Arthroscopic meniscus surgery for meniscus tears

Symptoms

Meniscus tears cause knee pain, frequently with swelling and a clicking or catching sensation. Squatting and kneeling become painful and difficult, and participation in sport can be hard. The pain can be quite severe at times.

Why it happens

Menisci can tear through twisting or pivoting of the knee during sport, or by other mechanisms. Sometimes the mechanism is so subtle that patients cannot recall an event that started the pain. The blood supply to the meniscus comes from its periphery, where it attaches to the knee capsule, and penetrates inward. As we age that blood supply recedes, which has real implications for how a tear can be treated.

How it is diagnosed

Diagnosis begins with a detailed history and a thorough physical examination. X-rays are the most important initial study; for the knee these are specialised, usually weight-bearing views, meaning you will be standing. An MRI may be added to look more closely at the meniscus and other soft tissues.

Treatment

Treatment depends on age, activity level, tear size and tear location. Older patients are usually treated non-operatively with physical therapy. If the tear is larger than 2cm, the prognosis for becoming symptom-free without surgery is poor. If the tear sits in an area of good blood supply, it may heal without surgery. Dr. Seneviratne evaluates each patient and recommends the least invasive course that will work.

The operation

The most common surgical treatment is arthroscopic partial meniscectomy: a tiny camera is introduced into the knee through a keyhole incision and, using instruments through a second keyhole, the torn portion of meniscus is removed. The procedure takes about 20 minutes under general anaesthesia and is one of the most commonly performed orthopedic operations in the United States.

Because the meniscus plays an important functional role, every attempt is made to preserve it and repair the tear where it is repairable. Patient selection matters for a good outcome. Tears in the vascular zone in younger patients are usually repaired. Dr. Seneviratne performs all three described repair techniques — all-inside arthroscopic repair, outside-in repair and inside-out repair — and has published on meniscus repair technique.

Recovery

Patients bear full weight and are discharged the same day. A cane may be needed for a few days; crutches rarely are. Most patients do not need narcotic pain medication and manage with Tylenol or an NSAID such as Advil or Aleve. The knee progressively improves over the following days and weeks. Dr. Seneviratne sees patients back in the office at about 7 to 10 days for suture removal and to start physical therapy, which is generally needed for 6 to 8 weeks. Running is usually possible at six weeks.