Knee Meniscus Repair

The meniscus is an essential structure of the knee, and damage to the meniscus can lead to knee osteoarthritis in the long term.

What is a Knee Meniscal Tear?

A Meniscal Tear is a break in your knee's meniscus wedge (cartilage).

Meniscal tears are common cartilage injuries in both contact and non-contact sports that require jumping quick lateral movements (e.g. netball).

Meniscus tears can be painful and debilitating.

A torn meniscus causes pain, swelling and stiffness. You also might feel a block to knee motion and have trouble extending your knee fully.

What is Knee Meniscus Repair?

Knee meniscus repair is a surgical procedure that aims to repair a tear or injury to the meniscus. When the meniscus is damaged, it can cause pain, swelling, and difficulty moving the knee.

Who is Suitable for Knee Meniscus Repair?

Not everyone with a meniscus tear requires surgery. Sometimes, non-surgical treatments such as rest, ice, compression, elevation (RICE) and physical therapy can help alleviate symptoms. Simple degenerative tears may cause pain which will resolve over 3 or 4 months.  Severe meniscal tears in the setting of severe osteoarthritis also do not need surgical intervention. However, knee meniscal surgery may be recommended if the tear is severe or if non-surgical treatments are ineffective.

Suitable candidates for knee meniscus repair include:

• Patients with a torn meniscus that causes pain, swelling, and difficulty moving (locking) of the knee
• Patients with a 'Bucket handle' meniscal tear
• Patients with a meniscal root tear

Benefits of Knee Meniscus Surgery

Knee meniscus repair may offer benefits, including

• Pain relief: Repairing the meniscus can reduce or eliminate knee pain.
• Improved knee function: A repaired meniscus can improve knee stability and range of motion, allowing patients to perform daily activities without difficulty.
• Faster recovery: Surgery may often speed up the recovery, particularly if debridement is needed.
• Better long-term outcomes: Knee meniscus repair has been shown to have better long-term outcomes than meniscectomy.

Knee Meniscus Repair Procedure

This surgery is typically performed under general anaesthesia and takes about an hour to complete.

Before the Procedure

• The surgeon will order diagnostic tests, such as an MRI to evaluate the extent of the damage and determine the best course of treatment.
• The patient will be advised to refrain from eating or drinking for several hours before the procedure to avoid complications during anaesthesia.
• The patient may need to stop taking certain medications, such as blood thinners, before the surgery.

During the Procedure

• The patient is given anaesthesia to make them comfortable and prevent any pain during the surgery. The type of anaesthesia used may vary depending on the surgeon's preference and the patient's medical condition.
• The surgeon makes a small incision in the knee and inserts an arthroscope, a thin, flexible tube with a camera and light attached to it. This allows the surgeon to visualise the inside of the knee joint on a monitor.
• The surgeon examines the torn meniscus to determine the extent of the injury and decide whether to repair or remove it. If the tear is small and located in an area with a good blood supply, the surgeon may choose to repair it. If the tear is large, complex, or located in an area with poor blood supply, the surgeon may choose to remove the damaged part of the meniscus.
• If the decision is made to repair the meniscus, the surgeon will use small surgical instruments inserted through additional incisions in the knee to stitch the torn edges of the meniscus together. The stitches may be absorbable or non-absorbable and may be placed either inside or outside the meniscus.
• If the decision is made to remove the damaged part of the meniscus, the surgeon will use surgical instruments to trim the torn edges of the meniscus and remove the damaged portion.
• Once the repair or removal is complete, the surgeon will close the incisions with internal sutures (dissolvable)  and cover them with a dressing. The knee may also be wrapped in a compression bandage to help control swelling.

After the Procedure

• The patient will be monitored in the recovery room until they are alert and able to move the knee.
• Pain medication and will be prescribed to manage pain.
• The patient will be advised to rest, ice the knee, and keep it elevated for the first few days after the surgery.
• Physical therapy may be recommended to help regain strength and mobility in the knee.

Post-op Instructions for Knee Meniscus Repair

Rest and Ice

Rest your knee as much as possible for the first few days after surgery. Apply ice to the area for 20-30 minutes every 2-3 hours to help reduce pain and swelling.

Pain Management

Take any pain medications as prescribed by your doctor.  Pain should settle in a few days, and patient should only take the strong opioid medications if needed. The Opioids such as Palexia or Endone are good for strong pain but can cause nausea, constipation and confusion. Often paracetamol and ibuprofen is sufficient to manage pain along with RICE.

Dressing Care

Keep your dressing and incision site clean and dry. You can remove the bandage in 24 hours and leave the deep water-proof dressings in place for 10 days or until you see the surgeon.

Mobility and Weight-bearing

Use crutches or a walker as directed by your surgeon. There will be clear Weight bearing instructions post operatively.

Physical Therapy

Attend physical therapy sessions as recommended by your doctor to help restore your knee's strength and mobility.

Follow-up Appointments

Attend all follow-up appointments with your surgeon to ensure proper healing and to monitor your progress.

Avoid Certain Activities

Avoid any activities that put stress on your knee, such as running, jumping, or twisting, until instructed by your doctor.

Communicate with Your Doctor

If you have any concerns or questions about your recovery or if you experience any unusual symptoms, contact your doctor immediately.

It is important to follow these instructions carefully to ensure a smooth and successful recovery from knee meniscus repair surgery.

Knee Meniscus Repair Prognosis

The prognosis for knee meniscus repair depends on several factors, including the extent of the damage, the patient's overall health, and compliance with postoperative rehabilitation. Most patients can expect to return to normal activities within four to six weeks after the surgery, although strenuous activities may need to be avoided for several months.

In general, knee meniscus repair has a high success rate and can provide long-term relief from pain and improved knee function. However, there is always a risk of complications, such as infection, bleeding, or nerve damage.

Knee Meniscus Repair Risks

Like any surgical procedure, knee meniscus repair carries a risk of complications. Some of the most common risks include:

• Infection: Although rare, infections can occur in the knee after surgery and may require additional treatment.
• Bleeding: Excessive bleeding during or after the surgery may require additional procedures or blood transfusions.
• Nerve damage: The surgical instruments used during the procedure may damage nearby nerves, leading to numbness or weakness in the knee or leg.  Broad numbness is rare but patchy numbness around or distal to the wounds is common.
• Blood clots: Patients may be at an increased risk of developing blood clots in the leg after the surgery, which can be dangerous if they travel to the lungs.