Meniscal surgery is one of the most commonly performed surgical procedures in Germany. The goal of the meniscal surgery is to fully restore the mobility in the knee. If possible, an attempt is made to reconstruct the normal anatomical conditions as well as possible during meniscal tear therapy with a meniscal repair. However, surgery is not necessary in all cases of meniscal injury. In many cases, conservative meniscus therapy without surgery is sufficient. Read all important information about meniscus surgery here.
When is meniscus surgery necessary?
Opinions differ widely about the benefits of meniscus surgery. Some doctors argue that any meniscal tear necessitates surgery or arthroscopy. Almost as often, however, is held that most cases of meniscal injuries were not so pronounced and surgery is usually unnecessary.
It is clear that the method of treatment for a meniscal tear depends on various influencing factors and there is no general recommendation for meniscal damage treatment. The choice of therapy depends on the severity of the pain, the age and the demands on the resilience of the menisci. The goal of meniscus surgery is always to maintain as much meniscal tissue as possible and restore full mobility as much as possible.
Meniscal tear without surgery
Sometimes a meniscal tear can be treated without surgery. This is the case, for example, with rather small cracks. In particular, injuries in the well-perfused outer zone of the meniscus (outer edge of the meniscus at the joint capsule) can sometimes heal on its own. Physicians speak in this case of a conservative (non-operative) meniscal tear therapy. The meniscal tear is treated with analgesics, cortisone injections and physiotherapy. The knee should be spared as much as possible during the first period after the meniscal injury. After a few weeks, light exercise is started. Your doctor or physiotherapist will show you exactly how to do this. Even with degenerative changes of the meniscus, a meniscal tear is treated without surgery. However, if pain occurs repeatedly on the meniscus, or if the examination reveals that parts of the meniscus have come loose at the tear and are now in the joint space, there is no alternative to meniscal surgery.
Before the meniscus surgery
Prior to meniscal tear surgery, the affected knee must be thoroughly examined. As a rule, in addition to the physical examination, a magnetic resonance imaging (MRI) is made. In the pictures, the attending physician can determine at which point the meniscus is damaged. In addition, it can be ruled out that the pain in the knee of other structures such as ligaments or cartilage tissue originate. Depending on how the result of the MRI fails, we chose the appropriate treatment method. In many cases, however, only a joint mirroring (arthroscopy) can show how great the damage actually is. Then, during arthroscopy, the surgeon decides which method of meniscus surgery to use.
Meniscus surgery: surgical methods
Two types of meniscal surgery are available with arthroscopic and open meniscal surgery. While in the past it was mostly open surgery, the arthroscopic meniscus surgery is the drug of choice today. The procedures are performed under regional anesthesia or sometimes under general anesthesia.
arthroscopy
Arthroscopy is a so-called minimally invasive method. This means that in the meniscus surgery not a single large cut, but instead two to three smaller cuts are made. The first cut introduces a rod-shaped camera that transmits images from inside the knee joint live to a monitor. The other cuts introduce the surgeon’s surgical instruments, with which he removes ragged parts or creates a meniscal suture. The advantage of arthroscopy is that the minor injuries to the skin heal faster and no major scar remains after meniscal surgery.
Open method
In some cases, open meniscal surgery is preferred over arthroscopy. The open method is used, for example, when not only meniscus tear treatment is to be done, but also additional damage to ligaments in the knee joint or on the joint capsule were found. In open surgery, the knee is opened with a cut that is about five centimeters long, which is re-sutured after meniscal surgery. In general, about ten days after the meniscus surgery, the threads can be removed again.
Meniscus surgery: surgical techniques
Whether operated arthroscopically or openly, the following surgical techniques are available for meniscal surgery:
- Meniscal repair (meniscal suture)
- Meniscal Part Removal (meniscal partial resection)
- Meniscal replacement (insertion of an artificial meniscus)
Meniscal repair (meniscal suture)
In meniscal repair, the ruptured meniscal tissue is re-sutured to healthy parts of the meniscus and knee joint capsule. For this purpose, the edges are smoothed, the tissue is returned to its original position and kept in this position by means of special resorbable materials. In the meniscal repair, a distinction is made between different procedures (outside-in, inside-out, all-inside and refixation with resorbable arrows, so-called arrows).
A meniscal repair is only possible if the meniscus tear does not run through the entire meniscus and the meniscus is still attached to the capsule, so that it can be sewn firmly there and continues to be supplied with blood vessels. A meniscal suture is basically the best method because it can largely restore normal anatomical conditions. Unfortunately, the meniscal suture is not possible in all cases, as the damage is often already too large in the diagnosis.
After a meniscal repair, the knee may only be moved very carefully for a few weeks so that the meniscal tissue can heal completely again. Overall, the load buildup is much slower and more dose than after a meniscal resection. You get a splint in the first time after a meniscal repair. After about three weeks, you can begin to partially relieve the knee. After about two months, light sports such as swimming, cycling or weight training may be resumed.
Meniscus surgery: meniscal resection
When meniscal resection either only the torn piece of the meniscus (meniscus part resection) or the complete meniscus (meniscus resection) is removed. A meniscal resection is used in meniscal surgery when individual parts of the meniscus have completely dislodged, when degenerative changes in the knee are visible, or when the tear is older and the torn parts are no longer supplied with blood vessels. A meniscal resection can be done on an outpatient basis, since affected people can use their forearm crutches to walk carefully again the same day. Already in the first weeks after the operation physiotherapeutic exercises are started. For mostly sedentary tasks, the work can be resumed after just one or two weeks.
Meniscus surgery: meniscal replacement
A long-known but ever-evolving method of meniscal resection is meniscal replacement. The damaged meniscus is completely removed and a replacement model of polyurethane, collagen or a human donor (Meniskustransplantation) used. Before such a meniscal replacement is implanted, it will be adapted exactly to the size of its own meniscus. Implantation is minimally invasive in the context of arthroscopy.
The advantages of this method are that the removed meniscal tissue can regenerate at best. The disadvantage is the very long after-treatment of this special meniscus surgery, which persists over several months. To date, there is not enough study data available to definitively assess the quality of this process. Meniscal replacement is therefore not (yet) one of the standard methods of meniscal surgery.
Donor meniscus is especially recommended in young patients who are likely to have knee arthrosis (joint wear) and other knee problems due to the meniscal damage. Donated human beings usually come from mortally injured people who have agreed to donate before they die.
Risks of meniscus surgery
Meniscus surgery has certain risks, as with all other surgeries. Especially with the open surgical procedure, bleeding can occur during meniscal surgery. In addition, there is always the risk of an operation that germs get into the wound and trigger an infection. An infection in the knee joint is a very unfavorable complication, since the inflammation can cause severe damage to the knee cartilage. In meniscal surgery, however, such cases are rare, as the procedure is performed under sterile conditions.
In rare cases, pain persists after meniscal surgery or returns after a period of time. With a meniscal replacement, there is also the risk that the implant also breaks. In addition, meniscus replacement after meniscal surgery may result in an elicitation in the knee that requires a puncture of the knee. Overall, however, such after-effects are very rare. Of course, even after a single meniscus surgery there is still the risk that the meniscus tears again. That needs to be treated surgically again.
Disease course and prognosis
Meniscus surgery can be outpatient in many cases, so you can usually go home on the day of surgery. Depending on the type of meniscus surgery and the size of the meniscal damage, a longer or shorter healing period is required.
At a meniscus It takes months until a full load of the knee is possible again. Straining the knee too early will disrupt scarring and delay healing. In addition, you risk such a new tear of the not yet completely healed tissue. After about four to six weeks you can fully load the knee again. However, it generally takes two to three months for the knee to be nearly as resilient as it was before meniscal surgery. After a Partial meniscectomy Only a few days’ rest is necessary until you can strain the knee again. At a Meniskusersatz on the other hand, as with the meniscal suture, you should plan a closed season of a few weeks.
After each meniscus surgery, an individual physiotherapy takes place, during which your knee slowly gets used to the movement and the muscles are strengthened. The exercises that you will learn in physiotherapy, you should carry out to better support the healing at home. After a successful meniscus surgery and a structured follow – up treatment without further complications, you can usually after the knee Meniscus surgery again almost as before the injury strain.