When a meniscus is torn, the options for treatment can include either repair or resection. In most circumstances, we strive to repair the meniscus because it is an important shock absorber for the same compartment of the knee. The loss of the meniscus invariably leads to the development of osteoarthritis over time.
In some circumstances, there can be a small meniscal tear that is not unstable to probing. In these circumstances, trying to stimulate a further healing environment for the meniscus can be a viable option to attempt to get it to heal. These tears would include small tears at the meniscocapsular junction (right up against the joint line) which have a higher chance of healing. Meniscal trephination is not indicated for tears that are more than 1 mm to 2 mm away from the meniscocapsular junction, because the holes in the meniscus created by the trephination could lead to further tearing, with a resultant lower chance of healing due to the decreased blood supply to promote healing in this part of the meniscus.
Meniscal trephination can be performed at the same time as other surgeries. It involves taking a small needle and puncturing into the joint lining and into the substance of the meniscus to try to stimulate a healing response at that location. The desired result from a meniscal trephination is to create a small blood clot at that area which will ultimately lead to scar tissue and healing of the small meniscus tear.
While meniscus trephination is an option for small tears, larger tears invariably need to be sutured to have the best outcomes. Meniscal tears which are unstable to arthroscopic probing should not be trephinated and instead should be repaired with meniscal sutures. We have found that vertical mattress sutures, in an inside out manner, are the gold standard meniscal repair technique and yields the best results and outcomes for patients.