Arthroscopic meniscus repair is used for certain symptomatic meniscal tears that have the ability to heal when surgically repaired. The goal of meniscal surgery is to relieve symptoms by either repairing the tear or removing only the torn and damaged portion of the meniscus when repair is not possible.
Because injury or loss of functioning meniscus increases loading on the cartilage in the same area of the knee, preserving functioning meniscal tissue when possible is important.
What Is Arthroscopic Meniscus Repair?
Meniscal tears can cause knee pain as well as mechanical symptoms such as locking, catching, intermittent sharp pain, and sometimes giving way.
Only the outer 10 to 30 percent of the meniscus has the blood supply needed for tissue healing. Because of this limited blood supply, most meniscal tears cannot be repaired and require arthroscopic partial meniscectomy, which removes only the torn and damaged portion of the meniscus.
A smaller number of tears, particularly simple vertical tears in the outer portion of the meniscus that occur after an injury, may have enough blood supply to heal when surgically repaired.
Meniscus repair is performed arthroscopically using a small camera inserted through small incisions. A small open incision is also often required to protect the nerves and blood vessels around the knee as the needles and sutures are passed through the tissues.
Who Is a Candidate?
Meniscal surgery may be appropriate for patients with symptomatic meniscal tears causing pain or mechanical symptoms such as locking, catching, intermittent sharp pain, or giving way.
A meniscus repair may be possible when the tear has characteristics that allow it to heal, including certain simple vertical tears in the outer portion of the meniscus where there is a good blood supply.
The success of meniscus repair is significantly higher in a stable knee with an intact anterior cruciate ligament (ACL). For patients who have both an ACL tear and a repairable meniscus tear, ACL reconstruction is advisable to increase the chance that the meniscus will heal.
Contraindications to surgery include:
- Infection of the knee
- Inability or unwillingness to complete the appropriate postoperative rehabilitation program
- Pain or symptoms that are not related to the meniscus
- Diffuse advanced arthritis of the knee without mechanical symptoms
How the Procedure Is Performed
Dr. Chudik performs meniscal surgery with the assistance of an arthroscope, a small camera inserted through small incisions that allows him to view the inside of the knee.
For tears that can be repaired, the edges of the tear are freshened and sutures are used to hold the torn edges together while the meniscus heals.
If the tear is not repairable, small shavers and cutting instruments are used to remove and contour only the torn and damaged portion of the meniscus.
Meniscus repair often also requires a small open incision to protect the nerves and blood vessels around the knee as needles and sutures are passed through the tissues.
The procedure is performed as outpatient surgery with light general anesthesia and local numbing medicine around the knee.
Recovery and Rehabilitation
Following meniscus repair:
- Crutches are used for approximately six weeks
- A postoperative knee brace is worn for six weeks to keep the knee straight and protect the repair
- Open incisions used for meniscus repair should be kept clean and dry for 10 to 14 days
- The wounds should not be submerged in water for three weeks
- Physical therapy should begin two to three days after surgery and continue for approximately three to four months
Successful meniscal surgery depends on postoperative rehabilitation, making it important to follow and maintain the prescribed therapy program.
Return to sports may occur when there is no pain and full knee range of motion, muscle strength, endurance, and functional use have been restored. Following meniscal repair, this usually requires approximately four to six months.
Risks and Outcomes
Potential surgical risks and complications include:
- Infection
- Re-tearing of the remaining meniscus
- Re-tear or failure of the meniscus repair to heal
- Knee stiffness or loss of knee motion
- Stress injury to the tibia or femur of the knee joint
- Continued pain and progressive arthritis
- Weakness of the quadriceps muscles if proper rehabilitation is not completed
- Unexpected areas of significant arthritis that may be responsible for symptoms and require longer rehabilitation and activity modification
- Persistent swelling and possible need for meniscus transplant
Injury or loss of functioning meniscus is associated with increased loading of the cartilage in the same area of the knee and increases the risk for earlier development of knee arthritis.
Why Dr. Chudik for Arthroscopic Meniscus Repair
Dr. Chudik performs meniscal surgery arthroscopically and evaluates whether a torn meniscus can be repaired or whether only the torn and damaged portion needs to be removed.
When a tear is repairable, he freshens the tear edges and uses sutures to hold the meniscus together while it heals. When repair is not possible, the goal is to remove and contour only the damaged portion of the meniscus.
For patients with both an ACL tear and a repairable meniscus tear, Dr. Chudik may also recommend ACL reconstruction because meniscus repairs have a significantly higher chance of healing in a stable knee with an intact or reconstructed ACL.