Many studies in adults have proven now the importance of the meniscus (cartilage) in the knee. It used to be common to have a torn meniscus just removed surgically. But years of investigation have shown that the end result of that treatment approach is early knee joint arthritis. So now, the damaged meniscus (menisci - plural) is carefully repaired whenever possible.
But what about young athletes with the same type of (meniscal) injury? What kind of results do they get with arthroscopic meniscal repair? This study from the University of Michigan in Ann Arbor helps answer those questions. They followed 49 cases of knee arthroscopic surgery used to repair knees with either an isolated meniscal tear or a combined meniscal and anterior cruciate ligament (ACL) tear.
They measured the results using level of knee pain, knee range-of-motion, and physical activity. The surgeons noted any physical limitations. Scores from a specific survey (Tegner and International Knee Documentation Committee or IKDC) designed to measure function were also included.
The authors also paid attention to results based on patient age at the time of injury and time between injury and surgery. MRIs were used to determine type of injury (isolated meniscus, meniscus plus ACL tear, type and extent of meniscus injury). X-rays showed if the physes (growth plates at the ends of bones) were still open or not as this could be an important factor in the outcomes of treatment.
A study like this is important because more and more young athletes are injuring their knees. The important role of the meniscus in sharing the joint load and as a shock absorber and knee stabilizer has been well-documented. Having some understanding of the healing rates and long-term results of surgery for this age group will help surgeons advise and counsel young patients. Knowing if bone age makes a difference aids in this process.
The patients in this study ranged in ages from nine to 17. There were twice as many boys as girls. Growth plates were open at the time of surgery in most (78 per cent) of the group. The number of athletes with open physes was the same in the meniscus tear only group versus the combined meniscus and ACL injury group. After gathering all the data and analyzing it, here are the significant findings:
Only two athletes required a reoperation after the initial repair. Both occurred as a result of another injury in athletes with completed bone growth (closed physes).
Reoperation did not seem to be linked with any delays in having the first surgery.
Most of the athletes were able to get back into competitive play at their preinjury level about six months after surgery. The exception were those who had a retear and patients who also had an ACL tear. These two groups required a longer rehab period before returning to full sports participation.
With the exception of the two athletes who reinjured their knees, healing was 100% after two years. Even tears in menisci that wouldn't normally heal in an adult were restored.
This study showed the importance of arthroscopic surgical repair of torn menisci in young athletes. Good results were obtained even for cartilage located in areas of little blood supply. The status of growth plates (open versus closed) does not seem to make a difference in results. The surgeons performing this study also note that the arthroscopic technique they used (called inside-out) was a significant factor in the healing response.
Reference: Kelly L. Vanderhave, MD, et al. Meniscus Tears in the Young Athlete: Results of Arthroscopic Repair. In Journal of Pediatric Orthopaedics. July/August 2011. Vol. 31. No. 5. Pp. 496-500.