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Meniscus Tear Treatment and Recovery: Is Meniscus Surgery a Major Surgery?

December 30, 2023

When the menisci in your knees are damaged or degenerated, it leads to a torn meniscus. Athletes often experience this injury due to overuse, but torn menisci can also happen as you age, owing to the natural process of degeneration. This condition may need surgery, and many of our patients ask us, “Is meniscus surgery a major surgery?

Menisci, those crescent-shaped fibrocartilage pieces in your knee joint, play a crucial role in its well-being. You have a pair between your femur and tibia bones, assisting with the load-bearing and shock-absorbing duties.

Initially, a torn meniscus might not show symptoms. Yet, if you keep using the injured menisci, you could end up with persistent swelling, pain, and even some clicking sounds. Symptoms might get worse, especially post-activity.

Dealing with a torn meniscus offers various conservative options—rest, pain relief, and physical therapy. Your doctor might recommend surgery based on the tear's size and other health factors.

Is Meniscus Surgery a major surgery?

Let's discuss the various surgical choices for torn menisci, covering what to anticipate in recovery, potential issues, and the overall outlook for each surgery type.

Categories of Meniscus Tears

Menisci can tear in various manners, and the tear kind can aid in deciding the optimal treatment approach:

  • A flap tear is a horizontal tear at the top of the meniscus, resulting in a loose cartilage flap.
  • A radial tear starts at the inner meniscus edge and extends outward.
  • A horizontal cleavage tear is a side-to-side tear within the meniscus body (not the edge).
  • A bucket-handle tear is a vertical tear, creating a bucket-handle-like loosened tissue.
  • Degenerative tears involve wear and tear at the meniscus edge.

Signs of a torn meniscus involve sharp knee joint pain, swelling, stiffness, and a sensation of "catching" during joint movement. Those with a torn meniscus may also feel a "popping" when the tear happens.

How Is A Torn Meniscus Treated?

Your treatment depends on the kind and size of the tear and the damage around your knee. X-rays or MRIs (or both) and a physical joint check guide your treatment. Smaller meniscus and many aging tears often get better with rest, ice, anti-inflammatory meds, and sometimes injections into the joint to ease swelling and pain. Alternatively, a less invasive procedure, knee arthroscopy, might be a good choice.

Cartilage and the meniscus struggle to heal due to limited blood supply. Major tears usually can't fully heal; treatment focuses on cutting out the damaged parts to help "restabilize" the meniscus for firm joint support. This process, a meniscectomy, is done with special tools through small knee cuts. After surgery, you can usually move and bear weight on your knee soon.

When damage is on the outer rim with a better blood supply, special sutures or fasteners can be used to mend the meniscus, letting torn edges fuse during recovery. Meniscus repair takes longer to heal than a meniscectomy, and you might have weight-bearing restrictions, needing a knee brace in the early recovery stages.

Is Meniscus Surgery A Major Surgery: When To Consider Surgery

Meniscus surgery is still one of the most common orthopedic procedures because many people have meniscus tears affecting their quality of life. If standard treatments don't work or the tear is severe, your doctor might suggest surgery to help you return to your usual activity level.

Surgery for a torn meniscus is not always the first choice. If you might have symptoms of a torn meniscus, your doctor might first recommend the "RICE" method:

  • Rest
  • Ice
  • Compression
  • Elevation

You can reduce inflammation and prevent more damage by icing your knee and taking a break from sports or other intense activities. Alongside RICE, non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen may cut pain and swelling. Wearing a knee brace can also be beneficial.

Your doctor might also suggest a corticosteroid injection into the joint. Cortisone shots have been proven to relieve pain for patients with meniscal tears or degeneration substantially.

Yale Medicine explains that meniscus injuries in older people often result from degeneration over time. This can be caused by routine activities such as squatting or climbing stairs.

What Is Involved In Meniscal Repair Surgery?

A meniscal surgery involves several processes.

The steps involved in meniscal repair surgery include:

Diagnostic Arthroscopy

2-3 small (< 1cm) portals are created to allow passage of a camera and surgical tools within the knee joint. The whole joint is inspected for damage.

Meniscal Repair

The torn meniscus is repaired using stitches. A repair is preferable to a resection as the shock-absorbing function of the meniscus is retained. Sometimes, this can be performed completely via keyhole surgery using an "all-inside" surgical device.

If the tear is extensive, an accessory incision is made on the side of the knee, and sutures are passed from the inside of the knee to the outside through the open accessory incision. These stitches are then directly tied over the capsule to provide strong repair. This is considered the gold standard for meniscal repair.

Meniscal Resection

In some situations, the torn meniscus is unsuitable for repair, and the torn portion is trimmed to a stable margin. This can relieve the pain and mechanical symptoms associated with a tear. Trimming the meniscus will reduce its shock-absorbing capacity and put more pressure on the surrounding cartilage. This will cause the cartilage to wear out quicker than normal and lead to arthritis in the knee.

Meniscal Recovery Plan

Patients can take a while to recover after a meniscal surgery.
  • Diet: You might resume a regular diet when you return home. Begin with tea or broth and advance slowly with toast and crackers, then a sandwich. If you become nauseated, go back to clear liquids.
  • Pain Control: Take pain medication. Ice as necessary (never place ice directly on the skin) and elevate the leg above heart level using 2 to 3 pillows. This will also reduce swelling.
  • Stop smoking: Smoking hampers healing as it disrupts the creation of new DNA. Additionally, smoking heightens the chance of infection and pneumonia post-surgery by decelerating the activity of your body's white blood cells.
  • Deep Breathing: Take a deep breath regularly and exhale. It aids in clearing the lungs post-anesthesia for better recovery.
  • Knee Immobilizer: If you've had Meniscal Repair, always wear the knee immobilizer during the initial three weeks to safeguard the healing process in its early stages. This applies even when you're asleep. Take it off only when engaging in exercises directed by your physical therapist and during showers.
  • Patients shouldn't flex the knee past 90 degrees for the first three weeks, even if your therapist says it is okay. After three weeks, you will change from the immobilizer to a knee-hinged brace. When transitioning to the knee hinge brace, it might be necessary to revert to using two crutches briefly to assist with balance if required.
  • Crutches: Patients must utilize two crutches for the first week, putting lightweight on the operative leg with the immobilizer on at each step. Keep in mind to put the involved foot flat on the ground. Most patients can be fully weight-bearing by the end of the first week while continuing to wear the immobilizer. After the first week, you may increase weight as tolerated, advance to one crutch for a few days, and then a cane if required. Meniscus (cartilage) Repair patients can't do pivoting, twisting, deep knee bends, squatting, or impact activities for four months. Meniscus repair patients mustn't squat for at least four months following the repair.
  • Return to Work: People with light work (like desk or computer work with no lifting, squatting, or kneeling) can return to work within a week to ten days with the brace on. The exception is for people who may have long commutes. Sitting without moving the leg down for extended periods raises the chance of developing a blood clot in the leg.

Individuals engaged in active office tasks or very light work with various responsibilities can resume work in approximately two or three weeks, contingent on lifting requirements and whether their employer is willing to adjust for lighter duties.

Tasks involving heavy labor (such as lifting or working at unprotected heights) typically can only be resumed after six weeks. Approval from their physical therapist is usually necessary for most cases. Engaging in the most strenuous labor, particularly working at unprotected heights, would naturally require a more extended recovery period.

Regarding driving, patients recovering from right knee surgery and left knee surgery (with a standard transmission car) should refrain from driving until they are out of the knee immobilizer, off all pain medications, and can fully bear weight without experiencing pain. Left knee surgery patients can resume driving after approximately three weeks if they are pain-free, off all pain medications, and can walk comfortably without crutches.

Key Takeaway

It is best to have a medical professional examine your knee pain.

Injuries like a torn meniscus are quite common, especially among athletes and older individuals. It's crucial to get treatment to avoid more harm and deterioration quickly. Your doctor will probably suggest using over-the-counter pain relievers and starting with the RICE method, especially for mild cases.

But if your knee pain and swelling persist, disrupt your daily routine, or your tear is larger than 1 cm, you should talk to your doctor about surgery. This could be a partial meniscectomy or repair surgery.

Choosing surgery is a significant decision and comes with potential complications during recovery and later on. Before deciding on surgery for a torn meniscus, thoroughly review the advantages and risks with your doctor.

© 2024, John Hibbitts, M.D. All Rights Reserved.