Meniscal root tears: to treat or not to treat?
YKC’s Jim Newman considers the question…
I’ve lost count of the numbers of knee conditions described by one journal or another as “silent epidemics” but here’s another one, and in this case the description might just be justified. Meniscal root tears are common in patients in their 40s and 50s who have very early signs of osteoarthritis of the knee but, because you have to look carefully for them, they can be tricky to spot and even trickier to treat.
The menisci are the knee’s natural shock absorbers and the meniscal roots ‘anchor’ the menisci to the tibia. A tear of the root renders the meniscus incompetent. Instead of absorbing shocks, the torn root leaves the meniscus free to split rather than resisting the forces placed upon it. That manifests as pain, usually towards the inside and back of the knee.
But the issue with meniscus root tears is not just the here and now. Meniscal root tears are one of the most common factors in initiating knee osteoarthritis. A root tear now is often a sign that the knee is about to go downhill fairly rapidly. Which leaves knee surgeons with the tricky question of what to do about it.
Treating the root
Patients with a meniscal root tear will sometimes end up having a partial meniscectomy – removing part of the meniscus, rather than repairing it. As we’ve explored in these pages before, that’s rarely ideal and within a year you’ll typically find the patient is back needing a knee replacement.
But a new study suggests that if you repair the root, fewer patients will require further treatment. To be clear, this isn’t a great study and more rigorous research is needed, but I point to it purely because its findings echo the sort of outcomes we see.
That’s not to say that every tear is repairable. An MRI scan can show the tear clearly enough but it’s only with investigation within the knee that you can tell whether the meniscus is salvageable.
If the meniscus is badly degenerated then repairing it can be like trying to stitch two pieces of tissue paper together.
See a knee specialist
Because of the delicacy and complexity of the procedure, the research does highlight the importance of seeing a specialist knee surgeon. This is not, generally speaking, something that a surgeon who might perform occasional knee arthroscopies would be able to do successfully. It’s an advanced technique that only a specialist surgeon will have experience in performing.
I find myself doing more of these procedures each year and it seems to me that there’s something in this area of research, which only highlights the need for further, more rigorous research.
If you are experience knee pain, don’t leave it to worsen. Talk to us about early diagnosis now.