Overview

Meniscectomy is a surgical procedure performed to remove all or part of a damaged meniscus in the knee joint. The meniscus is a C-shaped piece of cartilage that acts as a cushion between the thigh bone (femur) and the shin bone (tibia), helping to stabilize the knee and absorb shock during movement. Meniscectomy is typically recommended when a meniscus tear causes persistent pain, swelling, and limited knee function that does not improve with conservative treatments. The procedure can be performed using minimally invasive arthroscopy, leading to quicker recovery and reduced postoperative pain.

Causes

Meniscectomy is usually required due to a torn meniscus, which can result from:

• Traumatic Injury: Common in athletes or active individuals, caused by sudden twisting or pivoting movements.
• Degenerative Changes: Age-related wear and tear can cause the meniscus to weaken and tear more easily, particularly in older adults.
• Sports Activities: High-impact sports such as football, basketball, and soccer increase the risk of meniscal tears.
• Occupational Strain: Jobs involving frequent squatting, kneeling, or lifting can lead to meniscal damage over time.
• Previous Knee Injuries: Prior injuries can increase susceptibility to recurrent meniscus problems.

Symptoms

Patients who undergo meniscectomy often experience the following symptoms before surgery:

• Knee Pain: Pain localized to the inside or outside of the knee, worsening with activity.
• Swelling: Intermittent or persistent swelling of the knee joint.
• Locking Sensation: Feeling like the knee is stuck or locked in one position.
• Clicking or Popping: Audible sounds during knee movement.
• Reduced Range of Motion: Difficulty fully bending or straightening the knee.
• Instability: The knee may feel weak or prone to giving way during movement.

Diagnosis

Diagnosis of a meniscal tear requiring meniscectomy involves several steps:

• Medical History: Discussion of symptoms, injury history, and activity level.
• Physical Examination: Clinical tests like McMurray’s test or Apley’s test to assess meniscal injury.
• Imaging Studies:
  • MRI (Magnetic Resonance Imaging): The gold standard imaging technique to visualize the extent and location of the meniscus tear.
  • X-rays: Used to rule out fractures or arthritis but do not show soft tissues like the meniscus.

Treatment

Treatment depends on the severity and location of the meniscus tear:

Conservative Treatment (Before Surgery)

• Rest and Activity Modification: Avoiding activities that worsen pain.
• Ice Therapy: Reducing swelling and pain with ice application.
• Physical Therapy: Strengthening muscles around the knee to improve stability and reduce strain.
• Anti-inflammatory Medications: NSAIDs like ibuprofen for pain and swelling control.

Meniscectomy Procedure

• Partial Meniscectomy: Only the torn portion of the meniscus is removed, preserving as much healthy tissue as possible.
• Total Meniscectomy: Complete removal of the meniscus, rarely performed due to the increased risk of arthritis.
• Arthroscopic Surgery: Minimally invasive technique using small incisions, a camera (arthroscope), and specialized instruments for faster recovery and less postoperative pain.

Postoperative Care

• Rehabilitation: Early physical therapy focusing on range of motion, strength, and gradual return to activity.
• Pain Management: Short-term use of pain medications to control postoperative discomfort.
• Weight Bearing: Most patients can bear weight immediately or shortly after surgery depending on surgeon guidance.

Prognosis

The prognosis following a meniscectomy is generally good, especially in younger and active individuals. Most patients experience significant pain relief and improved knee function within a few weeks. Arthroscopic meniscectomy typically allows a quicker return to daily activities and sports compared to open surgery. However, removing meniscal tissue can increase the risk of developing osteoarthritis over time, particularly in cases where large portions of the meniscus are excised.

With proper rehabilitation and adherence to medical advice, patients can expect excellent short-term outcomes and maintain good knee function in the long term. Preventative strategies, such as strengthening surrounding muscles and avoiding high-impact activities, can help preserve knee health post-surgery.