Meniscal injuries: figures, risks and indications
Doctors
Topics
Treatments
Advice
- Dr Eric Choudja Ouabo
- Epidemiology of lesions
- Swiss statistics
- Ramp lesions
- Repair techniques
- Personalized instructions
- Meniscus suture
- Arthroscopic surgery
- Conservative treatment
- Evaluate each case according to age and activity
- Avoiding menisectomies in elderly patients
- Always look for associated lesions
Knee injuries in Switzerland: scale and challenges
Knee injuries represent a significant health and economic burden, particularly in pivot-contact sports such as football and skiing. Tens of thousands of accidents are recorded each year, with a high overall cost. In this context, meniscal injuries are common and rarely isolated; they are often associated with anterior cruciate ligament (ACL) tears, which complicates the picture and increases the risk of osteoarthritis in the medium term.
Recent epidemiology shows a gradual decline in menisectomies in favor of preservation strategies. This trend is supported by solid data: the long-term results of resection are less favorable than repair when it is possible.
Post-menisectomy osteoarthritis: what the numbers show
The relationship between instability, meniscal repair, and osteoarthritis is well documented. In the presence of a torn ACL, menisectomy exposes patients to a high rate of osteoarthritis at 10 years. Even with a reconstructed ACL, meniscus removal increases the degenerative risk compared to preservation. Conversely, meniscal suture, when feasible, reduces joint stress and protects the cartilage.
Some situations are particularly unfavorable, such as external menisectomy in young athletes, which can quickly be accompanied by serious chondral lesions. Hence the requirement for a measured indication and a systematic search for associated lesions (ramp, root, chondropathies).
A menisectomy can be catastrophic, especially in young, active people.
Therapeutic decision: individualize according to age, activity and injury
There is no standard treatment. Age, activity level, type of sport, location and morphology of the tear, as well as ligament integrity guide the decision. Pauci-symptomatic degenerative lesions often qualify for conservative treatment. Conversely, an unstable, symptomatic tear located in a vascularized area or compromising the annulus requires repair.
Imaging strategy and diagnostic arthroscopy also target frequently underdiagnosed lesions, particularly ramp lesions. Reducing anterior tibial translation by capsulomeniscal repair improves overall knee stability.
Repair techniques: principles and safety
The "all-inside," "inside-out," and "outside-in" techniques offer a modular arsenal depending on the location. Modern implants facilitate precise and reproducible procedures. The surgical approaches must respect the nerve and vascular structures, particularly in the posterior compartment. The position of the knee influences safety: adequate flexion increases the working space and distances the vessels.
The choice of instrumentation is primarily a matter of surgical mastery. The objective remains constant: to reduce the lesion, restore annular continuity and stabilize the meniscus in order to distribute the loads over a large surface area.
In Switzerland, 18,000 menisectomies are performed each year.
Identify and treat specific lesions: ramp and roots
Ramp lesion, posteromedial capsulo-meniscal detachment, is common in ACL tears and worsens anterior tibial translation. It requires dedicated exploration and hook repair from the back when indicated. Root lesions, by interrupting the annulus, mimic the effects of a total menisectomy and must be refixed.
Vigilance is therefore required: a knee that is too loose during testing suggests an associated injury. Proper repair improves biomechanics and protects the ligament graft when reconstruction is performed.
Heading towards meniscal preservation
Meniscal preservation is not a dogma; it is a biomechanical and prognostic logic. It is based on a careful assessment of the patient and the tissues. By prioritizing repair when possible, by abstaining from less troublesome degenerative changes, and by identifying associated lesions, it is possible to reduce the risk of osteoarthritis and promote a sustainable return to activity.
The key message is simple: repair when it is useful, avoid resecting for convenience, and contextualize each decision.
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