What is Arthroscopic Meniscus Repair?
The meniscus is a C-shaped cartilage structure in the knee that acts as a cushion between the femur (thigh bone) and tibia (shin bone). There are two menisci in each knee: the medial meniscus (on the inner side of the knee) and the lateral meniscus (on the outer side of the knee). These cartilages play a crucial role in absorbing shock, stabilizing the knee, and allowing smooth movement.
A meniscus tear occurs when the cartilage is damaged, often as a result of a sudden twist or turn, or due to degenerative changes over time. Meniscus tears are a common knee injury, particularly in athletes or individuals engaged in physical activities that involve twisting motions, sudden pivots, or deep squatting.
Arthroscopic meniscus repair is a minimally invasive surgical procedure used to treat meniscus tears. It involves using a small camera (arthroscope) and specialized surgical instruments to repair the torn meniscus. This method allows for smaller incisions, reduced recovery time, and less post-operative pain compared to traditional open surgery.
Why is Arthroscopic Meniscus Repair Needed?
Meniscus tears can cause symptoms such as:
- Knee pain, particularly on the inside or outside of the knee.
- Swelling and stiffness in the knee joint.
- Limited range of motion, including difficulty fully straightening or bending the knee.
- Catching or locking of the knee, where the knee feels as though it is stuck or unable to move normally.
Arthroscopic meniscus repair may be needed when:
- The tear is unable to heal on its own with conservative treatments like rest, physical therapy, or anti-inflammatory medications.
- The tear affects the function of the knee, causing pain, instability, or difficulty walking.
- The tear is in an area of the meniscus that has good blood supply, as this is necessary for the meniscus to heal after surgery.
How is Arthroscopic Meniscus Repair Performed?
Arthroscopic meniscus repair is typically performed in an outpatient setting, meaning the patient can go home the same day.
Steps of the Procedure:
- Anesthesia: The surgery is usually done under general anesthesia or spinal anesthesia (regional anesthesia) to numb the lower half of the body. This allows the patient to be comfortable during the procedure.
- Small Incisions and Insertion of the Arthroscope: The surgeon makes a few small incisions (typically 2-3) around the knee. A small camera (arthroscope) is inserted into one of the incisions, allowing the surgeon to view the inside of the knee joint on a monitor.
- Inspection of the Meniscus: The surgeon carefully inspects the torn meniscus to assess the location and type of tear. Based on the type of tear (longitudinal, horizontal, complex, etc.), the surgeon decides whether a repair is possible or if partial removal (meniscectomy) is needed.
- Repairing the Meniscus: If the tear is repairable, the surgeon will use specialized instruments to stitch the torn edges of the meniscus back together. This is done with sutures or anchors placed inside the meniscus and attached to the surrounding tissue. In some cases, tissue adhesives may be used.
- Closure and Dressing: Once the repair is complete, the incisions are closed using stitches or steri-strips (adhesive strips), and the knee is bandaged.
The procedure generally takes 30 minutes to 1 hour, depending on the complexity of the tear and repair.
Post-Surgery Care and Recovery:
Immediate Post-Surgery (First Few Days):
- Pain and Swelling: After surgery, you may experience some pain, swelling, and bruising around the knee. Ice, compression, and prescribed pain medications can help manage these symptoms.
- Rest and Elevation: Keeping the knee elevated and avoiding excessive movement during the first few days will help reduce swelling.
- Bandages: You will have a bandage or dressing on your knee. Follow your surgeon’s instructions for keeping the incision site clean and dry.
Rehabilitation (Physical Therapy):
Rehabilitation is key to a successful recovery. The goal is to restore strength, range of motion, and function to the knee.
- Phase 1 (0-2 weeks): During the initial phase, the focus is on reducing swelling and preventing stiffness. You will likely need to use crutches or a brace to limit weight-bearing on the knee. Gentle range-of-motion exercises may begin to improve flexibility.
- Phase 2 (2-6 weeks): As healing progresses, weight-bearing activity may gradually be allowed. Physical therapy will focus on strengthening the quadriceps and other muscles around the knee, as well as improving range of motion.
- Phase 3 (6-12 weeks): Strengthening exercises will increase in intensity as the knee becomes stronger. You will work on improving endurance, flexibility, and balance. More functional movements, like squatting or climbing stairs, may be incorporated.
- Phase 4 (3-6 months): As recovery continues, sport-specific activities and agility exercises may be introduced, depending on your progress. Your physical therapist will guide you through this phase, focusing on restoring the knee’s ability to perform dynamic movements.
- Phase 5 (6-12 months): For most patients, full recovery is achieved after 6-12 months. At this stage, most patients are able to return to sports and normal activities, although high-impact activities may need to be reintroduced gradually.
Long-Term Recovery:
It is important to follow the post-surgery rehabilitation plan carefully. Full recovery can take anywhere from 3 to 6 months, especially for athletes or individuals who engage in activities that involve running, jumping, or pivoting.
Potential Risks and Complications:
As with any surgery, there are risks involved, although complications are rare:
- Infection: There is a risk of infection at the incision sites, which may require antibiotics or additional treatment.
- Blood Clots: Deep vein thrombosis (DVT) is a rare but serious complication. Patients are typically encouraged to move their foot and ankle regularly after surgery to help prevent blood clots.
- Knee Stiffness: Some patients may experience stiffness or difficulty bending or straightening the knee after surgery, which can be managed with physical therapy.
- Re-tearing: There is a possibility that the meniscus could re-tear, especially if the patient returns to activities too soon or doesn’t follow the rehabilitation protocol.
- Inadequate Healing: The repair may not heal as expected, which could require further treatment or surgery.
- Swelling and Bruising: Some swelling and bruising around the knee is common after surgery and should resolve with time.
Benefits of Arthroscopic Meniscus Repair:
- Minimally Invasive: Smaller incisions mean less tissue damage, reduced risk of complications, and faster recovery compared to traditional open surgery.
- Less Pain: Most patients experience less pain after arthroscopic surgery, thanks to the minimal trauma to the tissue and muscle.
- Shorter Recovery Time: Because it is minimally invasive, recovery is typically quicker, with many patients able to return to light activities within a few weeks.
- Preservation of Meniscus Tissue: Unlike meniscectomy (where part or all of the meniscus is removed), arthroscopic meniscus repair aims to preserve the meniscus, which is important for long-term knee joint health and function.
- Improved Knee Function: The goal of the procedure is to restore function and stability to the knee, enabling the patient to return to normal activities and sports with less pain and greater mobility.
Long-Term Outlook:
- Most patients experience significant improvement in knee function and pain relief after arthroscopic meniscus repair. The procedure is highly effective at preserving knee function and preventing further damage to the knee joint.
- Full recovery may take several months, but most individuals can return to normal daily activities within a few weeks and resume sports within 3-6 months, depending on the tear’s severity and rehabilitation progress.
When to Contact Your Surgeon:
You should contact your surgeon if you experience:
- Signs of infection, such as fever, redness, swelling, or drainage from the incision site.
- Severe pain that doesn’t improve with medication or rest.
- Excessive swelling or bruising that doesn’t subside after a few days.
- Numbness or tingling in the knee or foot.
- Difficulty moving the knee, or if the knee becomes unstable or locks up.
Conclusion:
Arthroscopic meniscus repair is an effective surgical procedure for treating meniscus tears that preserves the meniscus and restores knee function. The minimally invasive nature of the surgery allows for quicker recovery, less pain, and fewer complications compared to traditional open surgery. With proper rehabilitation and adherence to post-surgery guidelines, most patients can expect to regain full function and return to their normal activities or sports within a few months.
If you have a meniscus tear and conservative treatments have not worked, we would be happy to take care of you!