Arthroscopic Meniscus Repair: A minimally invasive method to repair torn knee cartilage
Edited By: John R. Green III, M.D.
Last updated Thursday, January 19, 2006
Considering surgeryWhat kinds of surgery are recommended for meniscus tear? Arthroscopic surgery is recommended for meniscus tears. The basic
principle of meniscus surgery is preservation of healthy meniscus.
Since meniscus repair is only feasible in the peripheral area of
meniscus that has adequate blood supply, most meniscus tears are
treated with arthroscopic meniscectomy. (link)Who should consider arthroscopic meniscus repair for meniscus tear and in what cases? Even though the recovery is longer for a meniscus repair than for a
meniscectomy, any repairable meniscus should generally be repaired.
Meniscus repair is considered when:
- the patient is healthy and wishes to remain active,
- the patient understands the rehabilitation, and accepts the risks of surgery,
- the meniscus tear is located in the periphery of the meniscus,
- the meniscus tissue is of good quality, and
- the surgeon is experienced in meniscus repair
What happens if nothing is done for meniscus tear (best case/worst case scenarios)? In the best case scenario, the tear would heal back in the appropriate
place, achieving the same result as a meniscus repair. This is very
unlikely. In the worst case scenario, a repairable meniscus would tear
further and become unrepairable, and fragments of torn meniscus would
injure the articular (gliding) cartilage leading to accelerated
arthritis.What options exist for surgery for meniscus tear? Meniscus tears can be treated by meniscus removal (meniscectomy),
meniscus repair, or in unusual circumstances, meniscus replacement.
Since the goal of surgery is to preserve healthy meniscus, meniscus
repair is attempted when the tear is repairable.
The simplest
operation is meniscectomy, removing the damaged meniscus tissue. This
has good short term results but leads to the development of arthritis
ten to twenty years later. Meniscus repair also has good results, but
has a longer recovery time than meniscectomy and is limited to tears,
which are amenable to repair. Meniscus replacement is considered for
young, active patients who have previously had most of their meniscus
removed, and develop pain in the area without having advanced
degenerative changes to the articular (gliding surface) cartilage.
Please see meniscus replacement for additional information.When performed by an experienced surgeon, how effective is arthroscopic meniscus repair for meniscus tear likely to be and how long will the benefit last? When performed by an experienced surgeon, meniscus repair is highly
successful , with good results in approximately 90% of patients. Any
knee that is injured has a higher likelihood of developing arthritis. A
successful repair slows the development of arthritic changes. Factors
associated with higher rates of meniscus healing include repair within
2 months, more peripheral tear location, and concomitant ACL
reconstruction.How urgent is arthroscopic meniscus repair for meniscus tear? Surgery for a meniscus tear is not an emergency. Arthroscopic meniscus
repair is an elective procedure that can be scheduled to minimize
disruption of patients’ lives. Results are maximized by repairing
meniscus tears within the first two months of injury.What are the most frequent and most serious risks of arthroscopic meniscus repair for meniscus tear? How common are they? All surgery has risks. There is likely nothing you could imagine could
go wrong that has not gone wrong at some time. That being said,
meniscus repair is a safe procedure with a complication rate of 1.3%.
The most common complications are injuries to skin nerves, the vast
majority of which resolve without additional procedures by three months
post surgery. Injury to larger nerves or blood vessels is rare, as are
blood clots. Knee stiffness, infections, and other problems are
uncommon, but can occur. An experienced surgical team uses special
techniques to minimize these risks, but unfortunately they cannot be
completely eliminated.If risks occur during or after arthroscopic meniscus repair for meniscus tear how are they managed? The most effective treatment of complications is prevention. For
example, the risk of infection is decreased by giving antibiotics prior
to surgery, and the risk of blood clots is decreased by using
anti-embolism stockings. If infection does occur, repeat arthroscopy to
remove infected tissue and debris, in conjunction with antibiotics for
six weeks is generally effective. If blood clots occur, blood thinners
are used for three months to decrease the chance of clots growing or
breaking off and traveling to the lungs. Knee stiffness can often be
managed with physical therapy and braces, but may require arthroscopic
releases to restore motion. Since most complications can be effectively
managed when identified promptly, if patients have questions or
concerns about the post-operative course, the surgeon should be
informed as soon as possible.Surgery for Meniscus Tear at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-543-1552 to make an appointment.
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