Case Vignette – February 2021

My Mate with the Medial Meniscal Tear

A mate of mine was playing touch football recently and sustained a bucket handle tear involving his medial meniscus. He is in his late forties but is otherwise relatively fit and well.

An MRI scan examination has confirmed that the bucket handle tear exists.

Whilst there is little argument that he will benefit from an arthroscopic procedure, there are two operations that could be performed.

The first is to undergo a simple resection of the bucket handle component. It can be performed as a day case, he may benefit from one or two visits to a physiotherapist, the wounds will have healed within seven to ten days, and he can effectively get on with his life. He has been rendered more vulnerable to the onset and progression of osteoarthritis in that particular compartment of the joint because of the partial meniscal loss. It may be 20, 30 or even 40 years however before the trouble becomes apparent.

The alternative approach is to perform a so-called meniscal repair. This is heavily dependent upon the tear being in the peripheral vascularised zone. If it is not there, and if there is not sufficient blood supply, healing will not occur. Assuming however that it is in the peripheral zone and that it is well vascularised, a repair might be successful. Not all repairs however are successful. It is possible for example that my mate may have to undergo another operation. At the second sitting, maybe that meniscal segment will be removed after all. What could have been a week or two of discomfort can then be extended out to being many months of difficulty, with grossly escalating costs.

Obviously, there is no single answer. Every patient should be treated on his or her merits. It occurs to me however that there are times in medicine when we are driven by altruism to go just a little bit too far. What do you think?