A: Okay, I am finally ready to hear the bad news. Tell me how long it will take to get back on the football field. I'm 16, play defensive end, and have a torn meniscus. Coach isn't making any guarantees -- just saying, We'll see how rehab goes.

It's clear now that a torn meniscus (cartilage) in the knee should be repaired whenever possible. The previous practice of surgically removing the meniscus resulted in early osteoarthritis. So that practice has been abandoned unless it's completely unavoidable for some reason.

But there isn't a lot of data on these kinds of injuries in younger patients (children and teens). A recent study published by surgeons at the Mayo Clinic in Rochester, Minnesota looked at just teens (up to and including age 18) who had meniscus tears along with damage to the anterior cruciate ligament. They compared the results of surgical treatment for this group with another (previous) group studied who just had meniscal tears.

The measure used to determine results included knee range of motion, stability of the joint, pre- and post-op X-rays, and function. Function was assessed by looking at the activity level before injury, just before surgery, and after surgery. Everyone was in a rehab program after surgery and treated with the same protocol.

They found that return-to-sports involving sudden changes in direction (pivoting and cutting) was possible six to nine months after surgery for those with complex injuries before surgery. Complex means more than one part of the knee was damaged.

Only those athletes who demonstrated good knee stability after surgery were released to full participation. Patients with just a meniscal tear were able to return to their pre-injury level of sports participation much sooner (four to six months after surgery) -- if the meniscal repair was successful. And success was defined as no pain (or only mild pain that didn't restrict activities) and no locking, catching, or swelling of the knee.

There is a high rate of meniscal retear even with rehab so a bit of caution is advised (and obviously practiced by your coach). Retears can't always be repaired (or re-repaired in this case). Removing part or all of the meniscus often leads to early arthritic changes in that knee and that's what surgeons, coaches, and patients would like to help patients (players) avoid.

Reference: Aaron J. Krych, MD, et al. Surgical Repair of Meniscal Tears with Concomitant Anterior Cruciate Ligament Reconstruction in Patients 18 Years and Younger. In The American Journal of Sports Medicine. May 2010. Vol. 38. No. 5. Pp. 976-982.