Meniscus surgery is a common operation to remove or repair a torn meniscus, a piece of cartilage in the knee. The surgery requires a few small incisions and takes about an hour. Recovery and rehabilitation take a few weeks. The procedure can reduce pain, improve mobility and stability, and get you back to life’s activities.
You have two C-shaped discs of cartilage (soft tissue) that connect your thigh bone to your shinbone. These are called menisci. They’re like shock absorbers for your bones. They also help to keep your knee stable.
Athletes who play contact sports like football and hockey are prone to meniscus tears. But you can also get this injury when you kneel, squat, or lift something heavy. The risk of injury increases as you get older, when bones and tissues around the knee begin to wear down.
If you tear your meniscus, your leg might swell and feel stiff. You might feel pain when twisting your knee, or be unable to straighten your leg fully.
A torn knee meniscus can sometimes be repaired with surgery. A doctor’s recommendation to have meniscal repair surgery will be based on many factors, including:
- The patient’s symptoms, including knee pain, decreased range of motion, and instability
- Whether other structures, such as knee ligaments, are loose or damaged
- The patient’s age, overall health, and lifestyle goals, such as returning to a sport(s)
- The meniscal tear’s underlying cause, location, shape, and size
What Is Meniscus Surgery?
Meniscus surgery is an operation to remove or repair a torn meniscus, a piece of cartilage in the knee.
When is surgery necessary for a meniscus tear?
Surgery is not always necessary for a torn meniscus. The chances of self-healing may be very good, depending on the type and location of the tear, as well as the age of the patient and the general condition of the tissue.
Sports-related meniscal tears in young patients, who have good tissue quality, stand a particularly good chance of healing completely.
The chances of spontaneous healing are also good when the tear is in the outer third of the meniscus, because the supply of blood is better at or near the outer edge.
In all of the cases outlined above, physical therapy will speed up the healing process.
What Types of Meniscus Surgery Are Performed?
Arthroscopic Meniscus Repair
A tear in an otherwise healthy meniscus, especially a tear near the outer edge of the meniscus where the blood supply is sufficient, is best repaired using sutures. The special sutures and modern suturing techniques used during arthroscopic surgery, permit excellent patient outcomes. Having assessed the size and the location of the tear, an experienced surgeon will make a decision as to which suturing technique is the most appropriate.
Even in the case of relatively serious and large bucket-handle tears, it is important to conserve as much of the meniscus as possible, so as to limit the risk of osteoarthritis in the future.
Rehabilitation following Meniscus Repair
Meniscal repair is generally followed by an approximately four week phase of protective weight bearing with the aid of crutches.
The transition to full weight bearing begins in the fifth week. Patients will be expected to wait for a period of six to eight weeks before beginning to play low stress sports and six months before playing sports involving greater levels of stress to the knee.
Meniscus Surgery – Partial Meniscectomy
A partial Menisectomy is performed using a minimally invasive arthroscopic technique. It may performed under local or general anaesthetic.
The procedure is designed to remove the damaged portion of the meniscus (the layer of cartilage on top of the tibia that cushions and stabilises the knee joint).
First the knee area is cleaned and sterilised. Next the surgeon creates between two and five small incisions in the knee. An arthroscopic camera is then inserted into the area so that the surgeon can evaluate the cartilage and ligaments. The other incisions will be used as access points for the other arthroscopic tools.
The surgeon cuts or shaves away the torn pieces of the meniscus, preserving as much of the healthy tissue as possible. The edges of the area are cleaned and smoothed and the rest of the joint inspected for damage. Once the surgical instruments have been removed, the incisions are closed with sutures or surgical staples and the knee is bandaged.
What Happens Before Torn Meniscus Surgery?
If you and your surgeon decide to move forward with surgery for a torn meniscus, you may have some tests in advance. For example, blood tests, electrocardiogram (EKG) and chest X-ray can help determine whether you are healthy enough for surgery. (If you are relatively healthy, these tests are usually not needed.)
Someone from the anesthesia team will decide what type of anesthesia (pain control) you should receive:
- Local anesthesia is a shot that numbs only your knee area.
- Regional anesthesia is a shot that numbs your body from the waist down.
- General anesthesia is medication that puts you to sleep.
If you receive local or regional anesthesia, you may also be sedated to help you relax. Most often you will have a general anesthetic for this type of procedure.
A few days before surgery, your healthcare provider will:
- Give you a prescription for medications to manage pain after the surgery.
- Make appointments for physical therapy or a fitting for crutches.
- Tell you how to prepare for surgery. You may need to stop taking certain medications and not eat or drink for several hours before the procedure.
What Happens During Arthroscopic Meniscus Surgery?
The most common procedure for a torn meniscus is knee arthroscopy. It usually takes less than an hour.
First, you receive anesthesia. The surgical team cleans the skin on your knee and covers the rest of your leg with a surgical drape. The team might place a clamp on your upper thigh to help with positioning during surgery.
The surgeon makes a few small stab incisions (cuts) in your knee called portals. The team then fills the knee joint with a sterile fluid. The fluid helps control minor bleeding in the joint and washes away debris, which helps the surgeon see inside the joint.
The surgeon inserts a small tool called an arthroscope into the incision. An arthroscope is a thin tube with a small light and video camera at the end. The camera projects video images from inside your knee onto a monitor.
The surgeon uses the arthroscope to look at the tear and decide what surgical technique to perform:
- Meniscus repair: The surgeon sews torn pieces of cartilage back together so they can heal on their own. However, because of tear type and blood supply, less than 10%of tears are actually repairable.
- Partial meniscectomy: The surgeon trims and removes the damaged cartilage and leaves healthy meniscus tissue in place.
Your surgeon inserts other surgical tools depending on the technique used. When the meniscectomy or meniscus repair is complete, the surgeon closes the portals with stitches or surgical strips. Then the team will cover your knee with a bandage.
What Happens After Meniscus Repair or Meniscectomy?
Most people who have meniscus repair or meniscectomy don’t need to stay overnight at the hospital. You’ll wait in a recovery room for the anesthesia to wear off. When you are ready to leave, somebody else will need to drive you home.
Meniscus Surgery Recovery
How Long Is Recovery?
You may have to wear a brace or cast to keep your knee stable. You’ll likely also have to use crutches for at least a month to keep weight off your knee.
Your doctor may recommend physical therapy as part of your recovery. It’ll help increase your range of motion and help your knee get stronger. They may also share some exercises you can do at home.
If you have a partial or total meniscectomy, you can expect your recovery to take about a month. If your meniscus was repaired, it may take as long as 3 months.
Remember that everyone is different. No two people heal at the exact same speed. Your recovery time may be faster or slower depending on your age, weight, general health, lifestyle, and other factors (including how well you adhere to your surgeon’s post-surgical recovery instructions!).
If your surgeon finds evidence of arthritis in other areas of your knee, your recovery may progress more slowly, with more discomfort and pain. To get relief from arthritis pain, some people opt to wear a compression sleeve during recovery.
Rehabilitation and Physical Therapy
Physical therapy is usually carried out over a matter of weeks to make sure the knee regains its full range of motion. A physical therapist can teach the patient how to safely strengthen the quadriceps and other muscles that support the knee joint.
During the first several weeks after surgery, a patient will work with a doctor and physical therapist to:
- Protect the surgical stitches and affected meniscus tissue
- Reduce swelling
- Extend (straighten) the leg normally
- Regain motor control
During the next phase of rehabilitation, a patient will work with a doctor and physical therapist to:
- Stand on one leg, typically for 15 seconds or longer
- Walk with a normal gait
- Use both legs (without favoring the operated leg)
Once these goals are achieved, physical therapy will continue for younger patients and any patient who wants to return to athletics. This last stage of physical therapy involves preparing the knee for dynamic movement and balance. For example, a physical therapist may teach a basketball player specific drills that prepare the knee for stopping, starting, and pivoting during gameplay.