Arthroscopic Meniscus Surgery

Arthroscopic Meniscus Surgery (Video Link - Keyhole Meniscus Surgery)

The 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 (medial meniscus) and one on the outer side (lateral meniscus). These structures act as shock absorbers. They share the load on the knee and protect the cartilage cap over the knee bones. There are two problems which occur in menisci – one, that it degenerates (becomes weak) with age, and the other that it tears due to injury.

Anatomy of the knee

Types of meniscus tears

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 misfit meniscal fragments cause damage to the cartilage cap. This is called osteoarthritis, and is an irreversible damage to the joint.

Frequently Asked Questions

Q 1. How do you know that the 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 are the types of meniscus tear?
The meniscus tears in various configurations in a young person. It is important to understand the pattern of tear as it has bearing on treatment. The tear may be simple (2-piece) tear or one in multiple pieces. The latter is called complex tears. Whereas simple tears can be repaired in most instances, complex tears may need excision.

Meniscus tears in adults, where a full attempt is made to repair, are judged based on configuration. They are essentially of two types – vertical and horizontal.

Vertical tears are commonly along the length of the meniscus, and are called bucket-handle tears. These tears occur most commonly in association with other ligament tear of the knee, such as ACL tear. They tear such that one part of the meniscus is attached to the peripheral capsule and the other comes in between the knee and gets stuck there. This phenomenon is called locking. All attempts are made to repair these as they heal very well. Vertical tears also occur transecting the meniscus into two – front and back part. These are also called radial tears. One may never have locking, may/may not have pain thus the warning system of the body via pain/locking is nullified, but mechanically these are very damaging to the knee. Repairing them is very critical to prevent early onset of arthritis.

Medial Meniscus Root Tear repair to winning the World Jujitsu Championship

Horizontal tears are those where the meniscus is split in between like a sandwich bread. There is an upper and a lower part and the tear appears like a fishes moth. These are more often than not degenerative and repairing them involves stitching the fishes mouth shut.

Q 3. What is the treatment of meniscus tear?
Till a few decades back, meniscus was considered a vestigial structure and was removed mercilessly. 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 minimum part of it is excised arthroscopically (partial menisectomy).
Q 4. How is the surgery done?
The surgery is done via key-hole technique, i.e. small incisions, less than 1cm in size are made around the knee to facilitate entry of instruments and a telescope inside the knee.
Q 5. What is meniscus repair?
Meniscus repair involves stitching the torn meniscus back to its positions using specialized instruments. These are fine suturing threads used to sew the torn meniscus using stitching instruments. Sometimes, special implants are used for stitching in difficult areas of the torn meniscus.
Q 6. What is the post op recover period?
Meniscus excision: In these cases there are very few restrictions, the patient can fully weight bear almost the very next day. One may require a stick/crutch for 7-10 days, after which can walk unrestricted. Knee bending is permitted from very same day of surgery.

Meniscus repair: The aim in the rehabilitation is to keep the meniscus in an environment to give the body a chance to heal it up. Therefore, a few restrictions have to be observed: (a) movement at the knee is restricted to less than mid-way bending (90 degrees) till 6 weeks; (b) bracing the knee while walking for a variable period. The patient can weight bear as tolerated using the brace and crutches/walker the next day. The detailed rehab programme is customised, patient-to-patient. Return to sports after isolated meniscal repair is after 3 months. When in association with a ligament surgery, sports can be resumed only after 6-9 months.

We are pioneers in meniscal repair in India and do one of the largest numbers in the country. This is a highly specialised surgery that not many surgeons offer. We do over 200 a year.

More Video Links of Meniscus Repair Surgery

1. Video link - Medial meniscus excision and lateral meniscus repair

2. Video link - Lateral meniscus repair

3. Video link - root repair