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Meniscal Repair
What is the meniscus?
A meniscus is a c-shaped piece of cartilage that functions as a shock absorber between the bones of the knee. Each knee has two menisci, a medial meniscus (in the inner side of the knee) and lateral meniscus (in the outer side of the knee). The primary job of the menisci is to absorb pressure and distribute your body weight. Menisci also protect your leg bones from rubbing together, which can lead to osteoarthritis.
A meniscal repair is a surgical procedure to repair a torn meniscus via keyhole surgery. It is a minimally invasive procedure often undergone as an outpatient. Factors affecting success include tear age, location and pattern, age of the patient, as well as any associated injuries.
How meniscus injuries happen
Meniscus tears are often caused by sudden twisting motions. Sports injuries are the most common causes of these, but anyone at any age can injure their meniscus.
People sometimes tear their knee cartilage doing the following:
- Climbing stairs or hills
- Hyper-flexing (bending the knee too far)
- Squatting (especially while lifting a heavy weight)
- Walking on an uneven surface (like a poorly paved sidewalk or rough terrain)
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“KNEEO Technique” For Knee Replacements
Risk factors for meniscus tears
You’re more at risk for an injury to the meniscus if you meet the following criteria:
- You’re over age 30. Risk of meniscus injuries increases as you age, as the cartilage wears out.
- You play a sport that involves pivoting (e.g., basketball, golf, tennis).
- You play contact sports (e.g., football, hockey, rugby).
- You have a degenerative condition like osteoarthritis.
REASONS TO GET MENISCUS REPAIR SURGERY
In some cases, you can treat the pain and discomfort of a meniscus tear with RICE therapy (rest, ice, compression, and elevation) or NICE therapy (non-steroidal anti-inflammatory drugs, like ibuprofen or naproxen), ice, compression, and elevation).
However, if you suspect you’ve injured your meniscus, you should see a doctor. Many meniscus injuries occur in the inner two-thirds of the meniscus, in the “white” zone where blood supply is not as rich. Without nutrients, these injuries seldom heal on their own.
Left untreated, a damaged meniscus can lead to other problems in your knee. Loose meniscus cartilage may move around inside your joint, leading to locking or popping of the knee and knee instability. A chronically injured meniscus can also lead to arthritis.
MENISCUS REPAIR PROCEDURES
Arthroscopic meniscus repair (meniscus repair vs. meniscectomy)
Your orthopedic surgeon may recommend minimally invasive knee arthroscopy: the use of an arthroscope (a tube with a camera attached to it) to look inside the knee and diagnose and repair your injury.
Meniscus repair arthroscopy usually proceeds as follows:
- After administering anesthesia and prepping your knee, your surgeon will use a scope to look inside the joint and determine whether the tear can be repaired or if you will need a partial meniscectomy (removal of the damaged part of the meniscus).
- If your meniscus tear can be repaired, the surgeon will suture the torn edges together. This technique works in approximately 10% of all cases. Surgeons usually prefer to perform repairs rather than meniscectomies because preserving the meniscus protects your knees from arthritis in the future. However, because the torn ends of cartilage must heal back together, recovering from this surgery can take longer.
Meniscus repair may work for you if:
- meniscus tissue is in good condition (aside from the injury, of course)
- tears run vertically through the meniscus
- tears are small and on the outer edges of the meniscus, in the “red zone” where the blood supply is rich (these are called peripheral menisco-capsular tears)
- If your tear cannot be repaired (true in an estimated 90% of cases), the surgeon will perform a partial meniscectomy, trimming away the damaged parts of the meniscus and leaving the healthy tissue intact. Patients who undergo this surgery often progress faster than those who receive sutures.
Partial meniscectomy is preferred for:
- flap tears (where a flap of the meniscus is torn away)
- tears that run horizonally through the meniscus
- tears that run through the “white zone,” of the meniscus, where the blood supply is limited and injuries can’t heal well on their own
- Less commonly, if the damage to the knee is more extensive, a full meniscectomy (removal of the entire meniscus) may relieve all symptoms. However, most active people prefer to keep as much of their meniscus intact as possible so they can continue to participate in sports and other activities. Removing the meniscus means removing the cushion between the knee bones, which can hasten knee degeneration.
- In cases of serious damage, bone degeneration, or multiple knee problems, a total knee replacement surgery may be recommended.