Surgical Meniscus Injury Treatments:

If you fail to see improvement with the conservative treatments, your physician may recommend a surgical option. You are generally a candidate for surgery if you have injured your meniscus and you:

• Experience disabling symptoms that interfere with your daily living after 2 - 3 months (knee catching or locking, very stiff and painful, major instability).
  
• Have a larger, complex or displaced tear.
  
• Have major instability in your knee (often due to a combined meniscus/ACL injury)
  
• Are a high-level athlete

A torn meniscus is one of the most common knee surgeries. The type of surgery you require will depend on the size, shape and location of your meniscus injury. There are generally 3 types of meniscus surgeries that will be recommended: a meniscectomy, a meniscal repair, or a meniscal replacement. All of these will be performed by arthroscope while under some type of anesthesia; they usually don't require an overnight hospital stay. Your orthopedic surgeon will determine which surgery is most suited to your condition.

Arthroscopic surgery involves making tiny incisions around your knee joint and inserting a pencil-thin, fiber optic camera with a small lens and lighting system in one hole, and small surgical instruments in the other holes. The surgeon will take a look inside your joint to investigate all the soft tissues and bones. These images will then be transmitted to a TV monitor, which allow the doctor to make a diagnosis and/or perform the meniscus surgery under video control. At the end of surgery, your incisions are closed, and a dressing is applied.

Most surgeries will require extensive rehabilitation utilizing the conservative treatments noted above. Ultrasound therapy can begin soon after surgery, with permission from your doctor. Physical therapy and strengthening normally begin a few weeks after surgery (depending on the type of surgery). Your surgeon should provide a treatment plan to help you regain normal use as soon as possible.

Types of Meniscus Surgeries:

The most common meniscus surgery is a Partial Meniscectomy or Resection, which involves removal of the torn or damaged part of your meniscus. It is generally used for degenerative and horizontal tears located in the inner 2/3 of your meniscus (the white-on-white zone). This area has a poor healing rate because it receives little or no blood supply, therefore it is better to remove the damaged part rather than try to fix it. A meniscus repair is generally not used for these tears, because it will rarely be successful.

The goal of this surgery is stabilization, which will prevent catching, buckling and locking in your knee joint. The surgeon will trim and smooth out frayed edges on the inner rim (which can be difficult to reach), and remove the damaged part or flap of your meniscus.

Degenerative changes can lead to a completely collapsed meniscus. This is seen more frequently on your lateral meniscus, rather than your medial meniscus. A Complete Meniscectomy or Resection may be required, which involves surgical removal of your entire meniscus. If you have your meniscus removed, the rest of your joint gets overloaded (resulting in a 200% - 300% increase in contact pressure). This surgery is only performed if necessary, as removal of the medial meniscus can lead to becoming bow-legged and removal of the lateral meniscus can lead to becoming knock-kneed.

Although meniscectomies have faster recovery than other meniscus surgeries they can often lead to arthritis as the size of your meniscus (shock absorber) is reduced and/or removed. Normal knees have 20% better shock-absorbing capacity than meniscectomized knees.

If you have a discoid meniscus that did not heal through conservative treatments, part of your meniscus will be removed to relieve symptoms and preserve some of your meniscus cushioning function.

A Meniscal Repair is generally preferred over a meniscectomy, as it fixes the damage and helps prevent deterioration of your meniscus. However, this involves a more complex surgery, the recovery is longer and it is not always possible (depending on the location). Early diagnosis definitely can affect the outcome of this surgery. Younger people tend to be the best candidates as their tears are often stable and located near the outer edge of the joint capsule. These tears have a better chance of healing than those farther in the joint because they receive more blood supply (the red-on-red and red-on-white zones). After surgery and with permission from your surgeon, ultrasound therapy can help stimulate blood circulation to the injured areas to help you heal faster.

• Trepanation (Abrasion Technique) involves making small holes or shaving torn edges in your meniscus to promote bleeding and enhance healing. Longitudinal tears or bucket handle tears often won't heal unless they are abraded.
  
• Suturing involves using stitches or other devices the body absorbs (tacks, screws or arrows) to reconnect the tear, repair the damage, and save your meniscus. Your surgeon may try to repair your radial split tear or parrot's beak tear with sutures; however these tend to have a lower incidence of healing because of their location.

A Meniscal Replacement involves implanting a new meniscus into your knee. This is accomplished via:

• Allograft (transplanting a meniscus from a donor). This surgery is rarely done and has not proven effective over the long term.
• Collagen implant (engineered collagen is put in your knee with the hope that a new meniscus will grow in the joint). Results for this surgery are questionable and it is still not FDA approved.

Generally you will be able to return to normal activities and sports approximately 6 weeks after a partial meniscectomy and 3-4 months after a meniscal repair or replacement. Research indicates pain relief after a partial meniscectomy or abrasion is about 50 - 75%. However, healing and recovery time is generally dependent on the degree of damage done, your age, pre-injury level of function, and your rehabilitation.

There are always some risks associated with any surgery, which include but are not limited to possible infection, allergic reaction to medications, blood clots, and damage to surrounding nerves or blood vessels. However, modern techniques have significantly minimized the occurrence of these problems. Although surgery is often successful at repairing any damage and/or relieving pain, it does not necessarily return strength to your knee. Tenderness, pain, stiffness and weakness are very common after surgery. That is why a strong commitment to rehabilitation utilizing the conservative treatments above is essential!

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