Meniscus Repair: From Excision to Preservation

With the newer all-inside technique and fiber tape augmentation, patients can weight-bear from day one using a walking aid for three to four days until pain settles, though supervised physiotherapy is still required. Full graft incorporation into bone takes about six weeks. Running and jogging can resume at three months, and return to sport is not advised before three months, since many failures happen when patients return to pivoting activity too soon.

For the knee, heavily loaded squats, especially with all the focus on upper body and inadequate lower limb conditioning, high-speed incline treadmill running, twisting exercises on a disc twister, and overloaded quadriceps extension machines are the most common causes of ACL ruptures and quadriceps or patellar tendon injuries. For the shoulder, wide-grip flies taken too far posteriorly can stress the joint, especially in anyone with a prior subluxation history. The most important message is to stop when the body signals pain rather than pushing through it.

A thorough history of the mechanism of injury tells a doctor about 70% of what they need to know, since mild pain from ordinary walking is very different from a pop felt during sport followed by an immediate fall. Persistent pain despite conservative treatment should not be dismissed as non-compliance; something is usually being missed and warrants an MRI. Any significant mechanism of injury deserves a low threshold for imaging without delay, since ACL repair rather than reconstruction is possible if the patient is seen within two to three weeks of injury. Once an MRI is available and there is uncertainty about the findings, a second opinion through Jivo can confirm whether the patient needs conservative treatment, local surgery, or referral to Artemis.

A single ligament reconstruction, ACL or PCL, costs approximately $4,000 to $4,500, all-inclusive from admission to discharge. Meniscal debridement alone is $2,500 to $3,000, and meniscal repair ranges from $4,000 to $5,000 depending on the number of suture anchors used, at roughly $500 each. A simple Bankart repair for shoulder instability costs $4,000 to $5,000, with remplissage adding about $1,000. PRP injections without surgery run about $500 per injection, with 3 to 4 injections typically needed over roughly six weeks.

Ligament reconstruction, ACL or PCL, has a 98 to 99% success rate, with failures very rarely seen. Meniscal repair success depends on how much of the meniscus is torn and how early the patient presents, but even large tears repaired a year after injury succeed around 90 to 95% of the time. Shoulder stabilisation surgery, Bankart repair or Latarjet, is 95 to 98% successful when planned correctly, and rotator cuff repair succeeds 90 to 95% of the time.

The meniscus is the only shock absorber between the femur and tibia. Removing it leaves the two bones' cartilage grinding directly against each other, and arthritis follows within months to years, so modern practice preserves it whenever possible.

A ramp lesion is a hidden meniscal injury that is not visible from the standard arthroscopic view, so a knee can be scoped, show no obvious tear, and still have a missed ramp lesion. Surgeons now routinely check from a posterior medial portal or with a 70-degree scope to avoid missing it.