What Is The Postoperative Plan For Meniscal Root Repair Like
Patients who undergo meniscal root repair are usually sent home on the same day after surgery in a knee immobilizer.; They have restriction of weightbearing as well as they are asked not to unlock the knee immobilizer while ambulating so that they walk with a straight leg or a pirate leg.
They are allowed to range the knee when they are resting and sitting.; Physical therapy is usually started within one week.; They are asked to use ice, elevation and pain medications. It is preferred to avoid anti-inflammatory medications for the first 2 weeks.
The ranging of the knee is restricted to 90 degree of flexion for the first 4 weeks after which the range of motion is gradually increased. Patients are asked to use the knee immobilizer for about 6 weeks along with the crutches. They are gradually weaned out of the crutches and knee immobilizer after 6 weeks. Patients will usually be able to be at preinjury level in about 10 to 12 weeks.
Does Meniscus Surgery Lead To Knee Replacement
There can be several questions to answer when relating to arthroscopy. For, can Arthroscopy cause Arthritis, we know that yes, it can cause it again.
However, is it possible that it can lead to knee replacement? To answer that, there is a possibility that meniscus surgery may lead to knee replacement.
Due to osteoarthritis s one of the long effects of the surgery, if the situation is not controlled, then it can lead to complete failure of the knee. Therefore, at that point knee replacement can be the only option left.
Living With Pain Is Sometimes The Better Option
Hopkins researchers found that the common surgery, known as arthroscopic partial meniscectomy , accounted for an estimated two-thirds of all orthopedic knee arthroscopy procedures in older patients in 2016. An estimated 750,000 such procedures are performed each year.
Of the 121,624 knee arthroscopies performed on Medicare recipients by 12,504 surgeons in 2016, APM-only procedures accounted for more than 81,000, or 66.7 percent, the Hopkins-led team reported.
Getting the usage of APM surgery right is part of a broader movement in health policy and academic medicine toward measuring the effectiveness of care, with an eye toward delivering treatments that work rather than responding to patient demand that’s not based on hard data, Makary said.
“The goal shouldn’t be to eliminate pain in everyone,” Makary said. “It should be to supply medical that the evidence shows will help.”
Main Street doctors say the academic data confirms what they see in their practices and is consistent with other studies showing that doctors too often prescribe arthroscopic procedures for older patients.
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Does Every Meniscus Injury Need Surgery
Some people need surgery for a torn meniscus, but some dont. The decision depends on:
- Type, size and location of the tear.
- Your age.
- Your activity level and lifestyle.
- Related injuries .
- Presence of symptoms
Your healthcare professional may suggest you first try nonsurgical treatments, such as :
- RICE .
- Knee injections, such as cortisone.
Should I Have Arthroscopic Surgery On My Knee To Treat My Meniscus Tear
Arthroscopic surgery to treat a torn meniscus when the rest of the knee is normal can help to reduce the pain induced by the meniscus tear. Patients with arthritis, thinning of the cartilage, will often experience degenerative meniscal tears. Arthroscopic surgery for treatment of degenerative meniscus tears is less predictable.
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Knee Arthroscopy: Should This Common Knee Surgery Be Performed Less Often
- By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing
Imagine youre walking along and suddenly experience excruciating knee pain. Though it initially seems stuck in one position, after a minute or two you can limp along home, but just barely. At your doctors visit, an x-ray is normal but symptoms continue for weeks. An MRI is performed and now you have an explanation: a torn meniscus. A month later, youre no better despite rest, pain medicines, and physical therapy. Its time for surgery to fix it, right? Maybe not.
What Is The Role Of A Meniscus In A Knee Joint
The meniscus is a crescent-shaped disc of cartilage which is between your femur and tibia . There are two menisci in each knee joint. The meniscus is like a shock absorber that helps to stabilize the knee by balancing your weight across the knee. It also provides protection of healthy cartilage in the knee joint.
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Rehabilitation Following Meniscus Repair
Meniscal repair is generally followed by an approximately four week phase of protective weight bearing with the aid of crutches.
The transition to full weight bearing begins in the fifth week. Patients will be expected to wait for a period of six to eight weeks before beginning to play low stress sports and six months before playing sports involving greater levels of stress to the knee.
What Is Meniscus Surgery Recovery Like
The recovery time for meniscus surgery depends on the type of surgery you had. It takes longer for a meniscus repair to heal than a meniscectomy. Full recovery from meniscus surgery can take anywhere from six weeks to three months. Your care after surgery may involve:
- Crutches to take stress off the knee as it heals.
- Knee brace to stabilize the joint as you recover.
- Pain medications.
- Rehabilitation exercises at home to restore mobility, range of motion and strength.
- RICE .
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Ial Meniscectomy: Frequently Asked Questions
Podcast: Play in new window |
Note: One of the most common operations in all of orthopaedics, and not just sports medicine, is a partial meniscectomy, or surgery to trim a meniscus tear.;I have noticed in my clinics over the last few years that there are several questions asked by most patients with these injuries. I decided it might be helpful to answer them in a blog post.
How Long Will Total Knee Replacement Surgery Take
Urquhart: I like to put it in perspective for patients by using a flight analogy. While the actual operation may only take an hour or so, similar to a one-hour flight from Detroit to St. Louis, you should still budget plenty of time for the multiple steps before and after surgery just like the added time you budget to spend at the airport for security, checking your bags, etc.
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What Does A Meniscus Replacement Treat
Your provider may recommend this procedure if your meniscus is severely damaged or if you had your meniscus removed after a previous injury. Sometimes providers remove a meniscus if the damage is so severe that they cant repair it. Living without a meniscus can increase your risk of osteoarthritis and chronic knee pain.
A torn or injured meniscus can also lead to osteoarthritis. This condition happens when other cartilage in the knee wears away, causing pain and stiffness. A meniscal transplant can prevent or delay osteoarthritis from developing. But this procedure will not help people who already have knee pain from arthritis.
How Long Does It Take To Do A Meniscus Surgery
A meniscus surgery may last from forty-five minutes to an hour, but a surgery involving the repair of the meniscus may last one to two hours depending on the size of the injury.
There may be multiple surgical scars with some a little bigger than a poke hole incision as compared to partial meniscectomy which has 2-3 small surgical scars. This is due to the work needed to be done to repair the meniscus.
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Fact Sheet: Arthroscopic Mensicus Repair Surgery
- Inpatient treatment: 3 days
- Outpatient treatment: 4 weeks, then 14 days outpatient rehabilitation
- Earliest flight home: 7 days after surgery
- Recommended flight back home: 10 days after surgery
- Time before showering: 5 days after surgery
- Recommended time off work 2-6 weeks
- Time before removal of sutures: 5 days
- Time before driving a car: 6 weeks
What Is The Cleaning Of Meniscus Called
The cleaning up or the cleanup surgery for the meniscus also called as a debridement or trimming is named as meniscectomy.; When a decision is made to clean up a meniscus because it is not repairable, the surgeon uses motorized shaver or mechanical biters to remove all the frayed edges as well as flaps of the torn meniscus to leave it on a balanced edge.
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Will Kt Tape Help A Torn Meniscus
KT Tape: Full Knee Support One or more meniscus may be torn, ruptured, or inflamed. KT Tape can help reduce pain and inflammation for many common injuries*. With this application you will get support, pain relief, and normal body mechanics without restricting motion or circulation like other treatments*.
More You Need To Know About Knee Meniscus Surgery
Despite the fact that orthopedic surgeons keep performing meniscus surgery and insurance keeps covering it, there are an abundance of problems plaguing the procedure, and its likely well see this surgery relegated to the medical history books in the not-too-distant future. Lets take a look at just a few of the issues Ive covered over the last decade or so:
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The Complaint Surgeons Have Is That Some Surgeries Will Help Some Patients And That Every Meniscus Surgery Is Not A Bad Surgery And Research Is Not Reflective Of This Benefit
In March 2020, researchers announced a new study to answer this question. They write of their study:
Arthroscopic partial meniscectomy after degenerative meniscus tears is one of the most frequently performed surgeries in orthopedics. Although several randomized controlled trials have been published that showed no clear benefit compared with sham treatment or non-surgical treatment, the incidence of Arthroscopic partial meniscectomy remains high. The common perception by most orthopedic surgeons is that there are subgroups of patients that do need Arthroscopic partial meniscectomy to improve, and they argue that each study sample of the existing trials is not representative of the day-to-day patients in the clinic.
The researchers of this study announced that they will seek to find whether there are subgroups of patients with degenerative meniscus lesions who benefit from Arthroscopic partial meniscectomy in comparison with non-surgical or sham treatment.
What Happens Before A Meniscus Replacement
For this procedure, providers use a meniscus from a human donor . After removing it from the donor, providers freeze the meniscus to preserve it. Prior to surgery, providers test the meniscus for disease and measure its size and shape. They carefully select a meniscus that will fit properly into your knee.
To prepare for surgery, your provider will:
- Ask about medications you take. You may need to stop taking some medications before surgery.
- Order an MRI or X-ray, if necessary. These imaging studies allow your provider to see detailed pictures of the inside of your knee.
- Tell you what time to stop eating and drinking the night before your procedure.
You have a meniscus transplant in an outpatient surgery center or a hospital. Right before your procedure, your provider will give you general anesthesia to put you to sleep. You wont feel pain during knee surgery.
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Preparation For Total Knee Replacement Surgery
Patients undergoing total knee replacement surgery usually will undergo a pre-operative surgical risk assessment. When necessary, further evaluation will be performed by an internal medicine physician who specializes in pre-operative evaluation and risk-factor modification. Some patients will also be evaluated by an anesthesiologist in advance of the surgery.
Routine blood tests are performed on all pre-operative patients. Chest X-rays and electrocardiograms are obtained in patients who meet certain age and health criteria as well.
Surgeons will often spend time with the patient in advance of the surgery, making certain that all the patient’s questions and concerns, as well as those of the family, are answered.
The surgeon’s office should provide a reasonable estimate of:
- the surgeon’s fee
- the degree to which these should be covered by the patient’s insurance.
Total Knee Replacement Surgical Team
The total knee requires an experienced orthopedic surgeon and the resources of a large medical center. Some patients have complex medical needs and around surgery often require immediate access to multiple medical and surgical specialties and in-house medical, physical therapy, and social support services.
Finding an experienced surgeon to perform your total knee replacement
Some questions to consider asking your knee surgeon:
- Are you board certified in orthopedic surgery?
- Have you done a fellowship in joint replacement surgery?
- How many knee replacements do you do each year?
Misalignment Of Knee Can Lead To Degeneration Of Joint After Surgery
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Just as failing to perform an alignment on a car after installing a new tire will lead to uneven wear and tear and ultimately tire failure, performing knee surgery without taking into account the proper alignment of the leg bones above and below the joint could cause future problems including degenerative arthritis , according to a new study by Duke University Sports Medicine researchers.
Even a small varus knee malalignment more commonly known as bow-leggedness can lead to serious future problems for knee surgery patients, the researchers said. They added that physicians should at minimum closely monitor all young people who undergo reconstructive knee surgery to ensure that the leg bones stay in proper alignment, and in some cases surgically correct the bowleggedness. They see such strategy a possible preventative measure against the future development of severe arthritis of the knee.
Even a relatively small malalignment in normal knees can cause dramatic alterations in the pressures within the knee joint, and this negative effect can be greatly magnified if the cartilage within the knee has been damaged, said Joseph Guettler, M.D., orthopedic surgeon and sports medicine fellow at Duke. With early recognition and intervention of the malalignment, we can perhaps prevent the development of serious osteoarthritis from occurring in the future.
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Why Do We Ignore A Mountain Of Clinical And Scientific Evidence Against Meniscectomy
- The French team says the number of meniscectomies is excessive in the light of scientifically robust studies demonstrating the interest in meniscal repair or of non-operative treatment for traumatic tear and of non-operative treatment for degenerative meniscal lesions.
- Meniscectomy was long considered the treatment of choice. All but 1 of the 8 recent randomized studies reported non-superiority of arthroscopy over non-operative treatment, which should thus be the first-line choice, with arthroscopic meniscectomy reserved for cases of failure, or earlier in case of considerable mechanical symptoms.
They, like us, agree that it is high time that the paradigm shifted, in favor of meniscal preservation.
What Happens After A Partial Menisectomy
Rehabilitation following a partial menisectomy varies depending on the the patient and the severity of the injury that has been treated. After simple resectioning of a meniscus, patients will be allowed to move about on crutches on the same day as the surgery is performed. These patients are usually able to return to work after one to two weeks, unless their work involves higher than normal levels of stress for the knee.
A rehabilitation plan will normally include specific exercises to strengthen the joint. With a proper degree of caution, patients are permitted to begin taking part in “low stress” sports such as cycling after one week. Swimming may be considered only after the wound has healed completely. Sports that are typically more stressful for the knee such as football, tennis and basketball, are usually only advised after three to four weeks.
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Do You Have To Come To The Hospital For Total Knee Replacement Surgery
Urquhart: Knee replacements in healthy patients do not require a hospital stay. In fact, we now offer the surgery at the Brighton Center for Specialty Care, one of our outpatient specialty clinics.
Patients have the surgery performed in one of the operating rooms at the facility and then are moved into a recovery area where they are monitored and work with physical therapy to be safe to go home. The center has the ability and staffing to monitor patients overnight, if needed. Then the patient is able to finish their recovery at home.
Meniscal Regeneration: A Cause Of Persisting Pain Following Total Knee Arthroplasty
Henry D. Atkinson
1Department of Trauma and Orthopaedic Surgery, North Middlesex University Hospital, Sterling Way, London N18 1QX, UK
2Department of Trauma and Orthopaedic Surgery and North London Sports Orthopaedics, North Middlesex University Hospital, Sterling Way, London N18 1QX, UK
Many patients have persisting knee pain following total knee arthroplasty. We report the unusual case of a patient whose chronic lateral and medial knee pain were caused by entrapped regenerated meniscal tissue. This was diagnosed and successfully treated by arthroscopic debridement.
Knee osteoarthritis is a leading cause of functional disability in adults . Total knee arthroplasty is an effective treatment shown to dramatically decrease pain and improve function in appropriately selected patients ; however, many patients have persistent knee pain following TKA . The aetiologies of chronic pain following TKA are poorly understood ; however, postoperative infection, prosthetic malfunction, component loosening, and surgical experience have been proposed as contributing factors . We present an unusual case of a patient with chronic knee pain following TKA caused by entrapped regenerated meniscal tissue diagnosed and successfully treated by arthroscopic debridement.
2. Case Presentation
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