Meniscal Repair

Meniscus tear is the commonest knee injury in athletes, especially those involved in contact sports. A sudden bend or twist in your knees causes meniscal tear. This is a traumatic meniscus tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age. The two wedge-shape cartilage pieces present between the thighbone and the shinbone are called meniscus. They stabilize the knee joint and act as “shock absorbers”.

Torn meniscus causes pain, swelling, stiffness, catching or locking sensation in your knee making you unable to move your knee through its complete range of motion. Your orthopaedic surgeon will examine your knee, evaluate your symptoms, and medical history before suggesting a treatment plan. The treatment depends on the type, size and location of tear as well your age and activity level. If the tear is small with damage in only the outer edge of the meniscus, nonsurgical treatment may be sufficient. However, if the symptoms do not resolve with nonsurgical treatment, surgical treatment may be recommended.

Surgical Treatment

Knee arthroscopy is the commonly recommended surgical procedure for meniscal tears. The surgical treatment options include:

• Meniscus removal (meniscectomy)
• Meniscus repair
• Meniscus replacement

Surgery can be performed using arthroscopy where a tiny camera will be inserted through a tiny incision which enables the surgeon to view inside of your knee on a large screen and through other tiny incisions, surgery will be performed. During meniscectomy, small instruments called shavers or scissors may be used to remove the torn meniscus. In arthroscopic meniscus repair the torn meniscus will be pinned or sutured depending on the extent of tear.

Meniscus replacement or transplantation involves replacement of a torn cartilage with the cartilage obtained from a donor or a cultured patch obtained from laboratory. It is considered as a treatment option to relieve knee pain in patients who have undergone meniscectomy.

Arthroscopy of the Knee Joint

Knee Arthroscopy is a common surgical procedure performed using an arthroscope, a viewing instrument, to look into the knee joint to diagnose or treat a knee problem. It is a relatively safe procedure and a majority of the patient’s discharge from the hospital on the same day of surgery.

Knee anatomy

The knee joint is one of the most complex joints of the body. The lower end of the thighbone (femur) meets the upper end of the shinbone (tibia) at the knee joint. A small bone called the patella (kneecap) rests on a groove on the front side of the femoral end. A bone of the lower leg (fibula) forms a joint with the shinbone.

To allow smooth and painless motion of the knee joint, articular surfaces of these bones are covered with a shiny white slippery articular cartilage. Two C-shaped cartilaginous menisci are present in between the femoral end and the tibial end.

Menisci act as shock absorbers providing cushion to the joints. Menisci also play an important role in providing stability and load bearing to the knee joint.

Bands of tissue, including the cruciate and collateral ligaments, keep the different bones of the knee joint together and provide stabilization to the joint. Surrounding muscles are connected to the knee bones by tendons. The bones work together with the muscles and tendons to provide mobility to the knee joint. The whole knee joint is covered by a ligamentous capsule, which further stabilizes the joint. This ligamentous capsule is also lined with a synovial membrane that secretes synovial fluid for lubrication.

Indications for Knee arthroscopy

The knee joint is vulnerable to a variety of injuries. The most common knee problems where knee arthroscopy may be recommended for diagnosis and treatment are:

• Torn meniscus
• Torn or damaged cruciate ligament
• Torn pieces of articular cartilage
• Inflamed synovial tissue
• Misalignment of patella
• Baker’s cyst: a fluid filled cyst that develops at the back of the knee due to the accumulation of synovial fluid. It commonly occurs with knee conditions such as meniscal tear, knee arthritis and rheumatoid arthritis.
• Certain fractures of the knee bones

Procedure

Knee arthroscopy is performed under local, spinal, or general anesthesia. Your anesthesiologist will decide the best method for you depending on your age and health condition.

• The surgeon makes two or three small incisions around the knee.
• Next, a sterile saline solution is injected into the knee to push apart the various internal structures. This provides a clear view and more room for the surgeon to work.
• An arthroscope, a narrow tube with a tiny video camera on the end, is inserted through one of the incisions to view the knee joint. The structures inside the knee are visible to the surgeon on a video monitor in the operating room.
• The surgeon first examines the structures inside the knee joint to assess the cause of the problem.
• Once a diagnosis is made, surgical instruments such as scissors, motorized shavers, or lasers are inserted through another small incision, and the repair is performed based on the diagnosis.

The repair procedure may include any of the following:

• Removal or repair of a torn meniscus
• Reconstruction or repair of a torn cruciate ligament
• Removal of small torn pieces of articular cartilage
• Removal of loose fragments of bones
• Removal of inflamed synovial tissue
• Removal of baker’s cyst
• Realignment of the patella
• Making small holes or microfractures near the damaged cartilage to stimulate cartilage growth
• After the repair, the knee joint is carefully examined for bleeding or any other damage.
• The saline is then drained from the knee joint.
• Finally, the incisions are closed with sutures or steri-strips, and the knee is covered with a sterile dressing.

After the Surgery

Most patients are discharged the same day after knee arthroscopy. Recovery after the surgery depends on the type of repair procedure performed. Recovery from simple procedures is often fast. However, recovery from complicated procedures takes a little longer. Recovery from knee arthroscopy is much faster than that from an open knee surgery.

Pain medicines are prescribed to manage pain. Crutches or a knee brace may be recommended for several weeks. A rehabilitation program may also be advised for a successful recovery. Therapeutic exercises aim to restore motion and strengthen the muscles of the leg and knee.

Risks and complications

Knee arthroscopy is a safe procedure and complications are very rare. Complications specific to knee arthroscopy include bleeding into the knee joint, infection, knee stiffness, blood clots or continuing knee problems.

Conclusion

Knee arthroscopy is a very useful technique for treating knee problems. It allows the surgeon a clear view of the internal structures of the knee to diagnose and then treat the problem. Most patients are discharged on the same day of the surgery. Recovery is also much faster than an open approach. Knee arthroscopy is a relatively safe procedure that ensures a quick return to normal activities of daily living.