Meniscus

Cartilage (meniscus)

The cartilage (meniscus) is a small horseshoe shaped mobile shock absorber between the bone ends inside the knee joint. There are two in each knee on either side of the knee. Because the meniscus has a poor blood supply, it may have difficulty healing if it is torn and arthroscopy may be suggested in order to repair the injury.

Torn meniscus usually cause pain and catching localized to the side of the joint and local tenderness, some swelling, fluid in the knee or the knee is "locked" and will no longer bend or stretch.

There are several types of tears and several locations were cartilage tears can occur; it also cause damage to the articular cartilage (the gristle layer of shock absorber material that coats the surface of bone ends)

Treatment

A tear in the meniscus can be properly diagnosed on physical examination, in which case is usually a knee arthroscopy is recommended. Occasionally, the diagnosis of a torn meniscus remains unclear and a MRI scan is needed. The usual treatment is to trim the torn portion of meniscus. When the tear of the meniscus is recently arised and positioned in a perfused portion of the meniscus, a repair include using arthroscopically placed tacks or suturing the torn edges. But this is an exception and is more common as part of a wider problem such as knee instability ligament injuries.

Preperation

How to prepare for your operation

Prior to your surgery, you will have a physical examination. You visit the doctor's assistant and/or anaesthesist to check your health and explanation of the various forms of anesthesia and pain management, both during and after surgery. More information about anesthesia, you can read here.

The day of surgery is scheduled. You can return home on the on the same day of surgery.

You should borrow crutches as you will need them to walk for a few days following your surgery. For more information: www.thuiszorgwinkel.nl

The day of surgery

Be sure to have someone with you to drive you home. You should bring your crutches and personal items such as medicines. You wear comfortable clothing and shoes and leave valuables at home as much as possible.

You appear sober at the clinic.
After pre-fitting a compression stocking and pre-operative preparation you will positioned and treated in the operating room.
After surgery you will be moved to the recovery room.
The physiotherapist will explain how you can exercise at home and how to use the crutches safely.
When you are restored sufficiently, the anesthesiologist will agree with your dismissal. You may not drive home by yourself.

Recovery after surgery

Recovery of this procedure lasts 2 up to 6 weeks and goes roughly as follows:

The dressing covering can removed after24 hours by yourself. From that moment you can use the support stocking during the day and take it off at night.
The plasters can be removed after 3 days unless these are very dirty; then you can replace them by a clean one. The beige adhesive strips can be removed after14 days, also by yourself.
Keep your incisions clean and dry. You can take a shower after 5 days. Please do not take a bath or swimming exercise not before the wounds are healed
The knee may swell temporarily by practicing

Therapeutic exercise will play an important role in how well you recover. The formal physical therapy program may improve your final result. Your surgeon and/or physical therapist will see you in the clinic within a few weeks to check and evaluate your progress. Generally, in most cases patients return to a more active and normal lifestyle within two to 6 weeks when the ‘lubication’ of the joint has been restored.

Complications

Although the risk of a complication of this type of surgery is very low, complications may be related to anesthesia or infections. Consult your surgeon with the following complications:

Bleeding from the wounds or bleeding in the knee.
The wounds remain sensitive sometimes long after your arthroscopy.
There may be a thrombosis or pulmonary embolism occurs.
Infection of the knee joint
Damage to the knee arthroscopy structures around the knee, such as nerves or blood vessels

Expectations

Treating a torn meniscus is a relatively simple technique, which has few complications and good results within a short time but sometimes the outcome is not what you had expected. This may be related to the cause of your complaints. Always follow the specific instructions, and if you have questions about your rehab ask your doctor's or physical therapist’s opinion.

Frequent asked questions (FAQ)

My meniscus is torn, what will happen?
A torn meniscus will not heal itself. If you have a torn cartilage, and surgery is necessary, mostly a partial menisectomies will be performed to remove only the torn segment of the meniscus to minimize the loss of the cushioning effect and to retain the stability of the joint.

Can I load my knee after meniscus surgery?
Exactly what load depends on several factors, and you should always check with your doctor's or physical therapist’s prior to initiating or changing your post-operative rehab in any way. Generally spoken, a stitched meniscus takes up to 6 weeks using a splint and there is a ban on squat for 3 months.

From what kind of tissue does the meniscus exist?
The meniscus is made of fibrocartilage with a poor blood supply. In general, tears will not heal spontaneously

I am an older person; is operation of a torn meniscus an option?
It is certainly an option to operate a torn meniscus in older patients, especially when there in no significant wear in the knee or your keen is locked by a crack.

How likely is it that a meniscal repair with sutures in place heals?
The chances of recovery from an attached meniscus depend on many factors: the location and size of the tear, the quality of the meniscus, the fixation of the crack, the treatment and especially the stability of the knee. And the chance of cure is small in case of an unstable knee with a torn anterior cruciate ligament. Reconstruction of the anterior cruciate ligament may be a solution. There is a 70% to 90% chance of making a full or good recovery.

How much pain can I expect after surgery?
Usually the pain is not so bad. An ice pack, available at the pharmacy or drugstore may be helpful to reduce pain and swelling of the knee. Sometimes an anti-inflammatory treatment is given after a torn meniscus. Paracetamol is usually sufficient.

What are the chances of wear after removal of the meniscus?
In the past, the meniscus was completely removed, even if it was only partially torn. Since we now know that the knee can wear out more quickly after removal of the meniscus, it is only removed when necessary. And the larger the crack the greater the risk of osteoarthritis. But instability of the knee by a torn anterior cruciate ligament and such existing wear in the knee, play a role in it.

When do I have start with physical therapy?
You should discuss starting any exercise program with your orthopedic surgeon or physical therapist prior to initiating it. Most physicians will approve an early rehabilitation program, however others may ask you to wait a week or so after your procedure.

What exercises can I do after meniscus surgery?
As always, you should discuss starting any exercise program with your orthopedic surgeon or physical therapist prior to initiating it.

Do I need help at home after knee arthroscopy?
You may feel groggy for the first 24-48 hours. Rest and give your body time to recover from surgery and anesthesia. For the first 24 hours after surgery you should not be left alone. This is if you need help or unforeseen problems arise. The first few days you are not as mobile as usual so it's nice when family or friends will give you a helping hand. It is not advisable to participate in traffic if you sue painkillers and /or crutches. Discuss this with your surgeon and read the policy conditions of your insurance.

Is there an OK alternative, because of my medical history, for Delft Orthopedium?
Yes, in that case your orthopedic surgeon will operate you in the Vlietland hospital at Schiedam.

When should I contact Orthopedium clinic?
For questions please contact us during business hours; you can reach us by phone 088-0088444.

Call Orthopedium with any questions you have about your healing or if you notice any of the following:

There is increasing pain and swelling in the knee
Fluid or pus oozes from a wound
Continued bleeding through the bandage
Persistent swelling or warmth at the lower part of the leg

Prepare yourself by reading all the information given. For any questions please telephone or email contact with Orthopedium.