The meniscus is very important to the long-term health of the knee. In the past, surgeons would simply take out part or all of an injured meniscus. But today's surgeons know that removing the meniscus can lead to early knee arthritis. Whenever possible, they try to repair the tear. If the damaged area must be removed, care is taken during surgery to protect the surrounding healthy tissue.
Once diagnosed with a meniscus tear, a decision needs to be made regarding the treatment of this problem. Many meniscal tears, particularly chronic tears, can be treated non-operatively.
non-operative treatments may include:
- Physical therapy,
- Strengthening exercises,
- Anti-inflammatory medications, and
- Cortisone injections.
Why perform a meniscus repair?
In some situations, your surgeon may offer a meniscus repair as a possible surgery for damaged or torn cartilage. Years ago, if a patient had torn cartilage, and surgery was necessary, the entire meniscus was removed. These patients actually did quite well after the surgery. The problem was that over time, the cartilage on the ends of the bone was worn away more quickly. This is thought to be due to the loss of the cushioning effect and the diminished stability of the joint that is seen after a meniscus is removed.
When arthroscopic surgery became more popular, more surgeons performed partial menisectomies. A partial meniscectomy is performed to remove only the torn segment of the meniscus. This works very well over the short and long term if the meniscus tear is relatively small. But for some large meniscus tears, a sufficient portion of the meniscus is removed such that problems can again creep up down the road.
Who needs meniscus repair surgery?
Tears of the meniscus that cause so-called "mechanical symptoms" tend to respond best to surgical treatment. A mechanical symptom is caused by the meniscus physically impeding the normal movement of the knee.
Common "mechanical symptoms" include:
- Locking of the knee (unable to bend)
- Inability to fully straighten the knee
- A popping or clicking sound or sensation
In the operating room, the surgeon has two primary options, either remove the torn meniscus (a partial meniscectomy) or perform a meniscus repair to place the edges together with sutures or tacks.
How is the meniscus repair performed?
Techniques of meniscus repair include using arthroscopically placed tacks or suturing the torn edges. Both procedures function by reapproximating the torn edges of the meniscus to allow them to heal in their proper place and not get caught in the knee causing the symptoms described above.
What happens during meniscal surgery?
Meniscal surgery is done using an arthroscope, a small fiber-optic TV camera that is used to see and operate inside the joint. Only small incisions are needed during arthroscopy. The surgeon does not need to open the knee joint.
Before surgery you will be placed under either general anesthesia or a type of spinal anesthesia. The surgeon begins the operation by making two or three small openings into the knee, called portals. These portals are where the arthroscope and surgical instruments are placed inside the knee. Care is taken to protect the nearby nerves and blood vessels.
What happens after meniscal surgery?
Meniscal surgery is done on an outpatient basis. Patients usually go home the same day as the surgery. The portals are covered with surgical strips, and the knee may be wrapped in an elastic bandage.
Crutches are used after meniscal surgery. They may only be needed for one to two days after a simple meniscectomy. Surgeons specify how much weight can be borne after meniscal repair or allograft transplant. Patients having meniscal repair are usually told not to place any weight on the foot for four to six weeks after surgery. After a transplant procedure, most patients are instructed to touch only the toes of the operated leg on the ground for four to six weeks. Some sugeons allow their patients to place a comfortable amount of weight on the foot four weeks after repair or transplant surgery.
Patients who have had a meniscal repair or transplant usually wear a knee brace for at least four weeks. The brace keeps the knee straight. It is removed often during the day to do easy range-of-motion exercises for the knee.
Follow your surgeon's instructions about how much weight to place on your foot while standing or walking. Avoid doing too much, too quickly. You may be told to use a cold pack on the knee and to keep your leg elevated and supported.
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