In knee injuries, the phrase “ACL tear” is probably the most dreaded words that you could ever hear, while having a torn meniscus does not seem to be as terrible. But which injury is worse than the other? As in all things, it depends on the situation. For the purpose of this article, I will compare strictly an ACL tear vs a meniscus tear.
First of all, there are some components to compare:
ACL Tears and Meniscus Injuries can occur together. Often when someone tears their ACL, the medial meniscus is also torn or sprained. These two injuries are addressed in the same surgery. The meniscus can be repaired or debrided.
Both injuries can be treated either conservatively or with surgery. For meniscus injuries, the option to hold surgery would depend on the severity of the tear and if there is good blood supply.
If the meniscus tear lies within an area with good supply, the tear may be able to heal on its own. However, surgery may be required. The common surgery has been a meniscectomy. A meniscectomy entails removing the damaged piece of the meniscus.
Typically, this procedure is only performed when the meniscus tear is an avascular area, meaning very poor blood supply. With performing a meniscectomy, the knee joint loses the structure that provides “cushion” between the femur and the tibia.
The other surgical option is a meniscus repair. A repair can only be performed when the tear is a part of the meniscus with good blood supply. This is when the damaged part of the meniscus is repaired with sutures and is anchored down to the tibial plateau. The repair keeps the structure of the meniscus well intact.
The severity of an ACL sprain will determine whether or not surgery will be considered for the patient. However, surgical intervention is most likely required especially in athletic patients.
A patient that is older or not active may opt-out of surgical intervention. They may perform physical therapy to rebuild the strength of the knee, but the knee will always have increased instability.
It is important to note that the majority of ACL tears typically have an associated meniscus tear. But as mentioned earlier, we will look at strictly ACL tears.
An ACL repair is performed with either an autograft (your own) or an allograft (donor). An ACL repair is the best way to correct the stability of knee joint and allowing the patient to return to sporting activities.
The recovery time of meniscus tears and ACL tears differ drastically. With surgical intervention, a meniscectomy has the shortest recovery time.
A patient typically has about 4 to 6 weeks of recovery time and then is able to return to usual activities or athletics. The recovery time is extended with a repair of the meniscus.
A patient is usually placed on non-weight bearing and range of motion restrictions for 4-6 weeks and then may progress to full weight bearing and range of motion. A patient is looking at a full recovery around 4-6 months.
Finally, an ACL repair has the longest recovery time. A patient will typically have a recovery time between 6 – 9 months. An athletic patient may take longer to regain the proper strengthening and conditioning before returning to play.
As with any surgery, a patient may be predisposed to complications later on. With a meniscectomy, the patient is losing that layer of cartilage to help provide “cushion” and stability to the knee joint.
Long term the patient is likely to have increased chances of osteoarthritis of the knee. A meniscal repair will help reduce the effects of osteoarthritis because the damaged cartilage is repaired and saved versus being removed.
An ACL may possibly have the least long term effects. Some patients may have decreased strength of the operated side and increased patellar tendinitis. But if the recovery goes well, the patient will not have any instability issues which highly reduce the chances of progressive osteoarthritis.
If you want to learn more about the ACL, go to this ACL Video.
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