The meniscus is a cartilage disc and cushion within the knee. Meniscus tears are common in athletes. Surgical removal of a the meniscus tear is referred to as a partial menisectomy. If an elite athlete requires a partial menisectomy, then research shows that the athlete has a significant chance of developing osteoarthritis. To minimize the risk of developing knee arthritis, many surgeons may recommend a meniscus repair, instead of a partial meniscectomy. During a meniscus repair the torn meniscus is sutured together. A meniscus repair may provide protection against developing arthritis from a meniscus tear.
Knee injuries are more common in contact sports. Meniscus tears and ACL injuries are both very common in young football players. Osteoarthritis can be the end result of a severe knee injury. The elite athlete most at risk for osteoarthritis had a partial menisectomy, or removal of a torn meniscus.
Osteoarthritis is the long term, end result of chronic repetitive damage to the knee, or it can be due to the long lasting effects of one or more severe injuries resulting in the need for knee surgery. It is well known that professional football players have a high incidence of knee osteoarthritis. Until recently we knew little about the incidence of osteoarthritis in the elite, college level football player.
Partial Menisectomy in College Athletes
In a recent study of football players at the NFL combine, 27 percent of players who had a previous partial meniscectomy (removal of a torn meniscus) had developed moderately severe osteoarthritis. This compares to 4% of athletes who had osteoarthritis but no prior history of knee surgery. 24% of players who had a previous ACL reconstruction also had osteoarthritis. This compares to an 11% incidence of osteoarthritis in players who had a meniscal repair – where the tear of the meniscus is sutured back together.
One in 4 American Football players at the NFL Combine with a history of knee surgery have knee osteoarthritis despite being only 20 to 26 years of age.
Osteoarthritis is a common cause of disability. Although it is not known if these players had significant pain, it is well known that these arthritic changes will cause pain in the not too distant future of these young athletes.Osteoarthritis means that the cartilage in the joint has worn away. There is currently no proven means to reverse arthritic changes. PRP injections have been shown to potentially stop the progression of arthritis, but it is not a cure.
Partial Menisectomy and Knee Arthritis
This was one of the first studies to follow young elite football players to determine their risk of developing osteoarthritis following a partial menisectomy or ACL reconstruction. Much more research is necessary. We also need to carefully consider advising a meniscal repair versus a partial menisectomy (removing torn meniscus) in young elite athletes.
Partial Menisectomy or Meniscus Repair
When faced with a meniscus tear in an elite athlete there is significant pressure to return that athlete to the playing field. A meniscus repair will result in a far longer recovery due to the need to allow the meniscus to heal. A partial menisectomy will result in a quicker return to play…. but that comes with a potentially significant long term cost to the health of the athlete’s knee. Preference should be given to a meniscus repair and recent studies show that more meniscus tears are in fact repairable than previously thought possible. When you are discussing how your meniscus should be treated it is very much worth your time to discuss repair options versus a partial meniscectomy or removal of the torn piece.