David Menche M.D.
The Meniscus: New Approaches

Knee meniscal cartilage tears represent the most common knee problem leading to surgery in America. Meniscus damage can occur with activities of daily living without specific trauma, as well as trauma that occurs in sport or the work place. Once there is injury to the meniscal cartilage, the body’s response is often pain and swelling. At times, the knee may “lock”, “give way” or “go out”. The meniscal tear causes the body’s weight to be distributed unevenly. As a result of increased stress over time, the articular cartilage may break down—which can lead to degenerative arthritis.

Preserving the Meniscus

The first line of treatment is attempt at repair. Historically, in the days of open cartilage surgery, the entire meniscus was removed. With the advent of arthroscopy, standard treatment evolved to remove only the damaged area.

Unfortunately, long term follow up studies of these patients (partial menisectomy) have found that some patients may go on to develop degenerative arthritis. Today, cartilage surgeons recognize the protective value of the meniscal cartilage and make every attempt to conserve this valuable tissue.

Restoring the Meniscus

Suture Repair of Meniscal Tear

To maximally preserve the meniscal function after a tear, surgeons may repair the meniscus using a variety of techniques. These include using special sutures or absorbable implants to secure the tear.

Biological “healing glues” may also become available. Even with the newest techniques available, most tears are not repairable Therefore, it is imperative to remove as little tissue as possible to provide an optimal result.

Replacing the Meniscus—The Cutting Edge

For patients who have had the meniscus removed, the surgeon may offer an innovative solution called a meniscal transplant. It is important to remember that even though only a part of the meniscus was removed, at times the effect to the knee from a biomechanical standpoint is the same as a total menisectomy. The indications for transplant need to be assessed by your cartilage surgeon. Unlike other forms of tissue transplantation, this procedure does not require patients to be on medications to prevent rejection. Intermediate term follow-up studies in the literature are encouraging.

meniscus-4 meniscus-5
the Meniscal Transplant
Inserting the Meniscal
Transplant into Place

Future Trends

Investigators are now examining the potential of using collagen or another biologic tissue to serve as a bridge or scaffold for the body’s own healing/repair mechanism to use in reestablishing meniscal form and function. . The long term goal is to prevent the development or progression of arthritis. Through this effort, it is hoped that it may be possible to eliminate or lessen the need for later surgeries — such as total knee replacement.