Meniscus surgery: what is a meniscal tear and how do you treat it?

A meniscal tear is a common knee injury that involves damage to the meniscus, which is a C-shaped piece of cartilage that acts as a cushion and stabilizer between the thighbone (femur) and shinbone (tibia).

When the meniscus is torn, it can cause pain, swelling, stiffness, and limited range of motion in the knee. Meniscal tears often occur during activities that involve twisting or direct impact on the knee, such as sports or heavy lifting.

There are different types of meniscal tears, including:

• Radial tear: A tear that extends from the inner edge of the meniscus to the outer edge.

• Horizontal tear: A tear that occurs parallel to the surface of the meniscus.

• Bucket-handle tear: A tear that causes a portion of the meniscus to displace into the joint, resembling the handle of a bucket.

The severity of symptoms and treatment options depend on factors such as the location, size, and type of tear. In some cases, conservative treatments like rest, ice, physical therapy, and anti-inflammatory medications may be sufficient for managing symptoms. However, more severe tears or those causing persistent symptoms may require surgical intervention, such as arthroscopic surgery, to repair or remove the damaged portion of the meniscus. Proper diagnosis and treatment are essential for relieving pain and restoring function to the knee.

Symptoms of a meniscal tear

• Pain

• Swelling

• Stiffness

• Catching or locking

• Instability

• Limited range of motion

• Difficulty bearing weight

How to repair a meniscus tear

The treatment approach for repairing a meniscal tear depends on various factors such as the type, size, and location of the tear, as well as the individual's age, activity level, and overall health. Here are the common methods used to repair a meniscal tear:

• Conservative treatment: Small tears or tears in the outer edge of the meniscus may respond well to conservative treatments such as rest, ice, compression, and elevation (RICE), along with anti-inflammatory medications to reduce pain and swelling. Physical therapy exercises to strengthen the muscles surrounding the knee and improve flexibility may also be recommended.

• Arthroscopic surgery: For larger or more complex tears, arthroscopic surgery may be necessary. This minimally invasive procedure involves making small incisions around the knee and inserting a tiny camera (arthroscope) and surgical instruments to visualize and repair the tear. Depending on the extent of the tear, the surgeon may perform one of the following techniques:

  • Meniscal repair: In cases where the tear is repairable, the surgeon will sew the torn edges of the meniscus back together using sutures or other fixation devices. This technique is typically used for tears located in the vascularized outer edge of the meniscus, where blood supply is sufficient to support healing.

  • Partial meniscectomy: If the tear is irreparable or located in the avascular inner portion of the meniscus, the surgeon may trim away the damaged portion of the meniscus while preserving as much healthy tissue as possible. This procedure is known as a partial meniscectomy.

  • Meniscal transplantation: In rare cases where a large portion of the meniscus has been removed or if the individual has persistent symptoms following previous surgery, a meniscal transplantation may be considered. This procedure involves replacing the damaged meniscus with donor tissue.

• Rehabilitation: Following surgery, a structured rehabilitation program supervised by a physical therapist is essential to optimize recovery and regain strength, stability, and range of motion in the knee. The rehabilitation protocol may include exercises to improve muscle strength, flexibility, balance, and proprioception, as well as gradual return to activities and sports.

What risks are associated with meniscus surgery?

• Infection

• Bleeding

• Blood clots

• Nerve or blood vessel damage

• Stiffness or reduced range of motion

• Persistent pain or symptoms

• Failure to heal

What is recovery after meniscus surgery like?

The recovery timeline after meniscal surgery can vary depending on factors such as the type of surgery performed, the extent of the meniscal damage, the individual's overall health, and adherence to post-operative rehabilitation protocols. However, here is a general timeline outlining what to expect during the recovery process:

• Immediate Post-Surgery:

  • After surgery, individuals typically spend a few hours in the recovery room under observation before being discharged home.

  • Pain medication may be prescribed to manage post-operative discomfort, and instructions on wound care and activity restrictions will be provided.

• First Few Days:

  • In the first few days following surgery, it's common to experience pain, swelling, and bruising around the knee joint.

  • Rest, ice, compression, and elevation (RICE) are often recommended to reduce swelling and discomfort.

  • Crutches or a knee brace may be used to assist with walking and provide stability to the knee.

• First Week:

  • During the first week, individuals typically begin gentle range-of-motion exercises as directed by their surgeon or physical therapist.

  • It's important to avoid putting weight on the operated leg unless instructed otherwise by the surgeon.

  • Follow-up appointments with the surgeon may be scheduled to monitor healing and remove any stitches or staples.

• 2 to 6 Weeks:

  • As healing progresses, individuals may gradually increase weight-bearing activities and begin more advanced physical therapy exercises to improve strength, flexibility, and balance.

  • Depending on the type of surgery and the individual's progress, a gradual return to normal daily activities and light exercise may be allowed.

• 6 Weeks to 3 Months:

  • By this stage, most individuals are able to engage in more challenging physical activities and sports-specific rehabilitation exercises under the guidance of a physical therapist.

  • It's important to progress slowly and avoid activities that involve excessive twisting, pivoting, or impact on the knee joint to prevent reinjury.

  • Follow-up appointments with the surgeon may continue to monitor progress and address any lingering symptoms or concerns.

• 3 Months and Beyond:

  • Full recovery from meniscal surgery may take several months, with the timeline varying depending on the individual's response to treatment and rehabilitation.

  • Many individuals are able to return to their pre-injury level of activity and sports participation by this stage, although some residual symptoms or limitations may persist.

  • Ongoing maintenance exercises, proper warm-up and cool-down routines, and regular monitoring of knee health can help prevent recurrence of meniscal injuries and optimize long-term outcomes.

It's important for individuals undergoing meniscal surgery to follow their surgeon's post-operative instructions carefully, attend all scheduled follow-up appointments, and actively participate in rehabilitation to ensure a successful recovery and minimize the risk of complications.