Arthroscopic Meniscus Surgery

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What is a Meniscus?

The meniscus is a soft, rubber-like C-shaped cushion in between the bones of the knee. There are two of them – one on the inner side and one on the outer side. They participate in sharing the load across the knee. There are two problems that occur in menisci – one that it degenerates (becomes weak) with age, and the other that it tears due to injury. Degeneration in the meniscus causes pain, having become softer, it often breaks with minimum injury.

A typical meniscus tear occurs in young adults, as a result of a twisting injury. The torn meniscus becomes a ‘misfit’ in the joint and gives rise to mechanical symptoms such as locking, catching, clicking, etc. Over a period of time, these mechanical symptoms cause damage to soft covering (cartilage) over the bones. This is called osteoarthritis and is irreversible damage to the joint.

How do I know I have a meniscus tear?

Typically, the person gets a twisting injury, which results in repeated pain, catching, locking, etc. Often the symptoms are vague, and diagnosis can only be clinched on MRI.

What treatment options do I have?

The meniscus was considered a vestigial structure and was removed mercilessly for whatever reason for many decades. Research has shown the importance of meniscus the trend today is to save the meniscus. Whenever possible a meniscal tear is sutured. If suturing is not possible, a part of it is excised arthroscopically (partial meniscectomy). There are efforts toward transplanting meniscus from a cadaver, and also implanting artificial menisci.

How is surgery done for a meniscus tear?

Surgery is done by key-hole technique (arthroscopic surgery), under spinal or general anesthesia. It takes from 30 minutes for the surgery. One is able to walk on his/her legs within 6 hours.

What is the meniscal repair?

This is the latest technique in meniscal surgery where the torn ends of the meniscus are stitched back together arthroscopically. The technique used depends on where in the meniscus is the tear

Inside out technique: this is done in tears of the post horn and body of the medial meniscus

Outside in: This is done in tears of the body and anterior horn of the lateral and medial meniscus

All Inside: This is done in tears of the posterior horn, root, and body of both menisci

Can my meniscal tear be repaired?

Not all tears are repairable, the ones that are towards the periphery are more akin to being repaired as they have a better blood supply and heal up well. Also, tears that are fresh and in one plane heal up better.

Do I have to undergo physiotherapy after surgery?

Meniscectomy: In these cases, there are very few restrictions, the patient can fully weight bear on their feet, may require a stick/crutch for 7-10 days, and then can walk unrestricted and bend their knees as tolerated

Meniscal Repair: The aim of the rehabilitation is to keep the menisci in a conducive environment to give the body a chance to heal up. In these cases, movement at the knee is restricted to less than 90 degrees of bending for 6 weeks. The patient can weight bear as tolerated using a long knee brace and crutches/walker the next day. The long knee brace is worn for 2 weeks and then changed to a hinged knee brace. Bending is restricted to less than 90 degrees. For 6 weeks. After 6 weeks the brace is taken off and bending greater than 90 degrees is allowed. Return to sport post isolated meniscal repair is after 3 months. When in association with a ligament surgery sport can be resumed only after 6-9 months.

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