Treatment of Meniscus Tears Not Always "Routine"

 

The best orthopedic surgeons know that the type of tear and its location are the true dictators of how to proceed with a treatment that ensures not only restoration of function, but also helps protect the knee against future injury.

When sports medicine specialists see the same injuries over and over again, like meniscus tears, it's easy to dismiss them as routine and treat them the same way in every patient. Yet, the best orthopedic surgeons know that the type of tear and its location are the true dictators of how to proceed with a treatment that ensures not only restoration of function, but also helps protect the knee against future injury.

Woman with knee pain

A Painful Example: Derrick Rose
Derrick Rose, the 2010-11 NBA MVP, has so far had a bit of a rough start to a very promising career. Last year, he tore his ACL during the playoffs, requiring surgery and rehabilitation that cost him the entire 2012-13 season. Then, in November 2013, he suffered a meniscus tear. This time, the Bulls announced immediately that Rose would be out for the full season, a decision that was in stark contrast to the previous year, when no one ever officially committed to whether Rose was in or out the entire season. The constant speculation over whether or not his ACL had healed up enough to allow him back in the game put a ton of pressure on both Rose and the entire team.

Are the Bulls closing the door on Rose's 2013-14 season too early, or are they smart to play it safe? Despite Rose's insistence to the press that he'd be happy to join games later on in the current season, injury permitting, the Bulls are adamant that the choice be taken out of his hands completely. Their stance is that they'd rather have both knees fully healed than risk the entire future of his career.

Options for a Meniscus Tear
Rose isn't the first NBA player to go down with a meniscus tear, and certainly won't be the last. Yet, other team managers don't always make the same call. What's different about Rose that has his doctors saying they don't want him back on the court early?

There are three basic treatment options for a meniscus tear:

  • Conservative Treatment: Following the RICE formula-Rest, Ice, Compression and Elevation, plus some physical therapy and likely wearing a knee brace.
  • Repair: Surgery is performed to repair the torn meniscus by suturing the ends back together.
  • Removal: Partial removal of the damaged area of the meniscus.

Treatment is determined by the degree and location of the injury. For example, a small tear in the red zone (the outer edge of the meniscus) will often heal up on its own with just conservative treatment. A larger tear may need knee surgery; however, a large tear that's located entirely within the red zone will heal better compared to one that extends into the white zone; this is because of the more generous blood supply to the red zone compared to the white.

Doctors decided that Rose's injury was too advanced for conservative treatment, yet they chose the option for surgical repair rather than removal, even though removal results in a faster recovery that might put Rose back on the court before the season ends. Why not choose the path of quick healing?

What many doctors don't tell their knee surgery patients is that while partial or total removal of the meniscus might have a faster short-term recovery, the long-term prospects aren't as encouraging. Even partial meniscus removal increases the chances of developing osteoarthritis of the knee later in life; for a serious athlete like Rose, meniscus removal is also likely to mean a much shorter career over the course of his lifetime. It's not worth the trade-off.