Meniscus Repair

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Introduction

A meniscus is a C-shaped cartilage, that works as a shock absorber between the femur and the tibia. There are two menisci in each knee joint and they serve to protect the joint surface from injury and to stabilise the knee. Acute meniscus injury is quite common in young people during a knee sprain, while participating in sports activities.

Chronic degeneration of the meniscus is also common in the older population. An injured meniscus can cause pain, swelling, locking or decreased joint range of motion. If a large portion of a meniscus is torn a surgical repair with a suture is needed to promote healing. When repair is impossible, the fragment needs resection.

Indications and Contraindications

Indications

Indications for Surgical Meniscus Repair are based on:

Tear Type: The outer zone of the meniscus has a better blood supply and potential for healing, injury in an outer zone can be repaired.
Tear Size: Smaller tears have a better chance of healing after repair.
Patient Age: Healing after repair is more predictable in young patients.
Activity Level: Patients engaged in physically demanding activities are more in need of repair, rather than resection.

Contraindications

Complex Tears: Tears that are too large, too complex, or located in the inner zone are not suitable for repair and rather need fragment removal, as they have poor healing potential.
Chronic Tears: Long-standing tears lead to significant degeneration of the meniscus and may not heal with a repair.
Inadequate Tissue: An insufficient margin of healthy meniscus precludes a stable repair.
Severe Knee Arthritis: Patients with coexisting advanced knee arthritis may benefit more from alternative procedures (total knee replacement for example) as meniscus repair may not provide sufficient symptom relief.

Benefits and Risks

Many benefits and risks of meniscus repair are the same as those of any surgery or arthroscopy. Benefits and risks specific to meniscus repair include:

Benefits

Preservation of Native Meniscus: maintenance of joint stability and shock absorption capacity for long-term joint protection.
Improved Long-Term Outcomes: delay of arthritis or pain onset and improved overall knee function.

Risks

Limited Suitability: Not all meniscus tears are suitable for repair. Repair of highly degenerated meniscus will not improve long-term outcomes.
Prolonged Recovery: A more extended period of post-operative rehabilitation and physical therapy is required to ensure the healing process is successful.
Scar Tissue Formation: After meniscus repair, there’s a potential for the development of scar tissue within the knee joint, which can affect joint mobility and function.

Surgical Approach

Meniscus repair is typically performed arthroscopically. An arthroscopy, or a “key-hole surgery” is a minimally invasive procedure that involves making small incisions over the joint and introducing a camera to visualise the inside of the joint. Further, small instruments are inserted through separate incisions to allow repair.

Pre-Surgery Information

Prior to Meniscus Repair surgery, the following procedures and preparations will take place:

Patient Evaluation: A thorough assessment of the patient’s overall health, medical history, and orthopaedic condition. When necessary, your health might need optimisation and we may refer you to another specialist.
Medications: Inform your healthcare provider about any medications you’re taking, as some may need to be adjusted before surgery. You should stop taking aspirin or anti-inflammatory medications 10 days prior to the surgery. Also, you should discontinue any naturopathic or herbal medications during this period.
Imaging: X-rays, CT scans, and MRIs are used to evaluate the extent of damage and plan the surgery. CT scans are especially helpful in planning the surgical steps.
Skin preparation: The night before and on the morning of the operation, you will be asked to wash the leg with a sponge provided at the pre-admission clinic. If there is any suspicion of an iodine allergy, a Betadine Skin test might be used.
Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic, and you will need to administer them the evening prior to the surgery. An instruction leaflet will be given to guide them.
Patient education: During a physiotherapy assessment, a qualified physical therapist will provide you with personalised instructions on gait training, the use of crutches, and pre- and postoperative exercises. You will be fitted with crutches to take home and practise before the surgery.

On the day of the Surgery

Surgical paperwork will be administered by the nurses, and the anaesthetist will meet with the patient to ask a few questions.
A hospital gown will be given, and the operation site will be shaved and cleaned.
Betadine skin prep will be applied to the area above the operation site and wrapped.
All x-rays are to be sent with the patient to the theatre.

Surgical Procedure

Post-Surgery Information

Immediate Post-Surgery:

Meniscus repair is typically conducted as an outpatient procedure, allowing patients to return home on the same day.
The patient should use an ice pack overnight with a towel between the ice pack and the leg for comfort.
The provided pain medication should be taken as directed.
The patient should mobilise and put minimal weight on the leg with crutches as advised by the surgeon, depending on the extent of performed repairs.
A physiotherapist will guide the patient on post-surgery exercises before their hospital discharge..
The patient should avoid placing a pillow under the knee; instead, encourage movement of the ankle and toes.

Dressing and Swelling Management:

The bandage can be removed after 24 hours, and the provided waterproof dressings can be placed over the wound.
It is normal for the knee to swell after the surgery. The patient should elevate the leg when seated and apply an ice pack to the knee for 20 minutes, 3-4 times a day, to reduce swelling.

Follow-Up: Regular follow-up appointments with the team will help monitor your progress and address any concerns:

1 week postop: for wound check,
2 weeks postop: for suture removal
6 weeks postop: for x-ray assessment of healing progressing,
Later at 3, 6, 9, 12 months postop and further annually an x-ray will be mandatory.

Physical Recovery and return to sports in a young professional athlete needs an individualized physiotherapy program.

Concerns

If patients are worried about their level of pain, experience significant bleeding, or notice fever or redness around the surgical site, they should contact the office immediately. If assistance is needed after hours, patients can contact the hospital where the surgery was performed, and they will contact Professor Al Muderis on their behalf.

Norwest Private Hospital: (02) 8882 8882

Macquarie University Hospital: (02) 9812 3000