider surgical repair (sewing the edges together), because this zone has a good blood supply, and this kind of tear tends to heal well after surgery.
  • If you have a tear that extends from the red zone into the white zone, the decision is more difficult. Surgery repair for these kinds of tears has varying results.¹
  • If you have a tear within the inner two-thirds (white zone) of the meniscus, surgical repair is usually not done because there is insufficient blood supply for healing. When these tears cause symptoms, the torn pieces are usually removed (partial meniscectomy). In rare cases, the entire meniscus is removed (total meniscectomy).
• You may be able to prevent long-term complications, such as osteoarthritis, with successful surgical repair of your tear. Although no long-term studies have proven this, health professionals believe that successful meniscus repair helps to evenly distribute the forces on the knee joint. If the knee is protected from uneven force, there is a lower risk of joint degeneration.
• The pattern of the tear can determine whether your tear can be repaired. Radial tears sometimes can be repaired, depending on where they are located. Horizontal, flap, long-standing, and degenerative tears—those caused by years of wear and tear—generally cannot be repaired.

Medical Information

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What is a meniscus tear?

A meniscus tear is a common knee joint injury. This rubbery tissue acts as a shock absorber between the upper and lower leg bones. Each knee has two C-shaped menisci (plural of meniscus): a lateral meniscus at the outer side of the knee and a medial meniscus at the inner side of the knee. A meniscus tear can limit your knee function. See an illustration of the knee and the menisci .

How is the meniscus injured or torn?

A meniscus tear usually occurs with a twisting or pivoting motion and often with the foot planted and the knee partially flexed (for example, when lifting or playing tennis). Other knee injuries, such as a torn ligament, can happen at the same time. As you age, your meniscus becomes worn and may tear more easily. Meniscus tears are rare in young children.

What are the symptoms of a meniscus tear?

The symptoms of a meniscus tear often vary. In a typical minor tear, there may be pain and slight swelling at first. These symptoms usually go away in 2 to 3 weeks.

In a typical moderate tear, you may feel pain at the side or center of the knee, depending on where the tear is located. Often, you are still able to walk. Swelling increases gradually over 2 to 3 days and may make your knee feel stiff and limit bending. There's often sharp pain with twisting or squatting. These symptoms go away but tend to recur with minor twisting or overuse.

In severe tears, pieces of the torn meniscus can dislocate into the joint space. This can make the knee catch, pop, or lock. You may not be able to straighten your knee. It can also feel "wobbly" or unstable, or give way without warning. The knee may swell and become stiff right after the injury, or over 2 to 3 days.

Older people whose menisci are worn may not be able to think of a specific event that caused the tear or may recall symptoms developing after a minor incident such as rising from a squatting position. Pain and minimal swelling are often the only symptoms.

How will my health professional diagnose a meniscus tear?

Your health professional will do a physical examination of both knees to evaluate tenderness, range of motion, and knee stability. He or she will ask how the injury occurred and whether you have ever had any other knee injuries. X-rays are usually done. Your health professional may suggest that you follow up with an orthopedic surgeon.

How is a meniscus tear treated?

Your treatment decisions depend on your health professional's preference; when the tear occurred; the location of the tear; and your age, health status, and activity level. Treatment options include:

• Nonsurgical treatment with rest, ice, compression, elevation, and physical therapy. This may include temporarily wearing a knee brace.
• Surgical repair.
• Surgical removal of the torn section (meniscectomy). In rare cases, the entire meniscus is removed.

In general, surgical repair is favored over a partial or total removal. If the meniscus can be repaired successfully, saving the injured meniscus by doing a meniscal repair—rather than a partial or total meniscectomy—reduces the occurrence of knee joint degeneration.¹

Small tears located at the outer edge of the meniscus often heal with rest. Larger tears located toward the center of the meniscus may not heal well because blood supply to that area is poor. In a young person, surgery to repair the tear may be the first choice because it may restore function. See an illustration of common meniscus tears .

Your age and activity level will also determine whether surgery is a good option for you. In a young person, surgery to repair a tear may be the first choice because it has a greater chance of healing and restoring a more normal function to the knee. It is generally believed that there is a poorer potential for healing in older patients, but successful repair of tears in people older than age 50 has been reported.²

The most common risks of surgery include infection, a blood clot in the leg, damage to nerves or blood vessels, and the risks of anesthesia.

For more information, see the topic Meniscus Tear.

Your Information

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Your treatment choices are:

• Nonsurgical treatment to see if your knee heals on its own, wearing a temporary knee brace, and possibly starting physical rehabilitation to keep the knee muscles strong while the knee is not bearing as much weight.
• Surgical repair to sew the tear together.
• Partial meniscectomy, which is surgery to remove the torn section.
• Total meniscectomy, which is surgery to remove the entire meniscus. This is generally avoided, because this option increases the risk for osteoarthritis in the knee.

The decision about whether to have meniscus surgery takes into account your personal feelings and the medical facts. Following are some general considerations about meniscus surgery.

Deciding about surgery

Reasons to have surgery

Reasons not to have surgery

Surgical repair may result in less pain and the return of normal function to the knee. If you don't have surgery, you may have more pain or your pain may recur, making it harder to do your daily activities. You may be able to prevent long-term complications, such as joint degeneration (osteoarthritis), with successful surgical repair of your tear. Are there other reasons you might want to have surgery?

The meniscus could possibly heal on its own, making surgery unnecessary. All surgery, including meniscus surgery, has risks. Meniscus surgery poses a risk of infection, damage to nerves or blood vessels around the knee, and blood clots in the leg. You must follow your health professional's rehabilitation plan for the best level of healing. Afterwards, you may still continue to have pain and require more physical therapy or, sometimes, additional surgery. Taking some time to see if a meniscus tear heals on its own before having surgery does not necessarily mean that a surgical repair, if needed later, will not heal as well. Are there other reasons you might not want to have surgery?

Following are some specific considerations about meniscus surgery based on the location of the meniscus tear.

Meniscus tear and the need for surgery

Location of tear	Reasons to have surgery	Reasons to wait or to not have surgery
Tears in the red zone	The success rate of surgical repair is 90% to 95%.3	Many minor meniscus tears heal on their own with rest.3 If symptoms persist or get worse, surgery can be done at that time.
Tears extending from red to white zone	Your orthopedist may recommend surgical repair for tears in this zone, especially for younger, active people, because successful repairs restore knee function.	The success rate of surgical repair varies. There's no conclusive evidence supporting either option.
Tears in the white zone	Tears in the white zone typically do not heal well after surgical repair. If they cause pain or swelling, torn pieces typically need to be removed (partial meniscectomy) and the edges need to be shaved down to make the remaining meniscus smooth.	Removing part of your meniscus (partial meniscectomy) often reduces symptoms but may increase your risk for osteoarthritis.1

These personal stories may help you make your decision.

Wise Health Decision

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Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about surgery. Discuss the worksheet with your health professional.

Circle the answer that applies to you.

My knee pain won't go away. I don't think it will clear up on its own.	Yes	No	Unsure
I think surgery will help my knee in the long run.	Yes	No	Unsure
I need to be able to exercise to maintain my health, so I want to have my knee repaired.	Yes	No	Unsure
If I have to have surgery, I would rather have it done sooner than later.	Yes	No	Unsure
I want to see if my knee can be repaired and healed for next ski season (or for some other sporting activity).	Yes	No	NA*
I won't have to worry about this expense, because my insurance should cover most of the cost of this surgery.	Yes	No	Unsure

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not to have surgery.

Check the box below that represents your overall impression about your decision.

Leaning toward having surgery

Leaning toward NOT having surgery

Return to the topic Meniscus Tear.

References

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Citations

1. Koski JA, et al. (2000). Meniscal injury and repair. Orthopedic Clinics of North America, 31(3): 419–435.

2. Rodeo SA (2000). Arthroscopic meniscal repair with use of the outside-in technique. An Instructional Course Lecture, American Academy of Orthopaedic Surgeons, 82-A(1): 127–141.

3. Fu FH, Stone DA (2001). Meniscal injuries. In Sports Injuries: Mechanisms, Prevention, Treatment, 2nd ed., pp. 1124–1129. Philadelphia: Lippincott Williams and Wilkins.

Credits

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Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Editor	Sydney Youngerman-Cole, RN, BSN, RNC
Associate Editor	Pat Truman
Primary Medical Reviewer	William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer	David Bardana, MD, FRCSC - Orthopedic Surgery/Sports Medicine
Specialist Medical Reviewer	Kathie Hummel-Berry, PT, PhD - Physical Therapy
Last Updated	September 22, 2006