Meniscectomy is a surgical intervention in which the doctor removes the torn meniscus of the knee. Depending on how serious the tear in the meniscus is, the surgeon might decide to remove it partially or totally. The tear of the meniscus is one of the most common injuries of the knee, affecting one or both knees. In deciding on the approach for the intervention – open surgery or arthroscopic intervention – the surgeon will take into consideration the age, occupation and recovery period of the patient. However, in the majority of the cases today, the preferred method of intervention is arthroscopic – as you will have the opportunity to read below, it is less invasive and offers a faster recovery.
Arthroscopic meniscectomy is considered a minimally invasive procedure, guaranteeing reduced damage for the surrounding tissues and thus allowing the patient to recover in a more efficient manner. This procedure is also known as the keyhole surgery, being used for the partial or complete removal of the meniscus. It is often chosen in patients who have suffered extensive damage of the meniscus, presenting no chance of meniscal repair. The tear of the meniscus is frequently encountered in professional athletes and in those who practice contact sports. The arthroscopic approach is preferred to the open surgery, as it allows the athletes to return faster to their professional activity.
Arthroscopic meniscectomy is a procedure performed in an outpatient basis. Depending on the age of the patient and the pre-existing conditions, the surgeon will decide whether he/she prefers local or general anesthesia. The procedure will start with two small incisions made in the anterior part of the affected knee, just below the rotula. One incision will be used for the insertion of the arthroscope (camera and light source) that will allow the surgeon to visualize the operating field on a monitor. The other incision will be used for the insertion of the small surgical instruments – these are going to be used for the removal of the torn meniscus. After a part or all of the meniscus has been removed, the surgeon will suture the incisions and apply a dressing on the recently operated area. A drain might also be placed in order to remove the excess fluid accumulated in the knee joint. If there are no complications, the patient will remain in the clinic for no more than one day.
These are the most common risks of the meniscectomy procedure:
- Bacterial infection at the site of the intervention
- Deep vein thrombosis – a blood clot can form in the operated leg – increased risk for stroke or heart attack, if the blood clot travels to the brain or heart (very rare, often prevented through the administration of medication)
- Numbness in the recently operated area, especially in the spots where the small incisions were made
- Anesthesia-related risks – these are considered in the patients who will receive general anesthesia (the anamnesis of the patient is extremely important, as it can reveal whether the patient is allergic to anesthetics or not; moreover, it allows for the identification of associated conditions that can increase the risk for anesthesia-related risks or complications)
- Risk of nerve damage during the procedure
- If the procedure is not performed correctly, there is the risk of the knee becoming instable and unable of maintaining weight – this in time can accelerate the degenerative process of the knee joint
- Risk of excessive bleeding (hemorrhage) during the procedure.
These are the most common complications of meniscectomy:
- Damage to the articular cartilage or to the vascular structures (nerve – saphenous nerve injury, arteries), leading to reduced range of motion and loss of sensation
- Resecting more than it is necessary of the meniscus, thus affecting the loading capacity of the knee
- Bleeding inside the knee joint after the surgery (postoperative complication)
- Swelling in the knee joint that does not subside
- Tenderness in the recently operated area.
Given the fact that this is a minimally-invasive procedure, if there are no complications, the patients can return to sitting jobs from the third day after the intervention. The pain and other symptoms can be effectively managed through the administration of anti-inflammatory medication. The doctor might also recommend the application of ice packs in order to help with the swelling and pain. However, you should avoid applying ice directly to the skin, or it can cause circulatory problems. It is for the best to wrap the ice pack into a towel and then apply it to the skin.
After the intervention, you will have to stay in the clinic for a couple of hours. Upon discharge, you can place weight on the operated leg or you can decide to wear crutches (more recommended). It is also recommended to keep the leg elevated for the first days after the surgery, so as to avoid the formation of blood clots and help the swelling subside. In general, you can expect a full recovery in four to six weeks.
Physical therapy is essential for an efficient and fast recovery process. After a brief physical assessment, the physical therapist will draw up an exercise program. The PT program is destined to reduce pain and inflammation in the first days after the surgery; the next part will be to increase the range of motion in the affected knee and to strengthen the muscles in the area. The last part of the physical therapy routine will concentrate on getting the knee involved in more strenuous physical activities, such as cycling or walking on the treadmill.
In conclusion, this is a simple and minimally-invasive procedure that can help you regain the necessary mobility in your knee. Do not underestimate the importance of the recovery period and give your knee the proper amount of time to heal. Follow your physical therapy routine and you will be back to your old self in a short period of time.