How sure do you feel right now about your decision? Use the following space to list questions, concerns, and next steps. Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. My treatment for a torn meniscus will depend on more than just how I hurt my knee. Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice? Author: Healthwise Staff. Medical Review: William H. Blahd Jr. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
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Important Phone Numbers. Get the facts. Your options Have surgery to treat a meniscus tear. Don't have surgery. Use home treatment and physiotherapy to treat your knee. Key points to remember Your decision about surgery for a torn meniscus will depend on where the tear is located, the pattern of the tear, and how big it is.
Your surgeon's experience and preference, as well as your age, health, and activity level, can also affect your treatment options.
There are two kinds of surgery for a meniscus tear. One kind repairs the tear by sewing it back together. The other kind removes part or all of the meniscus. In general, it's better to fix the meniscus than to remove it. Some types of tears can't be fixed. For example, radial tears sometimes can be fixed, but it depends on where they are.
But most horizontal, long-standing, and degenerative tears—those caused by years of wear and tear—can't be fixed. You may want to have surgery if your knee pain is too great or if you are unable to do daily activities. Surgery may help you reduce the risk of other joint problems, such as osteoarthritis. There are no long-term studies to prove it, but many doctors believe that successful meniscus repair helps to evenly spread the stress placed on the knee joint.
If the knee is protected from uneven force, there is a lower risk of future joint problems. Some kinds of tears heal on their own. Instead of surgery, you may try rest, ice, compression, and propping up your leg on a pillow when you sit or lie down.
What is a meniscus tear? How is a meniscus injured or torn? What are the types of meniscus tears? How is a torn meniscus treated?
There are two basic types of treatment for a torn meniscus—non-surgical treatment and surgery. With non-surgical treatment , you use rest, ice, compression, and elevation, and you have physiotherapy. You may wear a knee brace for a short time. With surgery , you can have one of the following: Surgical repair to sew the tear together. Partial meniscectomy, which is surgery to remove the torn section of the meniscus. Total meniscectomy, which is surgery to remove the entire meniscus.
This surgery is not usually done, because it increases the risk of osteoarthritis in the knee. If you have a small tear at the outer edge of the meniscus in what doctors call the red zone , you may want to try home treatment. These tears often heal with rest. If you have a moderate to large tear at the outer edge of the meniscus red zone , you may want to think about surgery.
These kinds of tears tend to heal well after surgery. If you have a tear that spreads from the red zone into the inner two-thirds of the meniscus called the white zone , your decision is harder. Surgery to repair these kinds of tears may not work. You may need a partial meniscectomy instead. If you have a tear in the white zone of the meniscus, repair surgery usually isn't done, because the meniscus may not heal.
But partial meniscectomy may be done if torn pieces of meniscus are causing pain and swelling. How well does surgery work? In knees that have good stability. In longitudinal tears or in radial tears that occur in the red zone. If the repair is done in the first few weeks after the injury. In addition to repairing the meniscus, surgeons can also simply remove a piece of damaged cartilage. This is known as a meniscectomy. If the patient with a meniscus tear is young and active, the surgeon will try to perform a repair rather than a meniscectomy, when possible.
Talk with your doctor if you have questions about treating your meniscus tear. Symptoms of Meniscal Tears. Recovering From Meniscus Repair Surgery. Diagnosing Meniscal Tears. Airplane flights should not be scheduled within the first five days following surgery to decrease chances of blood clots. Dental work often releases bacteria into the blood, so should not be scheduled in the first six weeks after surgery.
If unavoidable, antibiotics around the time of the dental work may decrease infection risk. Meniscus repair is optimally performed within the first two months after meniscus tear to maximize meniscus healing.
Arthroscopic meniscus repair is an advanced surgical skill that should be performed by an orthopedic surgeon trained in arthroscopic techniques. The surgery should be performed in a hospital or outpatient surgical center that handles a large volume of arthroscopic knee surgeries. Surgeons who have had fellowship training in sports medicine have received additional advanced training in arthroscopic techniques such as meniscus repair.
The operation is best performed by a surgeon with an interest and experience in arthroscopic meniscus repair. Surgeons with these qualifications can be located through university schools of medicine, and are often members of specialty societies such as the American Orthopedic Society for Sports Medicine and Arthroscopy Association of North America. Arthroscopic meniscus repair is an outpatient surgery that is performed in a hospital or outpatient surgical center.
A center that handles a large volume of arthroscopic knee surgeries has experienced nurses and therapists to assist patients recover. After the anesthetic is administered and knee examined, a tourniquet is placed on the upper thigh and the thigh is secured to the table in a padded limb holder.
The knee and lower leg are cleansed and draped and a diagnostic arthroscopy is performed. A diagnostic arthroscopy is a thorough examination of the inside of the joint with a camera hooked up to viewing screens. The instruments are approximately 5mm in diameter and are inserted through three or four 1cm incisions around the knee. One incision is for sterile saline inflow, used to improve visualization within the joint.
A systematic inspection of the knee documents any problems, which can also be addressed. The meniscus tear is identified and probed with a small metal hook. The size, pattern, location, stability, and tissue quality of the meniscus tear are assessed, and decision made about repair versus removal of the damaged tissue.
The opposing edges of the meniscus tear prepared to enhance healing using a small rasp or motorized shaver. If the blood supply to the tear is questionable, several techniques can be used to improve healing including; placing a blood clot in between the two parts of the tear, creating small vascular access channels in the peripheral rim of meniscus, or making the joint lining bleed.
The meniscus is then secured back in place with one or more of a variety of devices including; suture, an absorbable tack, or a meniscus repair device. Sutures require additional small incisions to tie down. Arthroscopic meniscus repair can be safely performed under general or spinal anesthetic.
In addition, local anesthetic is injected into the knee and incision sites. The patient is encouraged to discuss preferences with the anesthesiologist prior to surgery. Arthroscopic meniscus repair generally takes between an hour and an hour and a half. Depending on how much other surgery is necessary to take care of other problems in the knee, the time may be a bit more or less.
Arthroscopic meniscus repair is moderately painful. Because more soft tissue surgery is performed, it is more painful than a standard arthroscopy, but less painful than a ligament reconstruction or another procedure that requires drilling holes through the bone. Local anesthetic is used during surgery to minimize pain, but patients generally have a swollen, painful knee for the first three days after surgery, which is manageable with oral narcotic and anti-inflammatory pain medication.
Oral anti-inflammatory medication is taken by mouth on a schedule, and narcotic pain medicine is taken by mouth as needed. Patients require narcotic pain medications an average of days after surgery. The combination of narcotic and anti-inflammatory pain medication produces highly effective pain relief with minimal side effects.
Good pain control is a balance between effectiveness and side effects. Mechanical symptoms including locking or catching of the knee can significantly limit desired activity. The decision to perform surgery should not be based on the presence or absence of a tear, but should be based on the severity of symptoms and the level of dysfunction. Arthroscopic meniscus surgery is generally associated with good outcomes and relief of pain.
Surgery done for the right reasons results in very high rates of success and patient satisfaction. Recovery from arthroscopic knee surgery can range from two weeks to a few months.
This is highly dependent on the type of meniscus surgery performed. Most commonly, part of the meniscus is removed; this is called a partial meniscectomy. Occasionally, depending on the tear pattern and type, a repair of the meniscus tear would be performed.
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