Treatment of Radial Tear of Lateral Meniscus in Active Adults
For an active adult with a radial tear of the lateral meniscus, arthroscopic repair is the recommended treatment, as radial tears are biomechanically devastating and repair provides an 86% functional healing rate at 5 years with return to pre-injury sport levels. 1
Why Repair Over Meniscectomy
Radial tears are more biomechanically detrimental than longitudinal tears because they disrupt the circumferential collagen fibers that bear hoop stresses, rendering the meniscus functionally incompetent even if tissue remains. 2 This leads to meniscal extrusion and accelerated arthritic changes in the lateral compartment. 3
- Meniscectomy does not prevent degenerative changes and should not be considered first-line treatment in young, active patients. 4
- The British Medical Journal guidelines emphasize that arthroscopic surgery for degenerative meniscal tears provides minimal benefit, but these recommendations apply to degenerative tears in older patients with osteoarthritis, not traumatic radial tears in active adults. 5, 6
Surgical Technique Selection
Multiple repair techniques are effective with no statistically significant difference in outcomes: 1
- All-inside suture repair using devices like QuickPass SutureLasso with 2-0 FiberWire shortens the gap by drawing meniscal stumps circumferentially and avoids bunching the meniscus to the capsule. 4
- Outside-in technique using 3 sutures through standard arthroscopic portals provides excellent reduction. 3
- Combined techniques (all-inside plus outside-in) can be used based on tear characteristics. 1
The choice depends on surgeon experience and tear location, as all approaches yield similar functional healing rates of 86% at mean 5-year follow-up. 1
Expected Outcomes
- 86% of patients achieve functional healing and return to pre-injury sport levels. 1
- Significant improvement in IKDC, Lysholm, and Tegner scores postoperatively. 1, 2
- Mean Lysholm score of 94.7 and Tegner activity score of 5.7 at final follow-up. 2
- Most failures (13%) occur within 2 years of repair, typically at the original tear site. 1
Postoperative Management
- Early mobilization to reduce pain and improve function—avoid complete immobilization to prevent muscular atrophy. 6
- Structured physical therapy focusing on quadriceps and hamstring strengthening. 6
- NSAIDs and cryotherapy (ice through wet towel for 10-minute periods) for pain and swelling control. 6
- Weight-bearing restrictions for 2-7 days, return to sedentary work within 1-2 weeks, and return to physical labor/sports at minimum 6 weeks. 6
Critical Diagnostic Consideration
Before proceeding with isolated meniscal repair, always evaluate for concurrent ACL injury, as meniscal tears are typically a consequence rather than cause of knee instability. 7 The most common clinical error is attributing instability to a meniscal tear when the underlying problem is ligamentous injury. 7
- MRI is the gold standard with 96% sensitivity and 97% specificity for diagnosing meniscal tears and concurrent ligamentous injuries. 7
- If ACL deficiency is present, address the ligamentous instability first or concurrently, as ACL-deficient knees have significantly elevated risk of subsequent meniscal damage due to altered biomechanics. 7
Special Note on Healing Potential
Radial tears involving the red-red or red-white vascular zones have documented healing potential, with one case report demonstrating spontaneous healing of a radial lateral meniscus tear. 8 This supports the biological rationale for repair in appropriately selected patients with vascular zone involvement. 2