Arthroscopic Meniscus Surgery

Arthroscopic Meniscus Surgery

Meniscus is a soft, rubber-like C-shaped cushion in between the bones of the knee. There are two of them – one on the inner side and one on the outer side. They participate in sharing load across the knee. There are two problems which occur in menisci – one that it degenerates (becomes week) with age, and the other that it tears due to injury. A degeneration in the meniscus causes pain, having become softer it often breaks with minimum injury. A typical meniscus tear occurs in young adults, as a result of twisting injury. The torn meniscus becomes a ‘misfit’ in the joint, and gives rise to mechanical symptoms such as locking catching, clicking etc. Over a period of time, these mechanical symptoms cause damage to soft covering (cartilage) over the bones. This is called osteoarthritis, and is irreversible damage to the joint.

Frequently Asked Questions

Q 1. How to know that your problem is due to meniscus tear?
Typically the person gets a twisting injury, which results in repeated pain, catching, locking etc. Often the symptoms are vague, and diagnosis can only be clinched on MRI.
Q 2. What is the treatment of meniscus tear?
Till a few decades back meniscus was considered a vestigial structure, and was removed mercilessly for whatever reason. Soon, side effects of this approach became clear and the trend today is to save the meniscus. Whenever possible a meniscal tear is sutured. If suturing is not possible, a part of itis excised arthroscopically (partial menisectomy). There are efforts toward transplanting meniscus from cadaver, and also implanting artificial menisci.
Q 3. How is surgery done for meniscus tear?
Surgery is done by key-hole technique (arthroscopic surgery), under anaesthesia from an injection in the back. It takes from 15-20 minutes to do the job. One is able to walk on his/her legs within 24 hours. If meniscus suturing is required it may take longer.
Q 4. What is meniscal repair?
This is the latest technique in meniscal surgery where the torn ends of the meniscus are stitched back together arthroscopically.The technique used depends on where in the meniscus is the tear

Inside out technique: this is done in tears of the post horn and body of the medial meniscus

Outside in: This is done in tears of the body and anterior horn of the lateral and medial meniscus

All Inside: This is done in tears of the posterior horn, root and body of both menisci
Q 5. Are all tears repairable?
Not all tears are repairable, the ones that are towards the periphery are more akin to be repaired as they have a better blood supply and heal up well. Also tears that are fresh and in one plane heal up better.
Q 6. What is the post op rehabilitation?
Menisectomy: In these cases there are very few restrictions, the patient can fully weight bear on their feet, may require a stick/crutches for 7-10 days and then can walk unrestricted and bend their knees as tolerated

Meniscal Repair: The aim in the rehabilitation is to keep the menisci in a conducive environment to give the body a chance to heal it up. In these cases movement at the knee is restricted to less than 90 degrees of bending till 6 weeks. The patient can weight bear as tolerated using a long knee brace and crutches/walker the next day. The long knee brace is worn for 2 weeks and then changed to a hinge knee brace. Bending is restricted to less than 90 degrees.for 6 weeks. After 6 weeks the brace is taken off and bending greater than 90 degrees is allowed. Return to sport post isolated meniscal repair is after 3 months. When in association with a ligeamnet surgery sports can be resumed only after 6-9 months.
Q 7. How often are repirs done?
We are pioneers in meniscal repair in India and do one of the largest numbers in the country. This is a highly specilised surgery that not many practices offer. We do over 200 a year.