Meniscal injuries and associated instabilities: how to treat?
Doctors
Topics
Treatments
Advice
- Dr Eric Choudja Ouabo
- Definition of meniscal injuries
- Surgical indications
- Ramp lesions
- Root lesions
- Advanced surgical techniques
- Meniscus suture
- Menisectomy
- Ligament repair
- Prefer suture to menisectomy if possible
- Systematically repair combined lesions
- Delaying return to sport after external menisectomy
Athletes and meniscus: specific requirements
In athletes, the high functional demands require nuanced decisions. The goal is to preserve meniscal tissue without exposing the patient to early recurrences, while allowing a safe return to play.
The strategy takes into account the type of sport (pivot-contact), the affected compartment and the overall stability of the knee.
ACL and meniscus: frequency of associated injuries
Ramp lesions are common in initial ACL tears; root lesions are less common but have a high biomechanical impact. Recognizing them changes surgical planning and determines postoperative stability.
Systematic repair of associated lesions improves the results of ligament reconstruction.
Preserving the meniscus helps prevent osteoarthritis.
Choosing the right strategy: suture or meniscectomy
An isolated lesion of the internal meniscus in a high-level athlete may be amenable to a sparing meniscectomy due to the risk of recurrence under stress, while the external compartment should, as far as possible, be sutured.
Apart from these special cases, preservation remains the rule, especially among young workers.
Technique: repair to stabilize, guide return to sport
Current techniques (all-inside, outside-in, popliteal anchors) reduce the failure rate, particularly at the lateral meniscus. Load progression and return to sport are protocolized, delaying impact after lateral meniscectomy and respecting healing times after suturing.
Coordination with physiotherapy optimizes return to performance.
Ramp lesions are present in 24% of ACL tears.
Preventing chondrolysis after external menisectomy
After lateral meniscectomy, returning too quickly exposes you to chondrolysis. Delaying running and impacts, monitoring effusion, and adjusting the load are essential protective measures.
Clear communication of recovery milestones secures the athlete patient's journey.
Focus on function: preserving meniscal capital
Preserving the meniscus is an investment in knee durability: less osteoarthritis, better biomechanics, and maintained performance. The decision is personalized and based on clinical findings, imaging, and the patient's goals.
The main thing is to avoid irreversible actions when repair is possible.
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