Meniscus Repair – Menisectomy

1.Meniscus Repair

Meniscus Repair1

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
  • Cortisone Injections

 

Why perform a meniscus repair?

 

Some meniscus tears may require surgical treatment. In some situations, your surgeon may offer a meniscus repair as a possible surgery for damaged or torn cartilage.Your doctor will likely suggest the treatment that he or she thinks will work best for you based on where the tear is, the pattern of the tear, and how big it is. Your age, your health, and your activity level may also affect your treatment options.

 

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

 

These symptoms occur when a fragment of the meniscus tears free and gets caught in the hinge mechanism of the knee, like a pencil stuck in the hinge of a door. 

A torn meniscus can cause long-term problems. The constant rubbing of the torn meniscus on the articular cartilage may cause the joint surface to become worn, leading to chondromalacia (softening of the cartilage) which is a precursor to Osteoarthritis.

In the operating room, the surgeon has two primary options, either remove the torn meniscus (a partial meniscectomy) or perform a meniscus repair.Whenever possible, surgeons prefer to repair a torn meniscus, rather than remove even a small piece. Young people who have recently torn their meniscus are generally good candidates for repair. Older patients with degenerative tears are not.
To repair the torn meniscus, the surgeon inserts the arthroscope and views the torn meniscus. Some surgeons use sutures to sew the torn edges of the meniscus together. Others use special fasteners, called suture anchors, to anchor the torn edges together.

 

What happens after meniscal surgery?

 

Meniscal surgery is done on an outpatient basis. Patients usually go home the same day as the surgery. The incisions are covered with surgical strips, and the knee will be wrapped in a bulky dressing with an elastic bandage over the top. It is common to see some blood appear on the outer part of the dressing the same day or sometimes the following day after surgery. DO NOT BE ALARMED IF THIS OCCURS. It is normal but if you are still worried, do not hesitate to call and we will reassure you. 

The most effective thing you can do to return to normal walking without a limp is to keep the leg elevated and iced as much as possible for two to three days after the surgery.

Avoid doing too much, too quickly:

 

Using cold packs on the knee is the most effective way with the least side effects to help control pain. The knee may be iced 20-30 minutes out of the hour or more if pain is significant. Keeping your leg elevated and supported is another good way to minimize swelling and pain.

After partial meniscectomy or meniscal repair, you will be instructed to place a comfortable amount of weight on your operated leg using a walking aid (i.e. crutches or cane). Patients will usually need physical therapy after meniscectomy. The length of physical therapy will depend both on the complexity of work done inside the knee as well as how strong and fit the patient was prior to the procedure. Rehabilitation is slower after a meniscal repair and in individuals who were not on a consistent fitness/strengthening program prior to surgery. Physical therapy will generally be three times a week in order to have the best recovery.

2.Meniscectomy

Meniscus Repair2Your meniscus is a layer of cartilage in your knee joint that acts like a shock absorber between the bones in your upper and lower knee. It allows your knee joint to move smoothly and helps keep it stable.

A torn meniscus may not heal on its own as there is a limited blood supply to that area. Symptoms may include:

  • Pain
  • Swelling
  • Limited knee function

If conservative treatment for your meniscus tear is not successful, your consultant may recommend a meniscectomy.

What happens during a meniscectomy?

A meniscectomy is usually performed arthroscopically under general or local anaesthetic. Your surgeon will make small incisions (cuts) in your knee and access the meniscus using special surgical tools and a tiny camera. They will assess any damage, clean out the area and repair any tears. Your surgical wounds will be closed using stitches, staples or steristrips

A physiotherapist will visit you before you leave hospital to show you gentle exercises that will help restore your range of motion and strength in your knee.

A meniscectomy is usually performed as a day case meaning you can go home the day of your operation. You will not be able to drive so please arrange for someone to take you home when you are discharged.

Going home after a meniscectomy

You may need to use crutches in the first few days following your surgery. Continue to take any pain relief medication as prescribed.

Use ice on your knee to help control swelling and pain. Wrap any ice pack with a tea towel and apply several times a day for 10-20 minutes.

If your incisions are dry you can remove your dressing after 2 days. Keep the area clean and dry until your follow-up visit. Use a waterproof dressing when showering.

Continue doing your exercises as prescribed. You should avoid any strenuous activity until released to do so by your consultant.

Be sure and discuss any return to work with your consultant.

As with any procedure there can be complications including:

  • Pain
  • Bleeding
  • Infection
  • Blood clots (deep vein thrombosis – DVT)
  • Further tears