Meniscal repair

What is involved?

There are 2 c-shaped shock absorbers within the knee joint that sit between the tibia (shin bone) and femur (thigh bone).  These are called the menisci.  They have a wedge or triangular cross section and are anchored firmly to the bone at the front and back of your knee.  They have more flexible attachments to the capsule of your knee joint around the periphery.  The menisci are important to the structural integrity and function of your knee joint and carry out multiple functions such as acting as shock absorbers, providing congruency and stability to the articulation, improving the lubrication and smooth running of the knee joint and helping with load transfer on weight bearing.  Damage to the meniscal cartilages can therefore lead to symptoms within the knee including catching and pain, locking, instability and in the long term degenerative change and arthritis.  It is therefore necessary sometimes to operate on torn menisci to improve symptoms and also reduce the long term wear and tear to the knee.  Meniscal repair reduces the chance of developing arthritis in the future.  The procedure is carried out arthroscopically using a variety of techniques to place sutures across the torn part of the cartilage to restore its normal anatomy and promote healing of the tear.  There are many different types of meniscal repair available and the precise surgery that you require is very much dependent on the location, severity and pattern of the tear.  Certain types of meniscal injury that are more appropriate for meniscal repair include a bucket handle tear of the meniscus which can also lead to a locked knee, a vertical unstable tear within the periphery of the meniscus and a full thickness radial tear that defunctions the meniscus entirely.

 

Why might I need a meniscal repair?

Meniscal repair surgery is carried out for 2 reasons:

 

  1. To help symptoms in the here and now.Cartilage tears can cause pain, catching, instability and occasionally locking of the knee dependent on the pattern of tear. Repair will help alleviate these symptoms.

     

  2. Meniscal repair is also carried out to prevent degenerative change within the knee.Certain types of meniscal tear lead to significant increases in contact pressures and load within the articular surfaces of the knee joint and failure to repair the meniscus can lead to accelerated arthritic change within the knee.

A thorough history taken by your treating doctor and appropriate imaging will confirm whether or not your knee is suitable for meniscal repair surgery. 

 

What happens after surgery?

The procedure is normally carried out under general anaesthetic as a day case operation and the majority of the repair can normally be carried out as a keyhole operation.  Dependent on the pattern of tear, the severity and the type of repair you may or may not require a knee brace following surgery.  Normally you will be fully weight bearing with the assistance of crutches immediately following your operation.  You will have dressings over the wounds used to access the knee and these will stay on for 2 weeks following surgery.  You will then be followed up in clinic at appropriate time points to ensure your recovery progresses as planned.  You will normally require a course of physiotherapy for 3 months following surgery.  It is likely following a meniscal repair that you will not be back to playing competitive sport for somewhere between 6-12 weeks post operation. 

 

Recovery milestones

Week 0 – 2

Over this period of time you must keep the wounds clean and dry, use ice and anti-inflammatories to reduce the swelling and help you regain your range of movement and rest your knee as appropriate.

 

Weeks 2 – 12

The meniscal repair will allow the tear to heal over this period of time.  It is important not to stress the repair during this stage by participating in impact or contact sports.  Gradually your physiotherapist will work with you to improve your strength and get you back to activities as appropriate. 

 

Frequently asked questions

  1. Will I need a brace following surgery?

    The majority of meniscal repairs do not require bracing post-operatively but certain patterns occasionally require a brace to restrict your range of movement to prevent excessive load on the area of repair and allow it to heal better.  Your surgeon will let you know before or after surgery depending on the type of operation you have had.

  2. Will I need crutches?

    Fully weight bearing after meniscal repair surgery is often beneficial in that it aids the nourishment of the cartilage from synovial fluid and pushes the meniscus out to the periphery of the knee joint where the blood supply is best.  Most patients however do need crutches for comfort. 

  3. When will I be able to return to work/sport?

This is very dependent upon the pattern of tear and extent of the meniscal repair surgery.  Please discuss each individual case with your treating doctor.