Overview
Treatment for a meniscal tear may be conservative (physiotherapy) or surgical (meniscal repair or meniscectomy), depending on several factors:
- the patient's age
- their level of activity
- the type of tear
- the severity of symptoms
Locking and giving way are the most concerning symptoms, and in patients of any age these are usually best addressed with surgery. Where pain is the only symptom, without locking or instability, a trial of physiotherapy for at least three months is typically recommended first. If pain persists beyond this point, a further discussion is needed to determine the most appropriate next step, which may include surgery.
The Procedure
Meniscal repair
Historically, all meniscal tears were treated by removing the torn tissue, and this remains a perfectly acceptable treatment in the right circumstances. However, decades of research and biomechanical study have shown how important it is to preserve meniscal tissue wherever possible, in order to protect the joint surfaces of the knee. As a result, every tear should now be assessed for its potential to be repaired rather than removed.
Repair is generally suited to tears with a good likelihood of healing, such as peripheral, bucket handle, and vertical tears. The meniscus can be divided into zones based on blood supply: the red zone (highest vascularity and the greatest chance of successful healing), the red/white zone, and the white zone (lowest vascularity and, traditionally, the most limited healing potential). Modern techniques, including the use of biological therapies alongside repair, have now made successful outcomes possible even for white zone tears.
Several repair techniques may be used, including inside-out, outside-in, and all-inside methods, employing different suture materials and devices depending on the nature and location of the tear.
Where appropriate, Mr Barkatali enhances meniscal repairs using a range of biological augmentation techniques to further promote healing. This can include preparation of the tissue around the joint capsule to encourage localised bleeding into the repair site, helping to stimulate the body's natural healing response. Another technique is notch venting — a small perforation of the femoral notch that releases stem cells and other reparative cells from the femoral canal into the knee joint. Mr Barkatali also makes use of platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) to create a thrombin clot, which is placed alongside the meniscal repair. This provides a concentrated source of natural growth factors at the repair site, further supporting the healing process.
Together, these techniques reflect the same underlying principle driving modern meniscal surgery: wherever there's an opportunity to help tissue heal rather than simply removing it, that opportunity should be taken.
Meniscectomy
Arthroscopic meniscectomy is a well-established, commonly performed keyhole procedure in which the torn or unstable portion of meniscus is removed. Performed under general anaesthetic through small incisions using a camera and fine instruments, it is a reliable option for tears that are not suitable for repair, generally providing good pain relief and restoration of function. However, the more meniscal tissue that is removed, the higher the long-term risk of osteoarthritis developing in that part of the knee.
Weighing up the options
Each approach has its own advantages. Meniscal repair offers superior long-term joint protection, but recovery is more demanding: the repair must be protected with restricted weight-bearing, bracing, and crutches, and patients are typically unable to drive or walk normally for around six weeks, followed by a further six to twelve weeks of rehabilitation.
Meniscectomy, by comparison, is a smaller procedure with a shorter recovery, typically around two to six weeks.
Outcomes
- 20+ years of experience.
- 1000+ surgeries
- <5% failure rate
Healing Begins Here
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5*
<1%
5000+
20+
“I dealt with instability from a meniscus tear for over 10 years, putting it down to growing pains. Mr Barkatali immediately identified the tear, and explained that it was better to get it sorted while I was young and mobile.
Recovery has been fantastic. I was in a brace and on crutches for the first six weeks, followed by great physiotherapy. Now, just four months after surgery, I’m already back to running and gym workouts. My knee is much more stable, and I’m finally balancing my weight evenly again. The surgery was great and the aftercare has been fantastic.”
David Fardon, Meniscal Repair in December 2020, aged 25.
“After the surgery, Mr Barkatali explained... the different things he'd done just to improve the procedure, like he drilled up into the femur to extract stem cells and then put them into the meniscus to increase the blood flow... It's healed very, very well. I went skiing three weeks ago for a week and had no issues at all. I would 100% recommend him to anyone.”
Sam Peacock (Lacrosse Player), Meniscus Repair in October 2023, aged 20.