Am I too old for meniscus repair if I am over 40?

Why age used to be a cut-off

Older studies suggested repairs healed less reliably in older patients, and many surgeons set an informal limit around 40. The reason was less the number of birthdays than the tissue: meniscus fibres become more degenerate with age, and degenerate tissue holds stitches and heals less well. Newer evidence shows that carefully selected older patients can heal repairs, so the decision has moved from age to the knee itself.

Tears that may still be repaired after 40

• A clear injury tear, such as from padel or football, in otherwise good-quality tissue
• A root tear, which often happens in middle age and behaves like losing the whole meniscus
• A tear occurring together with an ACL injury
• A displaced bucket-handle tear in a knee without significant arthritis

When repair is less likely to help

Long-standing degenerative tears, frayed complex tears and tears in a knee that already has moderate or advanced arthritis usually do poorly with stitches. In these knees exercise therapy is generally first, and if the knee is bowed and the inner side is wearing out, treatments that address alignment or the arthritis itself may be more relevant than the meniscus.

How the decision is made

Dr. Gelber looks at the history, examination, MRI and standing X-rays together. Fitness, body weight and your willingness to follow a slower recovery all count. Sometimes the final decision is made during arthroscopy, once the tissue can be seen and probed. Patients at Aman Hospital in Doha are told in advance what will happen in either case.