Repair or Replace: Which is best after ACL injury?

Doctors explain options, how age plays role in decision

HOUSTON – A misstep on the sports field or an awkward move while twisting or turning at home or work can lead to an ACL injury. Sometimes it doesn't take much to tear the meniscus, the rubbery piece of cartilage protecting the knee. When there's a tear that won't heal, is it better for doctors to repair or replace?

Seventeen-year-old Owen Joyce loves to practice soccer with his brother, Reilly. Joyce is a three-sport varsity athlete.

During tryouts last spring, he made a sudden move and another player fell onto his leg.

"When I went to lift it up it caved in, and this part of my knee went straight to the ground and it kind of noodled out. And it just felt like a huge release of pressure," Joyce said.

Joyce had an ACL injury and a torn meniscus; Both required surgery.

"Many, many years ago, meniscus tears were thought to be best dealt with by just taking the whole meniscus out. Unfortunately, that led to a lot of arthritis," orthopedic surgeon Dr. John-Paul H. Rue said.

Over the past 10 years, studies show a growing number of patients are opting to have the meniscus repaired.

"As we've gotten better with technology and the surgical tools and our ability to fix these or repair these, we've become more skilled at preserving the meniscus," Rue said.

Rue said surgeons weigh a patient's age and the extent of the injury. If the tear is in what they call the "red zone," where there's good blood supply, that helps with healing. One drawback is recovery after repair is slow -- six to eight weeks.

It's been several months since doctors repaired Joyce's ACL and meniscus. He's almost full strength.

Joyce has some advice to others in the same position.

"Your time will come soon enough when you are going to be able to get back on that field and play the way you used to," he said.

As we age, the meniscus becomes more brittle, making it more susceptible to tears. Minor tears can go away in two or three weeks. Moderate to severe tears often require treatment. The good news is that Joyce has just been fully cleared to play soccer again.