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Meniscal Repairs

Introduction

Meniscal tears are a very common form of knee injury, usually suffered during sports or by twisting the knee. Patients tend to report a slipping, popping, locking or 'giving' sensation when the injury happens.

Meniscal repair surgery is a keyhole procedure (arthroscopy) designed to remove or repair tears in the meniscus.

As the meniscus – a C-shaped layer of shock-absorbing lining between the thigh and shin bones – has no direct blood supply, healing can be problematic. For this reason, meniscal repairs are typically only performed on outer meniscal injuries, as this area has a healthy blood supply.

When is surgery necessary?

Surgery is only considered if non-surgical treatment has failed to stabilise the knee and alleviate symptoms.

The first line of care should be to follow the RICE protocol (Rest, Ice, Compression, Elevation), but if your knee remains painful, swollen or has restricted movement, surgery may be the logical next step.

If you have damaged the "white" part of your meniscus that has no blood supply, surgery may not achieve much beyond trimming away any protruding tears. If there is no immediate concern that these tears will cause arthritis in future, Dr. Letchford may recommend that you leave them be.

The decision to operate

Dr. Letchford will perform a physical examination including the McMurray Test for bending, straightening and rotating. He will also refer to your x-rays and MRI films as well as your medical history to assess whether or not surgery is needed.

He may also perform a knee arthroscopy to determine the severity of the meniscal damage, the results of which may dictate that surgery is needed.

Helping you understand your options

Before deciding to go ahead with surgery, Dr. Letchford will take the time to talk with you about:

  • The outcome you want
  • The risks and benefits of surgery
  • The results you can expect

Dr. Letchford will only recommend surgery if both you and he are in agreement that it offers the best possible outcome for improving your pain and preventing future deterioration of the joint.

About the procedure

What it involves

There are two types of meniscal surgery: removal and repair. Both treatments are performed arthroscopically through small incisions in the knee.

  • You will be given either general, spinal or local anaesthesia (put to sleep, numbed from the waist down or only in the affected area).
  • A tourniquet is place on your thigh to limit blood loss.
  • An incision is made over the knee, exposing the joint.
  • The damaged areas of your meniscus are trimmed, smoothed, returned to their original position, sutured up or removed.
  • The incision is closed. A drain may be inserted to remove fluid build-up.
  • Dr. Letchford may put a cast or brace on your leg to help stabilise it.

Hospital stay and recovery time

In-patient stay:          Day procedure (no overnight stay unless recommended)
Walk (aided):             Immediately
Walk (unaided):        1-2 weeks
Return to work:         2-3 days (gentle work)
Upon post-operative review (labour-intensive work)                                         

Possible risks and complications

Arthroscopic surgery for meniscal repair is a remarkably low-risk procedure. The most severe complications are usually temporary discomfort and bruising.

However, all surgery carries a risk and should not be entered into without due consideration. Please refer to our Knee Arthroscopy page for more information on the risks of this procedure.

Pre-operative checklist

Before you come in for your surgery, there are a number of things that both you and Dr. Letchford will need to do to ensure everything goes smoothly before, during and after the operation.

  • Existing medications

You should cease taking any blood-thinning or anti-inflammatory drugs, as well as any herbal or natural remedies you're taking, at least a week before your surgery.

  • Medical evaluation

You will undergo a routine medical examination to make sure you are in good enough health for the operation, and to identify any factors that might cause problems down the line, including body weight and existing infections or skin conditions.

  • Dental evaluation

Dental work can introduce bacteria into the bloodstream. To protect against the chance of developing an infection, please have any dental work done well before or after your surgery. You may need to take preventative antibiotics for a few months to a few years after your surgery to protect against the risk of infection.

  • Further tests and blood work

You will be sent for routine blood work to confirm you are healthy enough to undergo surgery. We may also perform heart checks or additional scans if the need arises.

  • Smoking

It is recommended that you stop smoking for as long as possible before your surgery, as it can encourage clots while hampering circulation and oxygenation of the blood.

Recovery, rehabilitation and precautions

  • Physiotherapy and exercise

As this is a relatively minor surgery, you should be able to return to normal life fairly quickly. High-impact sports and labour-intensive work will have to wait a few weeks, but swimming and cycling are a good way to strengthen the muscles around the joint during rehabilitation. Your physiotherapist can draw up an exercise plan for you.

  • Preventing infection

Make sure you change your dressing as instructed, and keep an eye out for any changes, including fever, chills, tenderness, excessive fluid, or increased pain, as these can indicate infection.

  • Preventing blood clots

You will be given a combination of anti-clotting drugs and pressure bandages to help prevent clots from forming. If you notice any shortness of breath or unexplained pain, contact a doctor immediately.

Further information

For more information on what to expect from your total knee replacement surgery, please take the time to read through the resources available at the American Academy of Orthopaedic Surgeons website.