Meniscectomy

To understand what a meniscectomy is it is first important to understand the anatomy and function of the meniscus. Your shinbone and thigh bone are connected by two C-shaped discs of cartilage, called menisci, Meniscus protects and stabilizes your knee by lubricating the joint and working as a shock absorber. Your knee is capable of holding your weight because of these menisci. The heavy lifting of objects, sports injuries, and kneeling can tear up your menisci. With aging, the menisci start wearing down, making your knee more prone to injuries.

A meniscal tear are among the most common knee injuries resulting in many consequences. After the injury, menisci need to be preserved from further cartilage damage. The incidence rate of menisci tears is 61 cases per 100,000 annually.

What Is Meniscectomy And What Is Done?

Meniscectomy is an outpatient, benign surgical procedure for removing the torn piece of the meniscus. Two types of meniscectomies are performed based on the surgical decisions: partial meniscectomy to remove only the torn part of the meniscus and total meniscectomy to remove the entire meniscus.

The treatment, which is best for you will be decided by your orthopaedic surgeon based on how big the damage is, the pattern, and the location of the tear. The suitable treatment option can also be determined on the basis of your age, health, symptoms of a damaged meniscus, and the level of your physical activity.

The main goal of meniscectomy is to remove the damaged part of the meniscus that causes the joint to damage. If left untreated, meniscus tears can cause your knee to lock or interfere with joint movement. When meniscus tears become symptomatic, the surgery becomes essential. Surgeons recommend meniscectomy when:

• When your knee becomes locked
• When the knee joint goes out of alignment and stops moving.
• The torn meniscus is not healing with conventional treatment.

What Are The Benefits Of Meniscectomy?

Besides trimming the torn piece of the meniscus, meniscectomy can diagnose a number of conditions and knee problems:

• Floating fragments of bone or cartilage
• Prolonged stiffness of joints
• Damaged cartilage
• The buildup of fluid in joints that needs to be drained
• Persistent joint pain

Meniscectomy is not meant for everyone. However, many people prefer meniscectomy over many surgical procedures because it involves:

• Lower risk of infection because of small incisions or cuts
• Faster healing time
• Only a few stitches
• Less tissue damage
• Less pain after the procedure

How To Prepare For Meniscectomy?

Starting strengthening exercises before surgery is recommended by doctors for three to four weeks. Exercise makes your knee muscles strong that helps you recover fast after surgery.

If you’re taking any OTC or prescribed medications, it is important to discuss them with your doctor. Your doctor can ask you to stop taking the medications before surgery because they can make you bleed more easily. Talk to your doctor about the information about before and after surgery

On the day of surgery, you will be recommended not to eat or drink before the procedure for up to 12 hours.

How Is Meniscectomy Performed?

The meniscectomy procedure involves two main approaches:

• Arthroscopic surgery is an outpatient surgery that requires general anaesthesia.
• Open surgery that requires a hospital stay

Arthroscopic Surgery:

Arthroscopic surgery involves the following steps:

1. Your doctor will numb the affected knee by general anaesthesia.
2. A few cuts, mainly three, will be made on the knee.
3. An arthroscope with an attached camera is inserted so that the surgeon can identify any problems. The camera will examine all the structures in the knee.
4. The small tools important during the procedure will be inserted through the arthroscope to find the problem.
5. When the damaged meniscus is fixed, the surgeon will remove the tools and close the incisions/cuts with sutures.

Open Surgery:

1. Open surgery or meniscectomy is done to expose the entire knee by making a large incision.
2. The surgeon identifies the tear by examining the knee joint.
3. The entire meniscus or the damaged part is removed.
4. The cut is sewn and stapled closed with stitches.

After-Care:

The surgery will be terminated in less than one hour. After the surgery, you’ll experience swelling and pain in the affected area. Inflammation can be reduced by placing an ice pack on your knee. Your doctor will prescribe medications, mainly opioids, for alleviating pain two to three days after surgery.

A long-acting local anaesthetic can be helpful to use instead of opioids. After this, you can take NSAIDs like ibuprofen. For one-week post surgery, you’ll need crutches to walk.

Recovery:

Open surgery requires more time to recover than arthroscopic surgery. Arthroscopic surgery usually takes four to six weeks to completely recover. Factors that influence the recovery time include:

• Your regular physical activity level
• Severity of injury
• Types of meniscectomy
• Your overall health
• The success of the surgical procedure

Before leaving the hospital, your doctor recommends OTC or prescribed medications for managing pain. Recovery time varies for every person. Some people return to physical activity within two weeks after surgery. For some people, it can take up to six to eight weeks to resume the usual activity.

You can also follow some recovery tips:

• Using crutches during the first weeks
• Placing ice packs on the affected knee
• Changing clothes regularly
• Resting well.

Are There Any Risks Associated With Meniscectomy?

Meniscectomy is considered a safe procedure, but any type of surgery can pose risks. Two major risks associated with meniscectomy are:

1. Deep Venous Thrombosis: When you do not move your leg even after the surgery and even when you gain strength, blood starts to clot in your leg vein. If you notice swollen, tender, and warm calf, it may be a sign of thrombosis.
2. Infection: The surgeon needs to keep the incisions clean. Uncleaned incisions can lead to the penetration of bacteria in your knee, causing infection. If you observe the signs of warmth, swelling, pain, and drainage from the incision, contact your healthcare provider right away.

Conclusion:

The recovery time after meniscectomy varies from person to person. You can have a faster recovery time if you’re fully committed to it. As meniscectomy has a high success rate, you can experience minimal side effects like pain and swelling.

References:

1. Do I Need Surgery for a Meniscus Tear? WebMD. [2019, May 16]. Retrieved from: https://www.webmd.com/pain-management/knee-pain/meniscus-tear-surgery
2. Anetzberger H, Birkenmaier C, Lorenz S. Meniscectomy: indications, procedure, outcomes, and rehabilitation. Orthop Res Rev. 2013 Dec 21;6:1–9.
3. Meniscectomy for a Meniscus Tear | Michigan Medicine. [2020, Nov 16]. Retrieved from: https://www.uofmhealth.org/health-library/uh2055
4. Knee arthroscopy: Benefits, preparation, and recovery. [ 2018 Jun 11]. Retrieved from: https://www.medicalnewstoday.com/articles/322099
5. Jeong H-J, Lee S-H, Ko C-S. Meniscectomy. Knee Surg Relat Res. 2012 Sep;24(3):129–36.
6. Surgery to Remove a Torn Meniscus. Verywell Health. [ 2020 Dec 04]. Retrieved from: https://www.verywellhealth.com/arthroscopic-surgery-for-torn-meniscus-2549899
7. Meniscectomy: Purpose, Preparation, Procedure, and Recovery. Healthline. [2019 Mar 12]. Retrieved from: https://www.healthline.com/health/meniscectomy.