Should Marathon Runners Get Surgery for a Torn Meniscus?

by Dr. Robert Marx

With the NYC marathon just a few months away, many people are ramping up their training in order to run through the five boroughs with over 40,000 others. It is a great day for NYC, with people of different ages, nationalities and fitness levels running together as a group.  However, injuries are a part of sport and marathon running and are no exception. Distance running puts enormous stress on many parts of the body, including the knee.  In fact, one of the most common injuries to the knee is the meniscus.

What is a meniscus? 
There are two menisci in each knee, one medial (inside) and one lateral (outside). The menisci are made of fibrocartilage and serve as shock absorbers between the ends of the thigh bone (femur) and the shin bone (tibia). The meniscus is attached to the capsule of the knee joint, which is richly innervated. Although the meniscus does not have nerves, a torn meniscus can pull on the capsule, causing pain.

How do meniscal tears happen?
Meniscal tears in runners usually result from overuse. They can also result from a sudden injury.  Meniscal tears usually occur in degenerative menisci, and can occur in people of all ages. The average age for a meniscal tear is in the forties, but runners young and old can suffer from these tears.

Non-operative & operative treatment for mensical tears
Small meniscal tears often do not require any treatment and may not even bother the patient. In fact, it is common for people to have an abnormal appearance of their meniscus on MRI, but have no symptoms. Not every torn meniscus requires surgery. But for runners who are unable to run, and have symptoms, physical examination and MRI evidence consistent with a meniscal tear, surgery may be necessary. In many cases, surgery can be avoided with non-operative treatment such as physical therapy, anti-inflammatory medications and the use of a brace. If not, arthroscopic surgery, which requires two small incisions around the knee, can be used either to remove or repair (stitch) the torn piece.

Most meniscal tears require meniscectomy, which is an excision of the torn fragments, because the meniscus has a limited blood supply and often does not heal.  Certain tears are amenable to repair that includes stitching the torn pieces back together. Rehabilitation after a meniscectomy is quick, with patients usually walking normally within a week or two. Compared to excision, rehabilitation is longer after a repair because the tissue must heal. Physical therapy is necessary to regain sufficient strength to be able to run again.

Dr. Robert Marx, Orthopedic Surgeon

Running again after surgery

Patients usually start running within two to three months, although some start earlier than that. Of course, running a marathon requires several months of training beyond that. Most patients who undergo meniscectomy can return to running without problems and do not have a significantly increased risk for arthritis, unless they have their entire meniscus removed, which is rare. Patients with preexisting arthritis of the knee often have a meniscal tear, but may or may not have significant improvement with surgery since the arthritis may be the cause of their pain, not the meniscal tear.  Patients with arthritis of the knee should approach arthroscopic surgery of the knee with caution. Consult with your physician about returning to running if you’ve had surgery.