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The Journal of Bone and Joint Surgery, Vol 71, Issue 6 811-822, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Non-operative treatment of meniscal tears
CB Weiss, M Lundberg, P Hamberg, KE DeHaven and J Gillquist
Department of Orthopaedics, University of Rochester Medical Center, New York 14642.
In a retrospective review of the results of 3,612 arthroscopic procedures
that were performed for the treatment of an acute or a chronic meniscal
lesion, with or without an associated ligamentous lesion, we identified
eighty meniscal tears (in seventy-five patients) that had been assumed to
be stable. Seventy were vertical longitudinal tears and ten were vertical
radial tears. The seventy longitudinal tears included fifty-two lateral and
eighteen medial meniscal lesions. All of the radial tears were in the
lateral meniscus. Of the seventy-five patients, fifty-two had been followed
for two to ten years. At the time of follow-up, only six of these fifty-two
patients had needed additional intervention because of symptoms that were
related to the meniscal tear. Four of them had the intervention after a
sports-related traumatic extension of a stable tear, and two, because
persistent symptoms were caused by the original meniscal lesion. A repeat
arthroscopy was performed on thirty-two patients (twenty-six of whom had a
longitudinal tear and six of whom had a radial tear), at an average of
twenty-six months after the original arthroscopy. Seventeen of the
twenty-six longitudinal tears had completely healed. Five of the six radial
tears had no evidence of healing and one had extended. Neither ligamentous
laxity nor a meniscal tear that was chronic at the time when it was
discovered appeared to preclude healing of the stable longitudinal tears.
No localized degenerative changes in the adjacent articular cartilage were
found in association with any of the stable vertical longitudinal or radial
meniscal lesions. Excluding the six patients who had had additional
surgical treatment, none of the fifty-two patients who filled out a
questionnaire reported that they had symptoms of a meniscal lesion, and
none of the forty-two patients who were re-examined two years or more after
the operation had signs of a meniscal lesion. Stable vertical longitudinal
tears, which tend to occur in the peripheral vascular portions of the
menisci, have great potential for healing. The tear should be left alone
unless it is the only abnormality that is found and it is causing symptoms
that warrant treatment. Stable radial tears, which tend to occur in the
avascular inner one-third of the meniscus, have little potential for
healing. Whether it is best to leave these lesions alone or to fashion an
intact rim by contouring the meniscus was not established by this study.
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