Meniscus Surgery

There are certain meniscus tears that require more urgent attention.  One of these types of tears is a bucket handle tear, where the torn meniscus flips from the back to the front of the knee.  This causes pain, locking of the joint, swelling, and difficulty weightbearing.  Generally these injuries require urgent attention to reposition the meniscus in the correct position and sew it back to where it belongs so it can heal properly.  Other types of tears that cause mechanical locking, catching, immediate and sharp pain, are usually treated semi-urgently as they can worsen.  Nonsurgical treatment will be unsuccessful for the treatment of tears causing mechanical symptoms.

Meniscus repair surgery is performed with a small scope inserted through one of two tiny incisions in the front of the knee.  There are different techniques for meniscus repair, but often a new-generation suture repair device is used to deploy a tiny all-suture anchor outside the joint that permits the attached suture to squeeze the tissue back to the anatomic position and heal properly.  Sometimes sutures can be passed outside the joint through separate tiny incisions and then tied together to ensure the repair is secured.

There are sometimes reasons to add a procedure to the meniscus repair such as microfracture or ACL reconstruction to ensure there is an appropriate biologic environment for healing.  Microfracture involves making tiny portals in the femur (outside the cartilage joint sections) to allow for bone marrow elements to enter the joint.  If you are having ligament surgery such as ACL reconstruction, there is good evidence having the ACL done at the time of the meniscus repair can improve healing capacity of the meniscus(1).

If the tissue cannot be repaired or if it is determined that if the tissue is repaired but will not heal and require additional surgery, the torn section of the meniscus will be trimmed, called partial meniscectomy.  The goal of partial meniscectomy is to only remove the damaged section of the tear.  The remaining section of the meniscus is smoothed, so that the previous tear does not worsen or propagate in the future.

Physical therapy for motion, strengthening, and swelling control is initiated very shortly after the arthroscopic procedure, within days.  You can shower three days after the procedure and let the knee get wet.  Generally if the meniscus is repaired, a brace and crutches are recommended for about one month to protect the torn tissue and facilitate healing.  Most independent activities and walking is fully resumed by six weeks.  Most patients undergoing meniscus repair can resume full activities approximately 3-4 months after surgery, depending on the type of repair and any other coexistent procedures performed, such as ACL reconstruction.

If a partial meniscectomy is performed, most patients resume most independent activity within 1-2 weeks, and driving is permitted very soon thereafter.  Sometimes partial meniscectomy patients can benefit from physical therapy for a few additional weeks, depending on the demands of the patient and the specific findings at the time of arthroscopy.