Understanding Meniscus Injuries: Is Surgery Always Necessary?
Meniscus injuries do not always require surgery. Today, meniscus preservation is prioritized to prevent early osteoarthritis. Diagnosis is based on a clinical examination and an MRI, allowing treatment to be tailored to each case.
Doctors
Topics
Treatments
Advice
- Dr Jacques Vallotton
- Function of the meniscus
- Consequences of meniscectomies
- Conservative treatment
- Diagnosis
- Prevention of osteoarthritis
- Conservative treatment
- Meniscal reinsertion
- Arthroscopic surgery
- Do not operate systematically
- Importance of MRI
- Preserve the meniscus
Understanding Meniscal Injuries: Preserve Rather Than Operate
The menisci are shock-absorbing and stabilizing structures that optimize knee congruity. For a long time, the response to a tear was partial or total removal, given the knowledge we have about the risk of early osteoarthritis.
In this context, contemporary strategy favors tissue preservation whenever possible. The goal is not to "make a lesion disappear," but to preserve the mechanical function of the knee and limit long-term consequences.
Role of the meniscus and injury mechanisms
A meniscal tear can be traumatic (vertical, longitudinal, bucket handle) or degenerative (horizontal, complex). Biomechanics differ depending on the location and type: a radial tear quickly compromises load transmission, whereas a stable tear may remain paucisymptomatic.
Thus, the therapeutic decision is based firstly on the clinical impact and stability of the lesion, more than on the existence of an isolated abnormal signal in imaging.
We do everything to preserve them, reinsert them, reattach them.
When to suspect an injury: signs to recognize
Elective pain in the joint space, episodes of locking, a feeling of giving way or acute flexion suggest meniscal damage. A comparative clinical examination, supplemented by specific tests, allows the affected compartment to be targeted.
MRI confirms the diagnosis, specifies the type of tear and looks for associated lesions (cartilage, ligaments). It does not replace the history and examination: it is linked to them to guide the course of action.
Conservative treatment as first line
For a degenerative lesion or a stable tear, surgical abstention with conservative treatment is the initial rule: adaptation of activities, physiotherapy, control of pain and swelling, sometimes infiltration depending on the context.
This approach aims to relieve symptoms while avoiding unnecessary meniscectomy, the deleterious effect of which on biomechanics is well established.
Not all meniscal lesions require surgery.
When arthroscopy is necessary and how it is performed
Arthroscopic surgery is indicated in cases of blockage, unstable lesions, or persistent discomfort despite proper treatment. The principle is to repair, reattach, or suture when anatomy and vascularity permit.
Resection is limited to what is necessary if repair is impossible. This preservation logic promotes faster rehabilitation and protects the meniscal capital.
Message to the patient: assess, correlate, decide on a case-by-case basis
Each knee is assessed individually, integrating symptoms, clinical examination, and MRI. In certain associations (significant cartilage damage), treating the meniscus does not change the overall prognosis, and inappropriate surgery should be avoided.
The goal is function: to resume activities without pain, while minimizing the risk of long-term osteoarthritis.
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