Meniscectomy for a Meniscus Tear
Meniscectomy is the surgical removal of all or part of a torn meniscus. A meniscus tear is a common knee joint injury. Surgeons who perform meniscectomies (orthopedic surgeons) will make surgical decisions based on the meniscus's ability to heal as well as your age, health, and activity level.
Your doctor will likely suggest the treatment that he or she thinks will work best for you based on where the tear is, the pattern of the tear, and how big it is. Your age, your health, and your activity level may also affect your treatment options. In some cases, the surgeon makes the final decision during surgery, when he or she can see the how strong the meniscus is, where the tear is, and how big the tear is.
The pattern of the tear may determine whether a tear can be repaired. Horizontal and flap tears generally require surgical removal of at least part of the meniscus. See a picture of different types of tears.
The choice of type of surgery is based on the size and location of the tear, your age and activity level, the surgeon's experience, and your preferences. Orthopedic surgeons most often perform meniscus surgery with arthroscopy, a procedure used to both examine and repair the inside of a joint. A thin tube (arthroscope) containing a camera and light is inserted through small incisions near the joint. Surgical instruments are inserted through other small incisions. Arthroscopic surgery may limit knee damage from surgery and may promote fuller recovery. But some tears may require open knee surgery.
In a total meniscectomy, the entire meniscus is removed. In a partial meniscectomy, the surgeon removes as little of the meniscus as possible. Unstable meniscal fragments are removed, and the remaining meniscus edges are smoothed so that there are no frayed ends.
You may have general or regional anesthesia for a meniscectomy. Arthroscopic partial meniscectomy is commonly performed in an outpatient surgical center.
What To Expect After Surgery
Rehabilitation (rehab) varies depending on the injury, the type of surgery, your orthopedic surgeon's preference, and your age, health status, and activities. Time periods vary, but meniscus surgery is usually followed by a period of rest, walking, and selected exercises. Most people who have arthroscopic meniscectomy can bear weight a day or two after surgery and can return to full activity within 2 to 4 weeks. After the full range of motion without pain is possible, you can return to your previous activity level.
The timetable for returning to walking, driving, and more vigorous activities will depend on the type and extent of the surgery and your success in rehab. To learn about some exercises you can do at home (with your doctor's approval), see:
Why It Is Done
A decision to remove all or part of your meniscus will take into consideration the location, length, tear pattern, and stability of the tear as well as the condition of the whole meniscus. Your surgeon will also consider the condition of the entire knee, your age, and any age- or injury-related degeneration.
If a meniscus tear is causing pain or swelling, it probably means that torn pieces of the meniscus need to be removed and the edges surgically shaved to make the remaining meniscus smooth. Your orthopedic surgeon will try to preserve as much meniscal tissue as possible to prevent long-term degeneration of your knee and allow you to return to full activities.
How Well It Works
Removing the whole meniscus generally reduces some symptoms. But losing the meniscus reduces the cushioning and stability of the joint. Most people, especially if they are young or active, are not satisfied with a total meniscectomy. This is why surgeons try to remove as little of the meniscus as possible.
Studies of partial meniscectomy have shown that 78% to 88% of people have good results from partial meniscectomy. This means that 78 to 88 people out of 100 people who have this surgery have decreased symptoms and are able to return to most or all of their activities.1
Meniscectomy is generally well tolerated and does not usually cause complications. But there is a risk of damaging the nerves during surgery.
There is a direct relationship between the amount of meniscus tissue that is surgically removed and the load distribution across the knee. If more tissue is removed, the knee is less able to sustain the load of walking, running, or other activities. With uneven load distribution, degeneration of the knee joint may happen at a faster pace than it would with an intact meniscus.
In any surgery, there is risk of infection or bleeding. And there are risks with general or regional anesthesia.
What To Think About
Surgical repair is generally favored over a partial or total meniscectomy. If the meniscus can be repaired successfully, it reduces the risk of knee joint degeneration that may occur with removal of all or part of the meniscus.
One study reports that the development of arthritis in the knee after meniscectomy may be influenced by heredity and environmental factors. This finding is significant, because surgical removal of meniscal tissue has been considered the cause of osteoarthritis in the knee. If this study's findings are correct, surgery may be a factor, but not the only factor, in eventual osteoarthritis in knees.2
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