Meniscectomy
The knee joint is the primary weight-bearing joint in our body. The knee is cushioned by two cartilaginous discs called the meniscus, which act as shock absorbers during weight-bearing activities. As the meniscus is soft in nature, it is highly vulnerable to tear, which creates pain, swelling, and locking in the knee joint. A sudden knee twist during any activity (traumatic tear) or as a result of repetitive loading stress over time (degenerative tear) can result in a meniscal tear.
A meniscus tear is a common sport-related injury among athletic individuals. But sometimes deep squatting or lifting something heavy can also cause a meniscal tear.
Depending on the severity of your injury, treatment options can vary from at-home remedies to surgical methods.
What is meniscectomy?
The surgical excision of a torn meniscus is known as a meniscectomy. There are two methods of meniscectomy: arthroscopy and arthrotomy. Arthrotomy is an open technique and is rarely used, while arthroscopy is a common procedure that is performed using a scope with a tiny camera mounted on it and with specialized instruments. The incisions made are small compared with traditional open surgeries, which heal faster.
A total meniscectomy refers to the surgical removal of the entire meniscus. While partial meniscectomy refers to the removal of only the damaged part.
When is meniscectomy recommended?
A decision to remove all or parts of the meniscus is considered when the tear is severe, i.e., the knee is persistently swollen and locked," or when the non-surgical methods fail to alleviate the associated pain and dysfunction. The other factors that determine the need for surgery are:
- Extent of tear and patient's age: Surgical removal of torn meniscus is recommended only when the tear is more than 5mm and in elderly people with degenerative changes in the knee.
- Location of tear: The meniscus tear that occurs in the periphery of the meniscus requires a surgical removal, while the inner meniscus tear is easier to repair because of the presence of more blood vessels in that area.
- Cause of tear: A meniscus tear that occurs as the result of a sudden injury tends to have clear edges, which can be repaired by non-surgical methods, while a tear resulting from wear and tear over time will be thin and ragged; hence, a surgical approach is needed.
What are the pre-procedure care for meniscectomy?
Two or three weeks before the procedure, your doctor may suggest some strengthening exercises to make the surrounding muscles stronger. The stronger your muscles around your knee, the faster your recovery will be.
The doctor will perform a physical examination to check for infections, scars, or any scratches around the knee area. He or she will also inquire about your medical history and may ask you to stop some medications that cause complications during the surgery. For, aspirin will elevate the chance of bleeding.
On the day of surgery, you will be asked to fast for 8 to 12 hours before the procedure. You may be asked to arrange comfortable and loose clothes to wear after the procedure and have someone drive you back home.
As the surgical procedure is carried out under anesthesia, a member of the anesthesia team will talk to you before the surgery to finalize the choice of anesthesia.
- Local anesthesia numbs only a small, specific area of the body. Its effect lasts for a short period of time and is often used for minor outpatient procedures.
- Regional anesthesia will numb a larger area of the body, like below the waist, and is generally used to make a person more comfortable during and after the surgical procedure.
- General anesthesia will make the person completely unconscious during the operation, with no memory of the surgery.
How is arthroscopic meniscectomy performed?
The patient is shifted to the operating room, and the procedure begins soon after the administration of the anesthesia. The procedure is as follows:
- Surgeon will make small incisions around the knee area.
- Through one of the incisions, the camera (arthroscope) is inserted which will give a clear internal image of the joint on a monitor.
- Once the tear is found, surgeon will examine the extent of injury and, based on that, either a small piece (partial meniscectomy) or the entire (total meniscectomy) meniscus is removed.
- The surgical instruments for the procedure are then inserted through the other incisions.
- After the procedure, surgeon will examine the rest of the knee to make sure it is healthy.
- The tools, and scope are removed, and the incisions are closed with a suture or surgical tape strips.
What are the post-procedure care?
The surgery can be performed on an outpatient basis, meaning you can leave the hospital the same day after the procedure. After surgery, you'll be in the recovery room for an hour or two. As the sedation wears off, you may experience pain and swelling in the knee area. Swelling and pain can be managed by practicing R.I.C.E. therapy: applying ice packs, keeping your legs elevated, wearing compression bands, and giving maximum rest. Medication for short-term pain relief to prevent infection and blood clots is usually prescribed.
Some exercises may be recommended that may help in regaining strength and mobility. You may start with simple thigh muscle exercises the day after surgery and increase them accordingly as per the instructions of your therapist.
Patients are generally able to get back to their normal activities in three to four days after an arthroscopic meniscus repair. These activities will initially be performed by wearing a brace.
Outlook
A meniscectomy involves the surgical removal of the torn part of the meniscus. It is an effective procedure for restoring the comfort and normal functions of the knee. The procedure may leave you less active for about a month or more, but you can return to your normal daily activities six weeks after the surgery. Each person recovers at a different pace. The knee can function normally for decades after the surgery. A partial meniscectomy has a better long-term outcome compared to a total meniscectomy, as there are chances that part of the knee may become arthritic in 10–15 years after undergoing a total meniscectomy.