Meniscus Tear FAQ’s

Arthroscopy is a surgery in which a camera with a light source is inserted through poke holes into the joint of the body to look inside. We may also use other poke holes to insert arthroscopic instruments to carry out arthroscopic surgery. Arthroscopy has revolutionized the management of joint injuries by giving early rehabilitation, as well as recovery, without causing many complications that are caused by open joint surgeries.

During an arthroscopic surgery, a camera with a light source is inserted into the joint of a patient through small incisions or poke holes. Arthroscopic instruments are also inserted in the joint through other poke holes. First the joint is inspected, the necessary procedures are carried out.

Most of the patients, after arthroscopic surgery, are discharged to home from the hospital or the surgery center where the surgery is performed within a couple of hours. Patients, if needed, are given ambulatory aids in the form of crutches and braces apart from medications.

A meniscectomy is a surgery in which a part, or complete, meniscus of the knee joint is removed to make the patients symptom-free due to the torn meniscus. Most of the time, a partial meniscectomy is performed, and we tend to keep the healthy meniscus in place so that it may help in the form of cushioning and movement of the knee joint.

Knee cartilage in the form of meniscus is there to help gliding, as well as cushioning the knee joint. Cartilage should not be removed, but if it is torn and the patient has symptoms which are unrelieved by conservative means, then this part of cartilage may need to be removed to make the patient symptom-free.

Meniscus tears can be repaired in selective patients. These patients are usually young, and it is of paramount importance that the meniscus be preserved, so as to delay or prevent early arthritic changes. The meniscus tear morphology also dictates as to which tears can be repaired and not excised. Tears, which are clean cut and tears at the periphery or outer ring tears of the meniscus have good success with repair. Complex tears as well as meniscus, which are chewed up or badly injured or tears towards the center are usually non-repairable and do not give good results due to a very low healing potential.

The cleaning up or the cleanup surgery for the meniscus also called as a debridement or trimming is named as meniscectomy. When a decision is made to clean up a meniscus because it is not repairable, the surgeon uses motorized shaver or mechanical biters to remove all the frayed edges as well as flaps of the torn meniscus to leave it on a balanced edge.

Meniscus repair surgery is usually an arthroscopic surgery but may be associated with small incisions on the side of the knee, so as to prevent any damage to the nerves and vessels on the site of the back of the knee. The main part of the surgeries are still arthroscopic in which the surgeon looks inside the knee through a camera through a small incision and uses instruments through another small incision to check on the knee and look at the structures, which include the articular cartilage from a meniscus as well as the ACL and PCL ligaments. If a meniscus tear is found which may or may not be diagnosed preoperatively by an MRI, the surgeon has to decide if he can repair the tear or will have to clean the tear. In case when a decision to repair a tear is made, the tear should be cleaned and prepared for the repair. The repair is usually done using sutures. These sutures can be passed through the meniscus using needles or through devices, which are only used from inside of the knee. There is not much difference between the various methods of surgery, and it is more of surgeon’s preference.

The healing time from a surgery for torn meniscus can vary according to the patient’s age, activity, type of tear, location of the tear, type of surgery performed. Patients who undergo cleanup or debridement of the meniscus usually recover well between 3 to 6 weeks depending on the type of profession or the needs they have from the knee. Patients who undergo repair can take up to 8 to 12 weeks to recover completely from the surgery.

Patients who undergo meniscus surgery usually recover completely. They can go back to preinjury activity level after healing. Even in sports persons the return to play is very high in patients who undergo meniscus debridement or repair.

Patients who have multiple comorbidities, including diabetes and obesity, may take prolonged periods to recover from meniscus surgery. Patients who have moderate to severe arthritis also take a longer period and may have incomplete recovery from meniscus surgery. Smoking is detrimental to the healing process in general and does cause delayed healing in knee surgery also.

Patients who have comorbidities like diabetes and obesity are at high risk for failure of meniscal repair surgery. Patients who smoke also are at high risk of failure. Patients are strongly recommended to quit smoking before the surgery. Any twisting or turning of the knee in the early postoperative period can lead to failure of a repair. For the same reason the patients are put in knee brace after meniscus repair surgery for 4 to 6 weeks and are given crutches to ambulate. There are specific restrictions, which should be followed for optimal results.

A meniscal root tear should always be tried to repair it so as to preserve the anatomy of the knee, which helps in delaying or preventing the development of arthritis in the knee. The repair is usually performed arthroscopically in which sutures are passed into the root and then they are passed through the bone by making a drill hole through the bone and tied over on the other end by the use of button or anchors. These surgeries are usually successful and lead to restoration of the anatomy of the knee. Patients who undergo root repair have certain restrictions in the postoperative period and it takes about 6 to 8 weeks for complete recovery and rehabilitation, and may further need another 4 to 6 weeks for the patient to come back to preinjury level.

A meniscus surgery may last from forty-five minutes to an hour, but a surgery involving the repair of the meniscus may last one to two hours depending on the size of the injury. There may be multiple surgical scars with some a little bigger than a poke hole incision as compared to partial meniscectomy which has 2-3 small surgical scars. This is due to the work needed to be done to repair the meniscus.

Risks associated with arthroscopic surgery are bleeding, blood clots in the calf, infection, injury to nerves or blood vessels, damage to cartilage, ligaments, meniscus, stiffness of the knee apart from anesthesia risks.

Most patients do not need to stay in the hospital and are discharged from the surgical area within a couple of hours after the surgery. Occasionally, patients with comorbidities may need to stay in the hospital for observation.

Most patients who undergo arthroscopic knee surgery are discharged from the hospital or surgical area within one to two hours after the surgery. They are given ambulatory aids and braces apart from medications if needed.

Patients who undergo meniscal root repair are usually sent home on the same day after surgery in a knee immobilizer. They have restriction of weightbearing as well as they are asked not to unlock the knee immobilizer while ambulating so that they walk with a straight leg or a pirate leg. They are allowed to range the knee when they are resting and sitting. Physical therapy is usually started within one week. They are asked to use ice, elevation and pain medications. It is preferred to avoid anti-inflammatory medications for the first 2 weeks. The ranging of the knee is restricted to 90 degree of flexion for the first 4 weeks after which the range of motion is gradually increased. Patients are asked to use the knee immobilizer for about 6 weeks along with the crutches. They are gradually weaned out of the crutches and knee immobilizer after 6 weeks. Patients will usually be able to be at preinjury level in about 10 to 12 weeks.

Patients who undergo meniscal debridement or trimming or cleanup surgery are usually done as a day care surgery. They are sent home the same day. They usually will have dressing on the knee and may use an aid for walking in the form of cane or crutch. They are asked to bear as much weight as they can tolerate. They can range their knee also as much as tolerated. They are sent on pain medications and can use anti-inflammatory medications for pain relief. They are asked to use a lot of ice and elevation. Patients can usually take off their dressing after 72 hours and can shower. Patients are usually seen in the office in 7 days and physical therapy is started after that. Recovery from meniscal debridement or trimming is usually fast and the patient can be on preinjury level in 6 to 8 weeks. Patients usually do not have to use any brace or immobilizer though they can use a compression sleeve to decrease the swelling.

Complications to be looked for after knee surgery are worsening pain, which is not relieved with pain medications, swelling over the surgical area, discharge from the surgical site. Patients need to call the physician’s office to discuss further management. Patients could also look for any calf pain as well as chest pain or other symptoms involving the heart or the brain. These patients may need urgent medical attention and should call 9-1-1 or visit an emergency room.

Patients are usually on pain medications for a few days after surgery. They are gradually tapered onto anti-inflammatory medications and can wean them off over a few weeks. Patients in physical therapy and their pain is well-controlled do not need to take regular medications and can take anti-inflammatory medications when pain worsens. Patients are also advised to use ice and elevation when the pain and swelling worsen.

The patient should inform of all the non-prescription medications or supplements that the patient is taking before the surgery as well as at the time of surgery. There are certain medications, which may interact with the anesthetic medications as well as medications that are given after the surgery. And cause serious side effects.

Though there is no special diet, it is always advisable to take a soft diet immediately after surgery. This will help not only prevent constipation, but also prevent nausea and vomiting.

Patients who undergo arthroscopic meniscectomies are usually able to resume their normal activities within a few days after the surgery. The patient can gradually increase the amount of work that they can do. It will take about six to eight weeks before the patient fully recovers from the surgery. Patients who undergo Meniscal repair may take a longer time, up to three to four months to complete recovery. Patients who undergo ligament reconstruction may up to six months to a year for complete recovery from the surgery.

Return to work depends on the type of work the patient does as well as the type of surgery he has undergone. If the patient has undergone arthroscopic partial meniscectomy and are in a low impact desk-type job, they are able to return to work as early as two weeks. Patient who undergo surgeries like meniscal repair or ligament reconstruction as well as patients who are in high-demand jobs and manual work may take longer time to return to work. The return to work is essentially decided by the recovery of the patient with the physical therapy and the decision is made in consultation with the physician and the physical therapist with the patient.

Most patients after arthroscopic surgeries are enrolled into physical therapy programs. These patients undergo special exercise programs, which are decided by the type of surgery that has been performed. Patients need to be in regular follow up with the physical therapist as well as the physician.

Most patients after arthroscopic surgery are sent for physical therapy as early as one week after the surgery. They also started a home exercise program.

Most patients follow with their physician after 7-10 days after the surgery, and then after that, monthly for a few months until they fully recover.

Most patients are called back to visit the doctor in 7 – 10 days after the surgery. If the patient has calf or chest pain or any other emergency, they should call 9-1-1. If the patient has worsening pain not relieved with pain medications, or swelling, fever, chills, discharge, then these patients may need to call the doctor during the office hours or leave a voicemail for the physician after office hours.

Meniscus are cartilaginous discs inside the knee which cushions the knee as well as helps in gliding and rotating movement of the knee. If a part of meniscus is removed after the surgery then there are certain amounts of increase in load on the bone and this may gradually enhance the arthritic changes in the knee. For the same reason, it is preferable not to remove the meniscus and if the meniscus is repairable it should be repaired. But if the meniscus is torn beyond repair then it must be removed so as to alleviate all the symptoms.