Before understanding whether or not meniscectomy surgery is advisable, it is necessary to understand what the functions of the meniscus are.
The meniscus of the knee joint: what is it for?
The meniscus is a fibro-cartilaginous pad present between the bony heads of joints; a typical example is the meniscus of the knee joint.
Its main function is to cushion forces in the knee joint by decreasing the pressure on the cartilage. Other functions involve joint lubrication, proprioception (set of functions deputed to control position movement) and knee stability.
With this in mind, we can already begin to understand how meniscectomy, previously performed very lightly in cases of MENISCUS TEAR, should, instead, be thought through very carefully, not only by the surgeon performing it, but also by the patient undergoing it.
Arthroscopic meniscectomy: what it’s all about
Meniscectomy is a surgical procedure that involves the removal of part of the meniscus and is performed arthroscopically. The surgeon accesses the joint through two very small incisions (portals) in the anterior region of the knee, on either side of the patellar tendon.
Through these two portals, a camera is introduced into the inside of the knee, allowing the tools used to remove the portion of the meniscus with the lesion (selective meniscectomy) to be seen.
Arthroscopic selective meniscectomy: what happens after surgery
Arthroscopic selective meniscectomy is the most performed surgery by all orthopedists worldwide and remains, to date, one of the most successful operations in the short term; for the patient, it means being able to return to regular activities, including sports, within a couple of weeks.
Studying those who underwent this surgery 15 or 20 years ago, however, we learned that cartilage, after meniscus removal, tends to wear out faster, leading to ARTROSIS and subsequent KNEE PROTESIS.
This deterioration is more likely to occur if you have an unstable knee due to a previous anterior cruciate ligament (ACL) injury, if the meniscus removed is the lateral rather than the medial, but most importantly, if the amount removed is more than 50%.
If the amount of meniscus removed is large and, more importantly, if its “root” (the posterior horn) is no longer present inside the knee, cartilage wear will progress faster.
The meniscal suture: some clarity
It was once thought that the meniscus was an anatomical structure with no healing ability. Therefore, when an injury occurred, the movable part had to be removed. Today, however, we know that the meniscus has blood vessels in its outermost portion, thanks to which it therefore has the ability to repair.
Therefore, if the injury is peripheral, that is, the area characterized by the presence of blood vessels (called the“red zone,” precisely), we know that if we stabilize it with an arthroscopic suture, they will most likely heal.
Today the imperative is to try, always, to maintain the native meniscus, even in case of rupture. Therefore, within arthroscopy, if the type of injury and the mechanical characteristics of the meniscus allow it (“red zone” or “white-red” zone), a Meniscal Suture will be performed rather than its removal.
Meniscal suturing allows us not to lose the biological functions of the knee; however, it presents us with two challenges:
- A challenge for the surgeon: the surgeon will have to perform an operation burdened with a higher failure rate: in fact, what we have sutured will not necessarily be able to heal because the meniscus is not a structure with great repair capacity. We know from international scientific studies that suturing can fail 15% to 20% of the time: this means that, about 1 in 5 sutured menisci will need a new arthroscopy within the first few years after surgery. If, on the other hand, the meniscus is removed, the surgical revision rate in the first few years will be only 1-2%.
- A challenge for the patient: meniscal suturing involves longer recovery times; in fact, to allow for healing, the knee cannot be mobilized immediately but progressively. Crutches will also be abandoned later in time than with a meniscectomy, and joint pain (due to the sutures) will unfortunately accompany the patient for a few months.
Meniscal suture: the surgeon’s word
Meniscal Suture works only if the patient is well informed.
So many times we orthopedists have listened to the frustration of the meniscal suture patient who sees in rehabilitation centers meniscectomized “colleagues” recovering with great speed while their progress happens more slowly.
Surgeons who must take it upon themselves to better inform patients about the treatment options that can be considered in the case of surgical meniscal injury.
Patients should be aware of the possible benefits of meniscal suturing in the long run, even though they will face a slower, more strenuous physical recovery burdened with a higher risk of failure.
in the end
The meniscus is a very important anatomical structure, and the goal should be, as much as possible, to preserve it.
It is true that meniscal suturing provides longer recovery time, but it also allows the meniscus’ cushioning function to remain intact, which has great long-term benefits.
In the case of meniscectomy, on the contrary, scientific studies tell us that on average after about 13 years, cartilage wear and tear will cause severe joint pain in the patient, requiring cartilage salvage treatments such as MENISCAL ALLOGRAFT TRANSPLANTATION.
And, when cartilage wear is too far advanced, the only solution left to treat the pain is Knee Prosthesis, a procedure that one would like to perform only on elderly patients.
Would you like more information about Meniscal Suture? Please do not hesitate to contact me.
