Who is a candidate for meniscus surgery by arthroscopy?

• For meniscus injuries there is conservative and surgical treatment, the choice depending on the type of patient.
• For patients under the age of 30, surgery to repair the meniscus is always the preferred option.
• In this article we shed some light on who is usually a candidate for meniscus surgery.

Humans have two menisci in each knee, the internal meniscus and the medial or external meniscus. When we talk about meniscopathy, we refer to any pathology suffered by one of these menisci. Depending on how this injury occurs, we can opt for one type of treatment or another, differentiating between degenerative injuries, due to the meniscus having been affected over time, or traumatic injuries, which occur due to blows or trauma to the area.

• Traumatic meniscopathy: This is usually caused by a forced movement of the joint due to a blow to the inside or outside of the knee, a fall after a jump, etc. These cases usually require surgery in the majority of cases as the patient is usually an athlete and their aim is to return to sport as soon as possible.
• Degenerative meniscopathy: Degenerative meniscopathy can occur due to traumatic mechanisms, the main difference being that the tearing mechanism does not have to be as strong as in the case of a young meniscus, as this meniscus has been weakened due to ageing, triggering the tear with a slight overload of the joint. In these cases it is possible that the surgeon may indicate the possibility of conservative treatment, but it will always depend on the area of the meniscus that has been affected.

If you want to know more about the different types of meniscopathy you can do so by clicking here.

In this case, it is unusual for only one area of the meniscus to be affected, and it is common for the tear to affect both the vascularised and non-vascularised areas, requiring a mixed procedure involving meniscal suture and partial meniscectomy. 

In any case, below we differentiate the patient's options depending on the type of area affected:

Rupture in the vascularised zone

The vascularised zone of the meniscus is the peripheral zone of the meniscus, i.e. it is the area that receives blood supply and can therefore regenerate itself, as occurs in any injured area of our body. In any case, whether to opt for conservative or surgical treatment of a meniscus injury in the vascularised zone depends in part on the type of patient:

• Young, active or athletic patients: In this case, surgery is always the preferred option, as the repair can be carried out with meniscal sutures, allowing the problem to be solved more easily, although rehabilitation is still necessary later on. In this way, almost all of the meniscal tissue is preserved, which is important in the case of sportsmen and women.
• Less active patients: In these cases, the doctor may advise the patient that conservative treatment is an option, which consists of rehabilitation to strengthen the muscles around the knee, to reduce the pressure exerted by the weight of the body on the knee and thus allow the meniscus to regenerate.

Rupture in the non-vascular area of the meniscus

In these cases, surgical repair is always the preferred option, since one of the usual symptoms in this case is joint locking, i.e. the knee is unable to perform its full range of motion. All of this, together with the pain it can cause, as well as the damage that can be caused by the injured part being released in the rest of the articular elements, mainly the cartilage that covers the ends of the tibia and femur.

In principle, the age of the patient is not usually an impediment to meniscus surgery, as long as the patient does not suffer from any type of disease that contraindicates the intervention. 

However, as we have indicated previously, depending on the age of the patients, it is possible that one type of treatment or another may be recommended:

• Meniscus tears in adolescents and adults under 30 years of age: In these cases, surgery is always chosen because tears at this age are usually caused by traumatic mechanisms during sport, and patients are primarily looking for a return to sport.
• Meniscus tears in people over 40 years of age: In these cases, in addition to the fact that the tear may be due to degenerative mechanisms, there is the possibility that the patient does not practise sport or their activity is low and they can live without the need to repair the meniscus because the symptoms are not very strong. In the event that the conservative option does not work or the patient is an active sports person, surgery may be a good option. However, this should be indicated by an orthopaedic specialist who will review the case.

If the patient is over 65 years of age, the options are practically the same as in the case of patients over 40 years of age, although in these cases it is more likely that conservative treatment will be chosen, since in these cases it is possible that the patient is also affected by osteoarthritis in the joint and may eventually require a prosthesis if it worsens. As in any case, a traumatologist or orthopaedic surgeon should be the one to determine the best option.

If you are considering having your meniscus operation performed in a private hospital, remember that you can request a free surgical assessment consultation through Operarme to meet with one of our specialists in Traumatology and Orthopaedic Surgery, who will familiarise himself with your case, assess it and together you will decide the best option for your case. 

You can request a free appointment with one of our traumatologists by clicking on the image below: