Some experts say that up to 7 mm full thickness of longitudnal tears, and any length of partial thickness for longitudnal tears reaching to only one surface (femoral or tibial) can be left untouched.
I have always been wary about leaving them behind because I feel they are the trigger points for future extensions.
Dear Ravi
The treatment of a meniscal injury will depend on its location, size, time of occurrence, age and level of sports activity of the patient. In my opinion, the treatment may be non-surgical for elderly patients with low functional demands and the remaining patients i performl arthroscopic surgery, even with minimal damage because I agree with you that this minimal lesion can evolve and cause more damage than it was
I agree with Nelson but only to some degree. As far as the minimal lesions are concerned, one should decide from case to case. I believe that in patients with meniscal lesions that cause no joint blockages the meniscus should be left untouched. One should keep in mind that a meniscectomy (partial or total) leads to changes in the joint biomechanics that could be more detrimental than minimal lesions per se. Unfortunately, hyperdiagnostics is typical for arthroscopic surgery.
Thanks Dr Tanchev!
It appears that you recommend all partial tears (reaching to one surface of meniscus) to be left untouched and also probably the small flap tears. It may be good if you can further quantify it.
And during arthroscopy, do you you perform range of motion of the knee to see if the meniscus is blocking the movement
or
you try to see the movement of the torn meniscus with a probe. or you
Performing range of motion during surgery to exclude blocking from partial meniscal tear is mandatory.It is very important to test the end positions of ROM,incl. the so-called home-screw mechanism.
All thoughts mentioned above are valid and wise but to my experience the inferior tears (reaching the tibial surface) are more safe thatn the femoral as there is difference of the articulating surfaces with the meniscus. So in young people I tend to check the stability, the locking with the hook and the movements as it is told above and if I find that there is mobility or tendency to lock I remove the tear. I confence that I am acting on my feelings and my observations and not on literature evidence but my patients are happy.
Exactness in mm is not really possible since there are many other variables. However the resection is a balance between removal and retention. Establishing the stability of the remaining fragment is important and avoid leaving any tear that could act as a stress riser.
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