Degenerative Meniscus Tears

In the case of older, degenerated (weakened and worn) menisci that typically split apart or break down under routine, day-to-day or minimal stress conditions, the meniscus itself has not been healthy for some time. A degenerative meniscal defect will almost never bleed, and in fact may often occur gradually, without the patient even being aware of it! When such gradual, degenerative meniscal cleavage or fissuring develops and is discovered by MRI scanning or arthroscopy, while it is still commonly said that the patient "tore" their meniscus, this is actually a mischaracterization. To most people, "tearing" something implies a sudden structural failure in response to a specific, applied force. While the terms "torn" and "tear" are convenient for surgeons to use because they are familiar to patients, it is misleading to use them in relation to a degenerated meniscus that is simply worn, frayed, fissured, fragmented or just plain broken down. When a patient hears a surgeon say "You have torn your meniscus", they naturally infer that their meniscus was healthy and functioning properly before it "tore", and that like freshly torn ligaments, their "torn" meniscus can simply be repaired back together again or "fixed", neither of which is the case with degenerated menisci. Within the confines of currently available medical technology, degenerative meniscal defects are almost never amenable to repair. Degenerate menisci break down either spontaneously or under minimal stress because their intrinsic strength and toughness have already been compromised by way of the aging process and/or joint surface erosion caused by arthritis. Attempts at surgical repair are, therefore, pointless and usually doomed to failure. There is little to be gained by trying to stitch mushy, permanently weakened and improperly functioning meniscal tissue back together again. For lack of a better available treatment, surgical removal of the painful, defective meniscal tissue is usually the most appropriate course of action

Degenerative meniscal defects can often be recognized by their appearance on an MRI scan and/or the circumstances under which the meniscus broke down (usually just routine daily "life" or during minimal stress, absent any genuine knee trauma). The age of the patient is also often a significant clue, as most degenerative tears occur in individuals over thirty. Many menisci were simply not genetically engineered to "go the distance", at least with respect to current human longevity. A thirty-year-old patient with a failed or failing meniscus may find the latter concept a bit difficult to accept, but from an evolutionary perspective, one must realize that for well over 99% of mankind's existence on this planet, the average human lifespan may have been 25 years or less due to the ravages of scarce food supply, a hostile environment and disease. There simply wasn't much point in nature developing menisci that lasted all that much beyond the age of thirty. The fact that some menisci last sixty or more years (mainly in people with "good genes" who do not let themselves get overweight) is actually what is biologically most remarkable!