Arthroscopy in Children and Teenagers (Ages 8 to 18)
Edited By: Gregory A. Schmale, M.D.
Last updated Friday, July 22, 2005
Considering surgeryTypes of surgery recommended Arthroscopic surgery is commonly performed for meniscal tears. Repairs may require moderate-sized incisions to tie knots in the suture passed through the meniscus and knee joint, or may be performed with no additional incisions at all — through a technically demanding “all-inside” technique. The incision and its size will be determined by the surgeon based on the patient’s condition, the location of the tear(s) and the surgeon’s preference. Some surgeons use special barbed devices that hook together the sides of the meniscal tear without requiring the large incisions of a sewn repair.Who should consider minimally-invasive surgery for a torn meniscus in athletic children? Patients with suspected meniscal tears with marked loss of motion should consider surgery, as should those with near normal motion but who are making little progress alleviating symptoms through exercise.What happens without surgery? A torn meniscus may function adequately, but it may lead to further loss of motion and cause pain with activities. It may also lead to a progressive tear and more severe loss of function. If the tear involves a large portion of the meniscus, it may put the patient at risk for early arthritis.Surgical options Meniscal tears may be treated with large (open) incisions through which repair or more commonly, trimming or complete removal of the meniscus might occur. Complete removal of a meniscus was a common orthopaedic procedure performed 30 to 50 years ago for a mensical tear. Now we understand that removing a whole meniscus too often results in early arthritisis and so it is avoided whenever possible.
Effectiveness For those who undergo repair, patients typically use crutches for six weeks and restrict squatting for six months. After six months following meniscal repair, the patient is allowed to fully participate in sports though they typically have experienced full relief of symptoms many months prior to this.
Patients often experience immediate relief of symptoms after trimming of a meniscal tear. They are usually cleared to return to sports in three weeks.
The success rate of meniscal repairs is estimated to be 75 percent in patients under 20 years of age, though 87 percent of these patients rated their knees as “very good”, suggesting that even patients with incompletely healed tears after repair may still experience good knee function.
Urgency The urgency related to meniscal tears depends on the patient’s symptoms.
Those who have a locked knee should undergo the procedure as soon as is possible, ideally within one to two weeks of diagnosis. Patients with a locked knee should use crutches so that they can keep weight off of the knee until they can be seen and treated by a physician.
Those patients who do not have a locked knee but have stiffness, swelling, or pain may follow an exercise program until a more permanent solution is identified. Crutches should be used if putting weight on the leg is painful.
Risks The early risks for arthroscopy for meniscal tears, in order of frequency, are:
- Blisters from the dressing (sterile strips) used to cover the small incisions. These usually heal within one-three weeks.
- Post-operative stiffness. It is relatively rare—less than 5 percent of patients experience stiffness which does not respond to early physical therapy.
- Nerve or blood vessel damage. Numbness on the front and outside of the upper leg or shin just below the knee can occur from injury to a nerve by placement of one of the small incisions about the knee or by the passing or tying of sutures for meniscal repair. These complications rarely occur but are well recognized risks of meniscal surgery. Undergoing surgery performed by a physician with experience in knee arthroscopy and meniscal repair in particular reduces the risk of these complications.
- Infections. They do occur, but are rare as water is used during the procedure to irrigate the knee.
Later post-operative risks for arthroscopy for meniscal tears include include recurrent tearing of the meniscus, which is a possibility after repair or trimming of a tear.
Managing risk
The following is recommended if risks occur:
- Blisters: Supportive treatment e.g. topical ointment and a non-adherent dressing.
- Post-operative stiffness. Physical therapy is recommended.
- Infections. Antibiotics can be prescribed and aspiration with
possible repeat arthroscopy to decrease the infectious load may be
recommended.
- Nerve/vessel damage. Exploration of the site of injury may lead to identification and release of entrapped nerves.
For a re-tear in the post-operative period, re-operation would likely
be recommended to either attempt a re-repair or additional trimming of
the meniscus.
Surgery for Meniscal tears in the knee of adolescents and children 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 206-987-3700 to make an appointment.
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