Arthroscopic meniscectomy

Arthroscopic meniscectomy is a surgical procedure during which an instrument called arthroscope is used to repair tears to the meniscus or to partially or entirely remove the meniscus from the knee joint.

A meniscus is a crescent-shaped piece of cartilage in the knee which acts as a rubbery cushion between the thighbone and shinbone, dispersing the pressure of your body weight, reducing friction, absorbing shock as you walk, and keeping the joint stable. Each knee has 2 menisci, one on the outside of the knee (lateral meniscus) and one on the inside (medial meniscus).

When the meniscus is damaged, the knee joint is exposed to increased stress, more vulnerable to wear and tear, causing frequent knee complaints.

A torn meniscus is one of the most common knee injuries. Any activity that causes you to forcefully twist or rotate your knee, especially when putting your full weight on it, can lead to a torn meniscus.

Sudden meniscus tears often happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved. Older people are more likely to have degenerative meniscus tears. Cartilage weakens and wears thin over time. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

Injuries to the medial meniscus are more common than injuries to the lateral ones. As the medial ligament is firmly attached to the joint capsule, it can easily become pinched between the condyles, which can lead to a longitudinal tear over time.

Conservative treatment – such as rest, ice and medication – is sometimes enough to relieve the pain of a torn meniscus and give the injury time to heal on its own. In other cases, however, a torn meniscus requires surgical repair. It is important to know, that without treatment even the smallest tear can cause the cartilage to become detached over time.

If a meniscal tear is suspected, your orthopedist will conduct a thorough health history and physical evaluation of the knee. He or she will usually refer you for an X-ray and/or MRI to confirm the diagnosis and further evaluate the knee joint.

Meniscus injuries are often classified based ont he way they appear on imaging tests. The most common types are shown in the table:

• normal meniscus
• radial tear
• longitudinal tear
• horizontal tear
• bucket handle tear
• parrot beak tear

Very often, meniscal tears do not cause symptoms or problems. However, some people with a torn meniscus experience a whole range of unpleasant symptoms such as:

stiffness and swelling of the knee
sudden intense pain, typically in the articular gap (this usually happens with acute injury)
pain in the articular gap when twisting or rotating the knee
inability to move your knee through its full range of motion (it cannot be fully straightened or bent)
the knee is slightly bent and locked in place (this happens when part of the torn meniscus is wedged between the condyles, blocking movement)
a popping sensation with movement

If you suspect you may have a problem with your meniscus, you need to see a traumatologist or orthopedist as soon as possible to prevent further trauma to the knee. Your doctor will conduct a physical exam to check pressure-pain sensitivity, localise the source of pain and measure range of motion. They will also perform specific tests involving bending or twisting the knee designed to isolate specifically which part of the cartilage has been damaged.

In most cases physical tests are sufficient to diagnose meniscal injuries, but depending on your specific symptoms your doctor may order imaging tests such as an X-ray and/or MRI.

Meniscus tears are treated surgically,either by fixing (meniscus repair) or by removing (meniscectomy) the torn part. At our hospital, meniscus surgeries are performed with arthroscopic techniques. These minimally invasive, high precision procedures allow for a faster recovery. They involve little damage to the surrounding tissue, as the incisions are tiny.

Meniscus surgeries are performed under general or – in some cases – regional anesthesia. Next tot he patella tendon the surgeon makes 2 or 3 small, pea-sized incisions, through which the arthroscope and the special tools are then inserted. The knee joint is filled with saline solution, which allows the doctor to better see the injuries and degenerative lesions inside the joint.

Torn or pinched parts of the meniscus are removed, or – if possible – torn edges are sewn back together.

The aim of the surgery is to preserve as much cartilage as possible, because meniscectomy (total removal) may result in the instability of the knee and accelerate further degenerative changes.

If your doctor recommends meniscectomy, you will need a complete physical examination before surgery to assess your general health. This helps prevent complications due to pre-existing health conditions. During the first consultation, your orthopedist will tell you exactly what kind of examinations are necessary. He or she will also inform you about the details of the surgery. You will receive a patient information form regarding anaesthesia and will be required to sign an informed consent form. Your doctor will ba happy to answer any of your question before you hand in the paperwork.

2 weeks before your meniscus surgery:

Inform your doctor about your chronic conditions and the medicines you take for those conditions
You may be required to stop taking certain medicines for a while.
Tell your surgeon if you have been drinking alcohol (more than 1 or 2 drinks a day).
Quit smoking before surgery as smoking can slow down your recovery.
Let your doctor know about any ongoing illnesses such as allergies, the common cold, flu, an episode of herpes, stomach bugs, etc.

On the day of your surgery:

Do not eat or drink anything for 6 to 12 hours prior to surgery.
Take all prescribed medicines with water.
Make sure to show up on time and register at the reception desk at Medicover Hospital

Patients are usually required to stay a night in hospital following surgery. On the morning of your release your doctor will assess the progress of your recovery and appoint a date for your follow-up examination. The hospial’s physiotherapist will teach you an exercise routine which you will have to keep doing until you are recovered.

In case of a partial meniscus removal, the knee can bear your full weight on the next day. After a repair, however, the knee should be spared for some time, the use of crutches is recommended for about 4 weeks. In both cases you will be prescribed medication to prevent thrombosis.

If you do not show any signs of complication in the initial stages stitches removal can take place a week after surgery. If you had partial or total meniscectomy, you can return to your daily activities after a week, but sports and intense physical activities are to be avoided for the next 3 to 6 weeks to let your knee heal. In case of a meniscus repair, full recovery can take up to 3 months. During that time you will be asked to rest first, then gradually increase physical workload until range of motion is restored and swelling disappears.