FAQs on Meniscectomy and Meniscal Repair

 

Elite athletes go for meniscectomy to treat knee problems associated with meniscal tear and return to sports swiftly. The arthroscopic procedure has higher than expected success rate and preferred due to its less-invasive nature and faster recovery.

What is meniscectomy?

Meniscectomy refers to surgical excision or trimming of either meniscus, a c-shaped cartilage providing cushioning to bones in the knee joint. There are usually two meniscus positioned on medial and lateral sides, between femur and tibia in the knee. Acting as shock absorbers, the cartilage limits flexion, extension, and rotation of your knee. A torn meniscus causes pain, swelling, stiffness, locking, and catching in the knee joint impacting patient’s daily activities.

Meniscectomy is an arthroscopic procedure performed to remove all or part of torn meniscus. If a section is damaged, only that part is removed. Complete removal is rare but done when there is a failed repair surgery or meniscus transplant is being carried out. Patients prefer meniscectomy for its less-invasive method, faster recovery, and shorter rehab.

How do meniscal tears occur?

Meniscus damage is caused by traumatic impact on the knee. Meniscal tears are also traced to forcefully knee twisting or rotation during high-impact sports, running, squatting, or lifting heavy objects. Degeneration associated with knee joint wear and tear also results in tears in meniscus.

Both surgical and non-surgical methods are used to treat a torn meniscus.

What are other methods used for surgical meniscal repair?

Other than meniscectomy, meniscal repair is also done through surgery. It uses sutures to stitch torn pieces and reconstruct the ligament. However, success of such a procedure depends on the extent of tears and type of injury to meniscus. Also, surgical repairing requires more extensive recovery and rehabilitation than meniscectomy. Repair is also restricted to younger patients and patter of tear. Lack of blood supply prevents healing of many repaired tears.

Who is a candidate for meniscectomy and meniscal repair?

One is recommended for meniscectomy and meniscal repair surgery based on the patter, size, and location of the tear. Age, strength of the meniscus, physical and medical conditions, and activity also influence the decision.

Meniscectomy is for those

  • Suffering from severe meniscal tear symptoms, including pain and movement problems
  • With moderate to large meniscal tears
  • Damage to the edge of the meniscus
  • Tears affecting two-thirds of inner meniscus
  • Multiple tears in meniscus

How is meniscectomy for meniscal Repair performed?

Meniscectomy can be partial or total depending on the need. Though arthroscopy is the most preferred mode of performing the surgery done in an outpatient setting, many go for open procedure.

The patient is put under general or regional anesthesia. Surgeons inject fluid to the knee joint to expand the area and access the cartilage easily. The tube-like arthroscope camera is inserted into the knee joint through a small incision and damage to the cartilage is assessed. Special instruments are put inside through small incisions and surgery is performed guided by the lives images obtained through the arthroscope.

Either the entire meniscus is removed or only it is trimmed to remove the damaged portion. In case of the second option, meniscal edges are smoothed and fragments are cleared. The arthroscope and instruments are removed and the incisions are closed.

How long does meniscectomy surgery take?

Meniscectomy done using arthroscopic procedure takes around 1 hour.

Do I need to stay at the hospital after meniscectomy?

Patients are discharged same day following an observation period of 2 to 3 hours.

What are the restrictions following meniscectomy?

  • Keep the incisions clean and dry
  • Use ice pads to control swelling
  • Take rest for 2-3 days following surgery
  • Use crutches for 1-2 weeks
  • Avoid driving for four weeks
  • Only do non-stressful activities and prescribed exercises for 2-3 weeks
  • Don’t bear light weight for a week and heavy weight for 12 weeks
  • No return to full activity level until 6 to 8 weeks
  • Use brace for controlled knee movement for 4-5 weeks
  • No high-impact activities for 24 weeks
  • No kneeling or climbing for 14 weeks.

What kind of rehabilitation is needed following meniscectomy?

  • Day 1 to 7: Start doing passive continuous motion and relaxation of soft tissues to avoid long period of immobilization of the knee
  • Week 2 to 6: Non-aggressive and static strength training workouts, such as motion restoration, aquatic therapy and active and passive non-weight bearing exercises using a brace on the affected knee.
  • Week 6 to 14: Progressive aggressive and flexible strength training, start weight bearing exercises, closed chain exercises, balance and proprioceptive exercises, workouts to restore functional movements, stationary bicycle use, etc.
  • Week 14 to 24: Sport/work specific training, enhanced muscle, strength, and flexibility workouts.

How long is the recovery period following meniscectomy?

Meniscus usually heals in 12 weeks. Heavy loading and return to athletic activities is allowed after 16 to 24 weeks subject to recovery conditions and doctor’s approval. However, it may take 2 to 3 months for a significant recovery level. You can attain 100% recovery in 8 to 12 months.

What are the potential complications of meniscectomy?

  • Surgical complications, including bleeding, infection, and damage to blood vessels. This can be avoided when the surgery is performed by an expert.
  • Many patients feel knee instability even a year after the surgery. It can be overcome by physical therapy.
  • Blood clots may occur.

References

Beynnon BD, et al. (2010). Meniscal injuries. In JC DeLee et al., eds., DeLee and Drez’s Orthopaedic Sports Medicine: Principles and Practice, 3rd ed., vol. 2, pp. 1596–1623.

Poulsen MR, Johnson DL (February 2011). “Meniscal injuries in the young, athletically active patient”. Phys Sportsmed 39 (1): 123–30

Nawabi DH, et al. Return to play after lateral meniscectomy compared with medial meniscectomy in elite professional soccer players.Am J Sports Med. 2014 Sep;42(9):2193-8.

Rockborn, P., Gillquist, J. Outcome of arthroscopic meniscectomy(A 13 year physical and radiological follow-up of 43 patients under 23 years of age) . Acta Orthop Scand. 1995;66:113–117.

Jeong HJ, et al (Sep 2012). “Meniscectomy.”. Knee Surg Relat Res 24 (3): 129–36.

Benazzi, M. Arthroscopic partial meniscectomy in athletes. 10 years follow-up. ESSKA livre des abstracts, poster No. 13. 1996;:169.

Herrlin, S.V., et al. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc. Feb 2013;21:358–364.

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