What is meniscus repair, and how does a stitched meniscus actually heal?

What the operation involves

Through two or three small cuts, an arthroscope lets the surgeon see inside the knee. The torn edges are freshened to encourage healing, then held together with special sutures, sometimes anchored with small devices that sit against the outside of the meniscus or the joint capsule. Depending on the tear, all-inside, inside-out or outside-in techniques are used, often in combination.

How healing happens

Healing depends on blood supply. Tears near the outer rim receive blood from the joint capsule, which brings cells that build scar tissue across the tear. Over the first weeks this tissue is weak. Over roughly three to six months it matures and strengthens. That is why the knee may feel fine long before the meniscus can safely take deep squatting or pivoting.

What helps a repair heal

• A tear in the blood-supplied outer zone
• A fresh tear rather than one left for many months
• A stable knee, which often means reconstructing a torn ACL at the same time
• Not smoking, and good control of conditions such as diabetes
• Following the rehabilitation limits on bending and loading

Some surgeons add techniques that release healing factors from the bone marrow into the joint. Whether this is used depends on the tear and the surgeon's judgement.

Who is a candidate

Repair suits many tears in younger and active people, bucket-handle tears seen early, and root tears in suitable knees. The final decision is often made during the arthroscopy, once the tear can be seen and probed. Dr. Gelber discusses this possibility with patients in Doha before surgery.