Meniscus Procedures
The meniscus is a C-shaped cartilage in the knee that acts as a cushion between the femur (thigh bone) and tibia (shin bone). It helps to distribute weight and reduce friction during movement. Meniscal injuries are common, particularly among athletes, and can lead to pain, swelling, and limited knee function. The primary surgical treatments for meniscal tears are meniscus repair and meniscus trimming (partial meniscectomy). Here is an in-depth description of each procedure:
Meniscus Repair
Indications: Meniscus repair is typically indicated for tears located in the outer third of the meniscus, where there is a good blood supply, facilitating healing. It is often recommended for younger, active patients and for tears that are amenable to suturing.
Procedure:
- Arthroscopic Examination: The procedure is performed arthroscopically. Small incisions are made around the knee, and an arthroscope (a thin, flexible tube with a camera) is inserted to visualize the meniscus.
- Assessment of the Tear: The surgeon assesses the type and location of the meniscal tear to determine if it is repairable.
- Suture Placement: Specialized instruments are used to place sutures across the tear to hold the edges together. Various techniques, such as inside-out, outside-in, or all-inside methods, may be employed depending on the tear’s location and configuration.
- Closure: Once the tear is repaired, the instruments are removed, and the small incisions are closed with sutures or surgical tape. The knee is then bandaged.
Pros and Cons:
- Pros:
- Preserves the meniscus, maintaining its cushioning and stabilizing functions.
- Reduces the risk of developing arthritis compared to meniscus removal.
- Cons:
- Longer recovery period compared to meniscus trimming.
- Higher risk of the repair not healing, especially in areas with poor blood supply.
- Initial Phase (Weeks 1-4):
- No limits to weight bearing. May need crutches.
- Gentle range-of-motion exercises.
- Rehabilitation Phase (Weeks 5-12):
- Progressive range-of-motion and strengthening exercises.
- Physical therapy to improve flexibility and strength.
- Return to Activity (Months 3-6):
- Gradual return to normal activities and sports.
- Continued focus on knee strength and stability.
Meniscus Trimming
Indications: Meniscus trimming, or partial meniscectomy, is indicated for tears that cannot be repaired, typically those in the inner two-thirds of the meniscus where blood supply is poor, or for complex, degenerative, or flap tears.
Procedure:
- Arthroscopic Examination: As with meniscus repair, the procedure is performed arthroscopically. Small incisions are made, and an arthroscope is used to visualize the meniscus.
- Assessment of the Tear: The surgeon assesses the tear and determines the extent of the damaged tissue.
- Trimming the Tear: Specialized instruments are used to trim and remove the damaged portion of the meniscus. The goal is to smooth the edges and leave as much healthy meniscus as possible.
- Debridement: The surgeon may also perform debridement to remove any loose fragments or debris within the knee joint.
- Closure: The instruments are removed, and the small incisions are closed with sutures or surgical tape. The knee is then bandaged.
Pros and Cons:
- Pros:
- Shorter recovery time compared to meniscus repair.
- Immediate pain relief and improved knee function.
- Cons:
- Removal of meniscal tissue can lead to decreased shock absorption.
- Higher risk of developing arthritis in the long term due to loss of meniscal tissue.
Recovery:
- Initial Phase (Weeks 1-2):
- Weight-bearing as tolerated, often with the use of crutches initially.
- Gentle range-of-motion exercises.
- Ice and elevation to reduce swelling.
- Rehabilitation Phase (Weeks 3-6):
- Progressive strengthening and range-of-motion exercises.
- Physical therapy to restore knee function and flexibility.
- Return to Activity (Weeks 6-12):
- Gradual return to normal activities and low-impact sports.
- Focus on maintaining knee strength and stability.
