What is the meniscus?
The meniscus is a wedge shaped semi-circular pad made of fibro-cartilage that acts as the shock absorber of the knee.
How does it tear?
Acute meniscal tears typically occur through twisting, loading or direct trauma to the knee. Different types of tears exist, and can be described by how recently they occurred, the shape of the tear, and the location of the tear within the meniscus itself.
What problems can a Meniscal Tear cause?
A pop may be felt when the meniscus tears acutely. People can usually still walk after the tear. Common symptoms include pain, swelling, stiffness, mechanical symptoms of clicking and catching, a feeling of giving way or the knee locking in position.
How is a meniscal tear treated?
The majority of meniscal tears are initially treated non-operatively with RICE and range of motion exercises through physiotherapy to strengthen your knee muscles.
A failure of non-operative management to control the symptoms of recurrent pain, swelling or mechanical catching and locking is also a reason to consider meniscal surgery. Meniscal Debridement is often performed, but sometimes the meniscal tear is suitable for repair
Why are only certain tears repaired?
Not all tears are suitable for repair. Your surgeon at Melbourne Hip and Knee will take into account a variety of factors when it comes to deciding if a tear will be debrided or repaired. The factors are usually clear prior to the operation, but information found during the Knee Arthroscopy will also guide us. If the tear has a low chance of healing after repair, then it is debrided. Repairing an unsuitable tear leaves the patient with a high chance of needing further surgery to treat the problem. The rehabilitation is also more restrictive after a repair, with a brace sometimes required.
A repair is performed, and more likely to succeed, in a younger patient with a simple tear that is acute (recent) and is located towards the outer aspect of the meniscus in an area with a good blood supply to help it heal. A repair will often be undertaken for a locked knee from a bucket handle meniscal tear or if the tear is part of a larger injury such as in conjunction with an ACL reconstruction.
What happens during the Meniscal Repair surgery?
Meniscal Repair surgery is a day procedure surgery performed via a Knee Arthroscopy.
Under a general or spinal anaesthetic, two small incisions are made in the front of the knee to gain access into the joint. Further small incisions may be required to complete the repair. A full assessment is performed within the knee to rule out other conditions, and the diagnosis of a meniscal tear suitable for repair is confirmed.
The edges of the torn meniscus to be repaired are trimmed to promote healing. The tear is then reduced. Sutures are then placed across the tear to hold the reduced edges together.
These sutures can be inserted using a variety of surgical instruments, some of which require further small incisions to complete the repair. Multiple sutures are often required to hold the repair. The repair is checked at the end of the procedure to make sure it is stable and not at risk of getting caught within the joint.
To aid the healing, small microscopic holes are made into an area of the cartilage and bone that doesn’t bear weight. This releases marrow and bloods cells to help promote healing. The surgery takes around 30 minutes to perform. This could be extended if other procedures such as ligament reconstructions are required.
You will go home on the day of surgery once you recover from the anaesthetic. Before you leave hospital, your surgeon from Melbourne Hip and Knee will talk to you about the findings of the arthroscopy and the management performed. A physiotherapist will review you and discuss the exercises that are permitted and, if required, how to use a brace.
What happens after surgery?
You will be given instructions about how to care for your knee and the dressings in the first two weeks. You will be able to walk on your knee, but may need to use crutches to help protect the repair for a short period of time. Depending on the location and severity of the tear, as well as any other injuries present, you may be placed in a brace that restricts bending beyond 90 degrees for 6 weeks. It is common to have some mild pain and swelling for a few weeks after your surgery, and your surgeon will ensure that you have adequate pain relief to go home with.
Post operative recovery
Your surgeon will see you at two weeks in our rooms at MHK to ensure you have recovered well, and to explain the findings and management of the surgery again. Typically, a second appointment is organised at 6 weeks to progress your rehabilitation.
For a simple meniscal repair, you should be able to return to a desk job after a week and be able to spend a few hours on your feet after 2 weeks. Depending on the restrictions in weight bearing or use of a brace, you will be able to return to gentle exercise after 6 weeks. Deep squats should be avoided for 3 months. You will be given some physiotherapy exercises and it is important to perform them twice a day for a few weeks until your muscle function has returned.