Our Summary

This research paper is a systematic review of studies on the surgical treatment of horizontal cleavage tears (HCTs) in the meniscus - a common type of knee injury. The researchers analyzed studies found in electronic databases like PubMed, MEDLINE, and EMBASE up to the end of 2018.

The review includes 23 studies involving 702 patients (708 knees), with an average age of around 37 and an average follow-up period of about 34 months. Most patients were treated with a partial meniscectomy (removing part of the damaged meniscus), followed by repair (mending the tear) and total meniscectomy (removing the entire meniscus).

The study found that both partial meniscectomy and repair led to improvements in clinical conditions such as pain, function, and daily living, and also showed better results in radiographic outcomes (medical imaging tests). However, the overall complication rate was 5.1%, with most complications occurring in patients who underwent meniscal repair.

Although meniscal repair might theoretically improve biomechanical loading (the way forces are distributed across the knee), it led to higher complication rates than partial meniscectomy. Therefore, doctors need to carefully consider which treatment option to choose based on the specific tear patterns and available implants. Future studies with long-term follow-ups are recommended to investigate potential complications and the possibility of delaying the onset of osteoarthritis.

FAQs

  1. What is the most common treatment for horizontal cleavage tears (HCTs) in the meniscus according to the reviewed studies?
  2. What were the most common complications observed in the studies and in which type of treatment did they mostly occur?
  3. What are the future recommendations made by the researchers in this systematic review on the surgical treatment of meniscus tears?

Doctor’s Tip

A helpful tip a doctor might tell a patient about meniscectomy is to follow the recommended post-operative rehabilitation program diligently to ensure a successful recovery. This may include physical therapy exercises to strengthen the muscles around the knee, improve range of motion, and prevent stiffness. It is important to gradually increase activity levels and avoid high-impact activities that could put stress on the knee joint. Additionally, maintaining a healthy weight and practicing proper body mechanics can help reduce the risk of re-injury and promote long-term knee health.

Suitable For

Patients with horizontal cleavage tears in the meniscus are typically recommended for meniscectomy, either partial or total, depending on the severity of the tear. Meniscectomy is often recommended for patients who have not responded to conservative treatments such as rest, physical therapy, and anti-inflammatory medications.

Patients who are relatively young and active, with a healthy knee joint and minimal signs of osteoarthritis, are good candidates for meniscal repair. Meniscal repair is a surgical procedure that aims to preserve as much of the meniscus as possible in order to maintain the structural integrity and biomechanical function of the knee joint.

It is important for doctors to carefully evaluate each patient’s individual circumstances, including their age, activity level, knee health, and tear pattern, in order to determine the most appropriate treatment option. In some cases, a combination of partial meniscectomy and repair may be recommended to achieve the best outcomes for the patient.

Overall, meniscectomy is a common and effective treatment option for patients with horizontal cleavage tears in the meniscus, but the decision to undergo surgery should be made in consultation with a qualified orthopedic surgeon who can provide personalized recommendations based on the patient’s specific condition and treatment goals.

Timeline

Before meniscectomy:

  1. Patient experiences knee pain, swelling, and limited range of motion.
  2. Patient undergoes physical examination, imaging tests (such as MRI), and possibly arthroscopy to diagnose the meniscus tear.
  3. Doctor recommends meniscectomy as a treatment option.

After meniscectomy:

  1. Patient undergoes the surgical procedure, either partial meniscectomy, repair, or total meniscectomy.
  2. Patient goes through post-operative physical therapy to regain strength and range of motion in the knee.
  3. Patient experiences improvements in pain, function, and daily living activities.
  4. Patient may have follow-up appointments to monitor recovery and check for any complications.
  5. Long-term follow-up is recommended to assess the outcomes of the meniscectomy and potential development of osteoarthritis.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a meniscectomy?
  2. How long is the recovery period after a meniscectomy?
  3. Will I need physical therapy after the surgery?
  4. What are the chances of the meniscus tearing again in the future?
  5. Are there any alternative treatments to a meniscectomy that I should consider?
  6. How will a meniscectomy affect my long-term knee health and risk of developing osteoarthritis?
  7. What type of rehabilitation program should I follow after the surgery?
  8. What are the success rates of meniscal repair compared to partial meniscectomy?
  9. How will the surgery impact my ability to participate in sports or physical activities in the future?
  10. Are there any specific factors about my tear pattern or knee anatomy that make me a better candidate for one type of meniscectomy over another?

Reference

Authors: Shanmugaraj A, Tejpal T, Ekhtiari S, Gohal C, Horner N, Hanson B, Khan M, Bhandari M. Journal: Knee Surg Sports Traumatol Arthrosc. 2020 Mar;28(3):915-925. doi: 10.1007/s00167-019-05557-5. Epub 2019 Jun 11. PMID: 31187178