Meniscal Repair Technique
Meniscus surgery is usually performed as an elective procedure meaning you decide when to have surgery because it’s not an urgent medical necessity. This generally means there is a period of time between when the initial meniscus injury happens and the day of surgery.
Certain techniques can be used first to help reduce the pain and symptoms of a meniscus injury. To reduce swelling, rest, elevation, and ice packs may be advised alongside anti-inflammatory painkillers. It is important to know that pain relievers including ibuprofen are associated with excess bleeding risk during surgery so your surgeon will likely suggest you stop taking these 1 to 2 weeks before surgery.
You may be given a course of exercises to strengthen your leg muscles and knee, as this can help with your recovery. If the pain is more severe, physiotherapy or an earlier surgery date may be advised.
There are several surgical treatment options for a meniscus tear including:
- Partial removal called partial meniscectomy
- Total removal called total meniscectomy
- Transplantation meaning replacement with a donor graft
- Knee replacement
As a brief overview:
Repair uses various techniques to suture the damaged parts of the meniscus back together and encourage healing.
Partial meniscectomy involves removing the damaged parts of the meniscus then reshaping the remaining tissue to make smooth surfaces. This can mean simply trimming off the outer edge.
Total meniscectomy wherein the entire meniscus is removed. Surgeons generally attempt to avoid this technique as it can cause permanent swelling
Transplantation means implanting the meniscus from a donor into the knee after a total meniscectomy. A donor is someone who has chosen to give parts of their body to help others after they have died. The replacement meniscus is known as an allograft, which means it is a graft taken from someone else’s body. This is not a commonly used technique.
Knee replacement involves replacing the damaged parts of the knee with prosthetic (artificial) parts. This would likely only be considered for people with significant injuries or who are not suitable candidates for the above surgical options.
Whether or not meniscus surgery will benefit you is based on many factors including the type of tear and the severity of the injury. For example, if the tear is in the middle of the meniscus it is much less likely to heal on its own than an injury towards the outer edge. A severe tear may mean you are not a suitable candidate for repair surgery because this type of injury is more likely to be very deep or go through the entire meniscus.
There are two techniques used for meniscus repair: arthroscopic or open.
For an arthroscopic procedure, fine tools and a camera are inserted through small incisions (around 1 cm) at a few locations around the knee.
An open technique requires an incision down the front of the knee.
Either of these methods may be performed under a general anaesthetic meaning you are given medication to help you sleep during surgery or under a spinal anaesthetic called an epidural with sedation. For this, numbing medication is injected into the spine to numb the lower half of the body and another medication is administered to help you feel relaxed throughout the surgery.
Below, is a broad overview of how meniscal surgery is performed after the anaesthetic is administered:
- Your knee is cleaned and prepared
- Incisions are made
- Your knee and surrounding structures are examined
- The damaged meniscus is removed, trimmed, or repaired
- The knee is checked for movement
- Wound closed and bandaged
How Is Meniscal Repair Surgery Performed?
The length of the operation largely depends on the type of injury and the techniques used to repair it. In general, meniscus repair surgery takes between 1 and 3 hours to complete.
On the day of surgery, you will meet with the surgeon performing the procedure. They will go over the details of the operation again and ask you to sign a consent form. This is a legal document showing you understand the risks associated with surgery and give consent to allow the surgeon to operate on you.
The anaesthetist will then administer medication that puts you into a deep sleep which is called general anaesthesia, or will inject anaesthetic into your spine called a spinal block or epidural that blocks all feeling in the lower half of your body. In addition to the spinal block, you will also be given a sedative to ensure you are relaxed and somewhat sleepy during the procedure.
If you are having an arthroscopic procedure, your surgeon will make two or three small cuts around 1cm long called incisions at different locations around the knee.
For an open procedure you will have a larger single incision made down the front of the knee.
During an arthroscopic procedure, a fine camera is inserted into the knee to allow the surgeon to examine the meniscus and surrounding structures of the knee carefully. This examination helps ensure there are no other parts of the knee that need repair. If the surgeon finds that repair is not possible during this inspection they may need to instead proceed with a meniscectomy or complete removal of the meniscus. If this is a possibility, your surgeon will discuss this with you before your surgery.
There are multiple potential techniques your surgeon may use to repair the meniscus. One of these is to sew long stitches through the meniscus and secure them at the back of the knee. Another is to use multiple small stitches and specialised knots to secure the meniscus in place.
If a meniscectomy is required, either just the torn portion or the entire meniscus is removed from the knee. Your surgeon’s goal will be to leave as much of the healthy meniscus as possible. Once the pieces of meniscus are removed, the remaining tissue is then smoothed and balanced.
Closing the Incisions
Before closing the wound or wounds, your surgeon will ensure the knee can securely achieve a full range of movement. The wounds are then stitched closed with sutures or stapled closed with medical staples. Finally, wound dressings and bandages are applied to protect the area as the skin heals.
Return to the Ward
After surgery, you will be returned either to your room or a recovery area so you can be monitored as you recover from anaesthesia. If you are staying overnight you may be moved to another ward for the evening. If you are going home the same day as your surgery, you will be reviewed by your surgeon or a member of their team. They will make sure you are well enough to go home before you are discharged.