Arthroscopic meniscus repair is an outpatient surgical procedure to repair torn knee cartilage. The torn meniscus is repaired by a variety of minimally invasive techniques and requires postoperative protection to allow healing. Physical therapy is useful to regain full function of the knee, which occurs on average 4-5 months after surgery.
Torn knee cartilage generally produces pain in the region of the tear and swelling in the knee joint. These symptoms are made worse with pivoting motions, squatting, and vigorous activities. Torn meniscus fragments can get caught in the knee joint and cause catching sensations. If a large enough fragment becomes lodged between the bearing surfaces, the knee may 'lock' and become unable to be fully bent or extended.For more detailed information on symptoms and diagnosis, please see our article on torn meniscus.
The goal of meniscus surgery is to preserve healthy meniscus tissue. A meniscus tear requires a blood supply to heal. Only the outer third portion of the meniscus has blood supply to enable healing of a tear. Repairs are generally limited to this peripheral region of the meniscus. Many types of meniscus tears occur in the region of the meniscus without adequate blood supply for healing. Meniscus removal is generally recommended for tears to regions of the meniscus without blood supply. Please see arthroscopic meniscectomy for more information.
Meniscus tears can be treated by meniscus removal (meniscectomy), meniscus repair, or in unusual circumstances, meniscus replacement. Since the goal of surgery is to preserve healthy meniscus, meniscus repair is attempted when the tear is repairable.
Meniscectomy, removal of the damaged meniscus tissue, has good short term results but leads to the development of arthritis ten to twenty years later.
Meniscus repair also has good results, but has a longer recovery time than meniscectomy and is limited to tears which are amenable to repair.
Meniscus replacement is considered for young, active patients who have previously had most of their meniscus removed, and develop pain in the area without having advanced degenerative changes to the articular (gliding surface) cartilage. Please see meniscus replacement for additional information.
When performed by an experienced surgeon, meniscus repair is highly successful , with good results in approximately 90% of patients. Any knee that is injured has a higher likelihood of developing arthritis. A successful repair slows the development of arthritic changes. Factors associated with higher rates of meniscus healing include repair within 2 months, more peripheral tear location, and concomitant ACL reconstruction.
The meniscus is an important structure for load transmission and shock absorption in the knee. The knee is subjected to up to 5 times body weight during activity, and half this force is transmitted through the meniscus with the knee straight, and 85% of the force goes through the meniscus with the knee bent ninety degreesarticular (gliding) cartilage, which leads to degenerative changes. A successful meniscus repair preserves meniscus tissue and mitigates these changes.
Even though the recovery is longer for a meniscus repair than for a meniscectomy, any repairable meniscus should generally be repaired. Meniscus repair is considered when:
The surgical animation below is an example of the arthroscopic meniscus repair procedure. Not all surgical cases are the same. The animation below is only an example to be used for patient educcation.
Surgery for a meniscus tear is not an emergency. Arthroscopic meniscus repair is an elective procedure that can be scheduled to minimize disruption of patients� lives. Results are maximized by repairing meniscus tears within the first two months of injury.
All surgery has risks. There is likely nothing you could imagine could go wrong that has not gone wrong at some time. That being said, meniscus repair is a safe procedure with a complication rate of 1.3%. The most common complications are injuries to skin nerves, the vast majority of which resolve without additional procedures by three months post surgery. Injury to larger nerves or blood vessels is rare, as are blood clots. Knee stiffness, infections, and other problems are uncommon, but can occur. An experienced surgical team uses special techniques to minimize these risks, but unfortunately they cannot be completely eliminated.
The most effective treatment of complications is prevention. For example, the risk of infection is decreased by giving antibiotics prior to surgery, and the risk of blood clots is decreased by using anti-embolism stockings. If infection does occur, repeat arthroscopy to remove infected tissue and debris, in conjunction with antibiotics for six weeks is generally effective. If blood clots occur, blood thinners are used for three months to decrease the chance of clots growing or breaking off and traveling to the lungs. Knee stiffness can often be managed with physical therapy and braces, but may require arthroscopic releases to restore motion. Since most complications can be effectively managed when identified promptly, if patients have questions or concerns about the post-operative course, the surgeon should be informed as soon as possible