Meniscus (Meniscectomy) Surgery Overview
What is a partial meniscectomy?
Partial meniscectomies are among the most common orthopaedic procedures performed annually. They are utilized for meniscal tears that cannot be adequately repaired. A meniscal tear may not be a candidate for meniscal repair due to a combination of factors including the tear type, the overall quality of the meniscal tissue, the tear location, and the patient’s specific goals. For example, small radial tears occur in an area of the meniscus with poor healing capabilities. These lesions can be removed with minimal compromise to the function of the meniscus or the greater function of the overall knee joint. Root tears, on the other hand, should almost always be repaired, if possible.
Who should have a partial meniscectomy?
The primary recommendation for undergoing a meniscectomy is for symptoms that do not improve, symptoms that affect activities of daily living, and mechanical symptoms (catching/locking/giving away). Stable asymptomatic tears can be managed conservatively without operative intervention. Additionally, degenerative tears were historically treated with meniscectomy. These tears are more like a “fraying” of the meniscus and are “wear and tear” injuries that occur in the presence of knee joint arthritis. These tears are no longer treated with meniscectomies as the most recent research suggests that there is minimal symptomatic benefit for this surgery when compared to conservative treatment. Additionally, it is important to note that meniscal repair is superior to meniscectomy at minimizing long term arthritic changes in the knee joint. This being said, every patient and every tear is unique. For many patients, a partial meniscectomy is the better treatment option for their specific needs, goal, and injury.
What are the surgical steps of a partial meniscectomy?
During a partial meniscectomy, Dr. Chahla will make three small incisions around the knee joint. These are called arthroscopic portals and are used to insert the arthroscope, which is a camera, and the arthroscopic tools. During the minimally invasive arthroscopic surgery, the edges of the meniscal tear are shaved until only a smooth edge remains. This will minimize any pain or functional symptoms caused by the meniscal tear. Throughout the procedure, every effort is made to minimize the amount of meniscal tissue that is removed. At the end of the surgery, all of the incisions are closed with a single non-absorbable suture (stitch) that is removed in clinic at your two week follow up appointment with Dr. Chahla.
What is the postoperative rehabilitation like?
Postoperative rehabilitation regimens are critical to facilitating the best possible outcome for any meniscal surgery. A major benefit of partial meniscectomies is that there are minimal postoperative restrictions. Patients are allowed to weight bear as tolerated with crutches immediately after the surgery. They are also allowed a full range of motion. Over the next few weeks, they can ramp up their activity levels and work towards full weight bearing. Patients are allowed to progress to higher impact activities, so long as they remain asymptomatic. It typically takes 4-6 weeks before a patient is able to return to all activities after a partial meniscectomy. If patients begin to develop pain and swelling following certain activities, this is a sign of arthritis and typically not a sign of a recurrent meniscal injury. Activities that cause pain or swelling should be limited and replaced in favor of lower impact activities such as swimming or cycling.
For certain patients, being able to weight bear during the first week of surgery is a large enough benefit that they would prefer partial meniscectomy to a meniscal repair. For others, this short-term benefit is not worth the long-term arthritic changes they may experience 10-20 years down the line. It is important that a patient understands what to expect from any procedure and rehabilitation regimen, so that they can make the best decision for their specific goals and activity level.