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How To Repair Knee Meniscus

What Is Meniscus Repair Surgery

How Arthroscopic Knee Surgery Repairs a Meniscus Tear

Meniscus repair surgery is a low-risk procedure which is performed in one of a few different ways. Below, we outline the three common methods of meniscus repair surgery.

  • Knee arthroscopy repair: The surgeon makes small incisions in your knee, and inserts a tiny camera into the knee. They view the tear, and insert small surgical instruments to stitch the tear together. Over time, the body absorbs these stitches.
  • Arthroscopic partial meniscectomy: The surgeon removes a part of the meniscus in order to restore knee function.
  • Arthroscopic total meniscectomy: The surgeon removes the entire meniscus.

Why Meniscus Repair Surgery Is Needed

Surgical treatments include meniscectomy or a repair of the tear.

Meniscus tears that cause mechanical symptoms tend to respond well to surgical treatment. A mechanical symptom is caused by the torn meniscus physically impeding the normal movement of the knee.

Common mechanical symptoms include:

These injuries are surgically treated either with a partial meniscectomy or a meniscus repair to place the edges together with sutures or tacks.

What Is A Torn Meniscus Surgery Recovery Time

As we stated before, recovery times vary from patient to patient, according to both the severity of the injury, as well as the type of procedure performed. Below, we outline what the average meniscus repair surgery recovery will look like for each of the above procedure types:

  • Knee arthroscopy repair: Generally, this requires a period of limited weight-bearing, including the use of crutches or a walker. We also recommend limited motion, and sometimes a knee brace. Generally, it takes 4 to 8 weeks to increase weight bearing and range of motion. Most of our SPORT patients walk without their knee brace or crutches after around 2 to 3 months.
  • Arthroscopic partial meniscectomy: Partial removals usually see shorter recovery times than meniscus repair surgery. We advise our patients to use crutches for a few days, and to take it easy for around 2 weeks. Most patients gradually increase their activity levels at their own pace if they feel no pain.
  • Arthroscopic total meniscectomy: Total removals might take as long as 4 to 6 weeks for full range of motion restoration.

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The Biggest Mistake People Make After Knee Meniscus Surgery

Did you have any meniscus surgery in the past and youre still dealing with pain, swelling and possibly even losing motion in your knee? Well, this is not normal. But youre also not alone. This happens way more often than I like to admit. And the good news is that it can be helped without another surgery. If youre watching this video today, and youre considering having a meniscus surgery for your knee, then youll want to listen closely so that you dont make this mistake after you have your meniscus surgery.

And if youve already had your meniscus surgery, then you know what to do so that youre not getting more swelling, pain and not losing motion than that knee and youre staying out of the surgeons office, so you dont have to go back again for another knee surgery.

My name is Dr. David Middaugh. And Im a specialist physical therapist El Paso manual physical therapy. And this channel is dedicated to helping people stay healthy, active and mobile. while avoiding unnecessary surgery, injections, and medications. Please subscribe to this channel and turn on your notifications so that you dont miss a single video with great tips and advice that we put out every single week. So lets get to it.

Will A Meniscus Tear Heal On Its Own

Meniscus tears and knee arthroscopic surgery

The meniscus has a limited blood supply and, therefore has limited ability to heal on its own. Only the outer one-third of the meniscus contains blood vessels required for healing. This is known as the red zone. The inner two-thirds of the meniscus is avascular and is also known as the white zone. Most meniscus tears that affect the white zone cannot heal on their own.

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Persistent Knee Pain After Arthroscopy

Persistent Knee Pain after Arthroscopy

So youve had knee arthroscopy but your knee still hurts. This is something I frequently see in my office especially for second opinions. The usual scenario is one where a patient had arthroscopic knee surgery for a torn meniscus. The surgery went well but the patient still has pain even though its now 2-3 months later. These patients are usually quite frustrated because they were under the impression that they would bounce back fast after their simple surgery. Adding insult to injury is the fact that almost every patient has had a neighbor or co worker who had the same surgery and who was back doing everything in 2 weeks.

In order to really understand what is happening I need information. I spend a lot of time trying to understand the current symptoms but I also ask about the symptoms before the surgery. It is also extremely helpful when a patient brings in their Op report, Pre-operative MRI and surgical pictures. Patients can usually borrow the surgical photographs or perhaps even get their own copy. These pictures allow me to see the state of the articular cartilage and the severity of the treated meniscus tear.

I like to see recent X-rays. I usually take standing weight bearing views of both knees, Lateral and Patellofemoral Sunrise view. These X-ray films are very important because they tell you information that the MRI does not.

In most cases a good ear to listen and the tip of my finger are the best diagnostic tools.

What Does Knee Replacement Surgery Recovery Look Like

During knee replacement surgery, your doctor will make an incision before moving your knee cap and cutting away any damaged bone, cartilage, and joint surfaces. Artificial joints will then be attached and tested by bending and rotating your knee before your doctor closes your incision with stitches.

Whether youre having a total or partial knee replacement will have an effect on your pain level and recovery.

A traditional total knee replacement will typically require one to three months of recovery with the use of a walker or a cane. On the other hand, a partial knee replacement is much less invasive. Patients usually walk without assistance within two weeks. This is because the incision is much smaller and there is significantly less blood loss. While this may sound more appealing than a total knee replacement, only about 10% of patients are good candidates for a partial knee replacement procedure.

After your surgery, youll follow weight-bearing guidelines. How much pressure your new knee can initially support will depend on the condition of your natural bone, as well as the type of prosthesis you have.

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What Symptoms Does A Meniscal Tear Give You

  • Usually people will develop pain on the side of their knee
  • There may be an associated clicking/catching feeling
  • The pain can come on suddenly with a specific movement but in older people the pain usually comes on slowly with time
  • Some swelling of the knee may be present
  • The pain is irritated by twisting movements and squatting down
  • Major meniscal tears can lock your knee , these are known as bucket handle tears

Natural Wear And Tear

Torn Knee Meniscus Repair

As with all tissues in the human body, the meniscus is also subject to natural wear and tear. The elasticity of the fibrous cartilage decreases and the connective tissue of the menisci loses firmness, becomes adipose or brittle. In these cases, one simple deep knee bend or a rotation of the joint, when getting out of the car for example, can cause a meniscus tear.

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Meniscus Repair Surgery For Torn Knee Cartilage

Surgery is one of the options that is sometimes considered for the treatment of a meniscus tear. A meniscal tear is an injury of the meniscusa strong, supportive, and flexible tissue in your knee, and it can often be treated non-operatively.

Non-surgical treatments for meniscus tear may include:

What Is The Most Common Meniscus Root Repair Technique

The most common root repair technique is called a transtibial technique. In this technique, sutures are placed into the torn meniscus root and then shuttled down tunnels in the tibia to tie the repair into place. There are some isolated reports of using suture anchors to repair a meniscus root repair, but this area of the knee is very difficult to access and the suture anchors can leave large knots which could subsequently interfere with the cartilage surfaces in the knee. Therefore, the transtibial meniscus root repair technique is by far the most common procedure that is performed. There are 2 main variants of the transtibial root repair technique. These include 1-tunnel and 2-tunnel techniques. In our hands, because we have performed many second look arthroscopies, we have found that the 2-tunnel technique allows for a broader surface area of the meniscus against the decorticated bone and seems to allow for a more solid and secure repair.

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When Should I See My Healthcare Provider

Your healthcare provider will tell you when to schedule an appointment for follow-up. But you should call if you develop:

  • Fever higher than 101 degrees Fahrenheit.
  • Lots of drainage on the dressing.
  • Pain or swelling that is not relieved by resting or elevating the leg.
  • Pus or foul-smelling drainage from any incisions.
  • Trouble breathing.

A note from Cleveland Clinic

Meniscus surgery can fix an injured or torn meniscus, a piece of cartilage in the knee joint. Talk to your healthcare professional if you have knee pain that interferes with your life, work or activities. An arthroscopic procedure can reduce pain, improve mobility and stability, and help you return to activities.

Last reviewed by a Cleveland Clinic medical professional on 04/17/2021.

References

Rehab And Physical Therapy

Pullout repair of the medial meniscus posterior root tear ...

Most surgeons will recommend an at-home exercise regimen to help stimulate healing and get back to your normal activities. How much you do will depend on your general health and any underlying conditions you may have.

In some cases for example, if you need to return to athletics quickly physical therapy or sports medicine at a rehabilitation center may be recommended. If you are relatively young and in good shape, you may be able to return to running and walking after meniscus repair within a few weeks.

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Question 8 Of : How Do I Know If I Have A Torn Meniscus

  • 1You cant move your knee as much. After a meniscus tear, you might not be able to straighten or rotate your knee like you normally would. You might also feel like your knee is locked, or that it cant support your weight.XTrustworthy SourceMayo ClinicEducational website from one of the world’s leading hospitalsGo to source
  • 2Your knee is really sore. Pay attention to your regular, daily movements, like climbing out of bed or walking down the street. With a meniscus tear, your knee might feel painful, swollen, and/or extra stiff. You might also feel like your knee is popping.XTrustworthy SourceMayo ClinicEducational website from one of the world’s leading hospitalsGo to source
  • The pain may be especially obvious when you rotate or twist your knee.
  • What Does An Mri Look Like After A Meniscus Root Repair

    It can be very difficult to interpret an MRI after a meniscus root repair. In general, one can follow the small tunnels from the transtibial technique up to where the root attachment should be. If there is tissue there, it usually means that the meniscus root repair has healed down to bone. The other aspect that needs to be evaluated is the amount of extrusion of the meniscus. If the meniscus is extruded, the patient may not be having a restoration of their shock-absorbing capacity of the meniscus. Other factors can also be present with extrusion, including the progression of arthritis which can cause a well-done meniscus repair to extrude outside the joint.

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    What Are Surgical Treatments For Meniscus Tears

    Surgical treatment is typically undertaken for athletes and for people whose meniscus tear symptoms interfere with their quality of life despite nonsurgical treatment attempts. The surgical treatments are arthroscopic and thus minimally invasive. Aboard certified orthopaedic surgeon should perform the surgery. Sports medicine and knee orthopaedic surgery specialists typically perform these knee arthroscopies.

    There are two ways that meniscus tears are treated surgically. If the meniscus tear is in the inner two-thirds of the meniscus where there is no blood supply, then the meniscus tear does not have the ability to heal. In this instance, the torn portion of the meniscus is removed with small instruments. This procedure is termed a partial meniscectomy. The procedure is viewed on a large viewing monitor since the arthroscope is placed in the knee through a very small incision. Since the great majority of tears reside in the portion of the meniscus that cannot heal, partial meniscectomy is the most common surgical treatment.

    Risk Factors For Meniscus Tears

    Fix Your Torn Meniscus Without Surgery

    You’re more at risk for an injury to the meniscus if you meet the following criteria:

    • You’re over age 30. Risk of meniscus injuries increases as you age, as the cartilage wears out.
    • You play a sport that involves pivoting .
    • You play contact sports .
    • You have a degenerative condition like osteoarthritis.

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    What Causes A Meniscus To Tear

    A forceful twist or sudden stop can cause the end of the femur to grind into the top of the tibia, pinching and potentially tearing the cartilage of the meniscus. This knee injury can also occur with deep squatting or kneeling, especially when lifting a heavyweight. Meniscus tear injuries often occur during athletic activities, especially in contact sports like football and hockey. Motions that require pivoting and sudden stops, in sports like tennis, basketball, and golf, can also cause meniscus damage. The sports injury does not have to occur during a game but can also occur in practice, where the same motions lead to meniscus damage.

    The risk of developing a torn meniscus increases with age because cartilage begins to gradually wear out, losing its blood supply and its resilience. Increasing body weight also puts more stress on the meniscus. Routine daily activities like walking and climbing stairs increase the potential for wear, degeneration, and tearing. It is estimated that six out of 10 patients older than 65 years have a degenerative meniscus tear. Many of these tears may never cause problems.

    Because some of the fibers of the cartilage are interconnected with those of the ligaments that surround the knee, meniscus injuries may be associated with tears of the collateral and cruciate ligaments, depending upon the mechanism of injury.

    How Are Meniscus Tears Diagnosed

    Meniscus tears are diagnosed by a combination of a characteristic patient history, physical exam and MRI. The history of injury and the knee symptoms that the person is experiencing are important clues. When a meniscus tear is present, physical exam often reveals tenderness over the area of the torn meniscus and pain with provocative maneuvers for meniscus tears. A thorough knee exam is important to evaluate range of motion and assess the knee ligaments as well.

    X-rays should be obtained to evaluate for the concomitant presence of knee arthritis and to evaluate for other maladies such as loose bodies.

    MRI is the best noninvasive method for meniscus tear diagnosis. High quality MRIs have been shown to be quite accurate for the diagnosis of meniscus tears.

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    Types Of Meniscus Tears

    The menisci can be torn in different ways, and the type of tear can help determine the best course of treatment:

    • A flap tear is a horizontal tear that forms at the top of the meniscus and results in a flap of loose cartilage.
    • A radial tear is a tear that begins at the inner edge of the meniscus and extends toward the outer edge.
    • A horizontal cleavage tear is a side-to-side tear that occurs in the body of the meniscus .
    • A bucket-handle tear is a vertical tear that leaves loosened tissue resembling a bucket handle.
    • Degenerative tears involve wear and fraying at the edge of the meniscus.

    Symptoms of a torn meniscus include sharp pain in the knee joint along with swelling, stiffness and a catching sensation when the joint is moved. Those suffering from a torn meniscus may also experience a popping sensation when the tear occurs.

    Can You Have Multiple Meniscus Surgeries

    Meniscus Root Tear Repair

    Multiple meniscus surgeries are not common and only happen in rare circumstances. For middle-aged patients, if the first meniscus surgery was not successful then there is a good chance that the second one wont be either.

    We recommend waiting for quite a while before attempting a second surgery as it can take over a year to fully recover from the first surgery and you wont fully know if it is successful until then. In addition, giving physical therapy and your strengthening exercises a full year to be effective is recommended before doing any new surgery.

    In the instances where someone has multiple Meniscus surgeries, this typically happens when there is a new tear or the old tear wasnt fully removed and was torn further causing locking or catching in the knee. In these instances, you may need to have a second knee arthroscopy to allow the knee to work properly.

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    Physical Therapy Exercises For A Knee Meniscus Tear

    If you have a knee meniscus tear, you may benefit from a physical therapy exercise program to rehabilitate your knee. Working with a physical therapist can help you regain maximal knee range of motion and strength and can help you return to your normal optimal level of activity.

    Research even shows that participating in physical therapy for a meniscus injury may help you avoid surgery for your knee. Your PT may use various modalities and treatments to control your pain or knee swelling or to improve the way the muscles around your knee contracts and supports the joint.

    Exercises should be a major component of your knee rehab program after a meniscus tear. Physical therapy exercises in the clinic, and as part of a home exercise program, can help you recover fully from your meniscus injury.

    But which exercises are best for your specific condition? The only way to know is to work with your PT he or she can prescribe the right exercises for your specific condition.

    Here is a sample exercise program that you may be prescribed for your knee meniscus injury. The exercises focus on improving the knee’s range of motion and strength and improving the overall function of your knee joint. Exercises should not cause any extra pain in your knee.

    Before starting this, or any other knee meniscus exercise program, check in with your healthcare provider and physical therapist to be sure exercise is safe for you to do.

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