A meniscus tear injury can occur to either one or both of the menisci found within the knee joint. Menisci are crescent-shaped rings, triangular in cross-section. They are made of collagen and rubbery in nature. It is believed that they have a shock absorbing function. Some experiments have suggested that injury to the meniscus may increase the risk of arthritis.
The mechanism of injury can involve twisting, pivoting, sudden stops and turns of the knee while playing sport. It could also be caused by movements such as kneeling, squatting or lifting something heavy. Even stumbling or mis-stepping can cause a tear. Sometimes tears can occur without obvious trauma because the meniscus is degenerate. Tears can also be present as part of the wider degenerative changes found with osteoarthritis.
TREATMENT OPTIONS FOR MENISCUS TEARS
Treatment options for meniscus tears include pain management and physiotherapy or meniscus surgery.
If there is a large, displaced tear, identified on an MRI scan, then surgery would be recommended. Sometimes smaller meniscal tears can ‘flip’, causing sharp catching pain. Surgery may also be helpful in this situation. The surgical options include debridement or excision (removal of the tear), or repair using stitches (sutures).
ABOUT MENISCAL SURGERY
The type of surgery required will depend on a number of factors, including the nature of the tear and how old the tear is. Whatever treatment is undertaken, is usually done through key-hole (arthroscopic) surgery.
Meniscal surgery may be performed to repair a torn meniscus using stitches. There are different techniques that can be used.
While sensical repair may be the preferred option, it is sometimes not possible. This could be because the quality of the meniscus tissue is poor, or the pattern of the tear is less amenable to repair. Instead, removing the torn meniscus (called excision, or partial meniscectomy) can provide improvement in symptoms.
The principle of surgery is to try and preserve the meniscus as far as possible, while ensuring that it is stable.
OUTCOMES FOLLOWING SURGERY
Excision can be effective at improving symptoms immediately, particularly if you have significant catching type pain.
However, in the long-term, you may continue to have pain and stiffness. This is because the healthy meniscus has the important function of a shock absorber; injury disrupts this function. (Information).
Repair can also be effective, but there is a risk of failure of the repair. This may require a further procedure to remove the failed stitched and torn meniscus. (Information).
THE DAY OF SURGERY
On the day of your surgery you will see your surgeon and anaesthetist. The anaesthetist will discuss anaesthetic options with you, which may include general or regional anaesthetic. The nurses will prepare you for your operation.
- After surgery, you will be sent to recovery before going to the ward.
- You will find a dressing and bandaging consisting of wool and crepe on the knee after your operation.
- You will experience pain following surgery – please use the painkillers provided, even if there is little pain. This is to prevent pain worsening when painkiller medication wears off.
- It would be usual for you to go home on the same day following surgery.
- You will be given guidance and information before discharge from hospital.
RISKS OF SURGERY
As with any surgery, complications can occur. Risks include infection, blood clots (deep vein thrombosis and pulmonary embolism), persisting or worsened pain and on-going stiffness. Some peoples symptoms may not improve.
Other risks include a reaction to anaesthesia, or requiring another procedure to remove a failed repair.
- You may have a bandage (wool and crepe) when you are discharged. This can be removed after 24-48 hours.
- The dressings covering the wounds should not be disturbed. This is because they protect the wounds, which need to be kept dry and clean until completely healed. It can be normal to notice dark hard areas on the dressing caused by dry blood. The dressing should remain undisturbed for 2 weeks. If there are any concerns, please contact the nursing team (information given on discharge) or Mr Asopa.
- The knee will be swollen after surgery and this will take time to settle. Rest, ice, elevation and compression (for example, with a tubigrip) can be used to help recovery.
- Icing can be done for 15 minutes every hour (wrapped in cloth to avoid skin damage). Devices are also available for purchase or rent online to help with recovery.
- It is important to avoid excess activity for the first 6 weeks.
- If you have had a meniscal repair, it is also important to avoid flexion beyond 90 degrees for the same period. This is to avoid stressing the stitches used for the repair.
- Rehabilitation can involve physiotherapy to strengthen and improve the range of motions. The rehabilitation plan will depend on the findings and procedure/s performed during surgery.
You will have a follow-up appointment to check progress and wound healing. The results and a proposed plan for recovery will also be discussed.
It is considered day-surgery. Recovery is much quicker than someone who undergoes a major procedure such as joint replacement.
You will need to use crutches when you go home because the knee may be swollen and painful. The recovery period, or time until you stop using the crutches, depends on exactly what procedure you have and the severity. Patients can also recover at different rates.
The operation normally takes half an hour.
It is likely that you will be able to go home on the same day as your surgery. You will be given guidance and advice on what to do after discharge.
Book your Appointment
with Mr Vipin Asopa
Mr Asopa performs ACL meniscal surgery in hospitals across London and Surrey. To book an appointment or for any questions or information, please contact Mr Asopa's Medical Secretaries Mandy and Mary by phone or email: