Meniscal repair surgery

The menisci is a medical term to describe the two crescent-shaped discs that are located on either side of the knee joint. The menisci are attached to the joint surfaces of the lower leg bone (tibia) and are commonly referred to as the knee cartilage.

The pair of menisci (called the medial meniscus and the lateral meniscus) act as a shock absorber for the knee joint surfaces. The menisci also aid the stability of the knee joint when it is rotated.

You may require meniscus tear surgery if you have had a knee injury and the menisci have become damaged.

In the event that a torn meniscus does not heal adequately, two forms of knee surgery are available.

Orthopaedic knee surgeons can either perform a direct repair on the torn meniscus or you have the option of a meniscus transplant operation. The type of surgery offered may depend on the following factors:

• The general health of the knee
• The type and extent of the meniscus tear
• The activity level of the patient
• The age of the patient

If you experience any of the following symptoms, you may have torn your meniscus:

• Knee pain when twisting or rotating
• Pain when running or walking
• Popping in the knee when moving
• Swelling in the knee
• Limited movement of the knee
• Difficulty extending the knee
• The knee feels locked

You will most likely be offered keyhole surgery on the knee meniscus tear (arthroscopy). A knee arthroscopy and involves making very small incisions on either side of the knee and inserting a small tube known as an arthroscope into the knee joint.

Using special instrumentation, the surgeon is able to visualise the knee joint and the damaged meniscus. Depending on the exact state of the meniscus, the surgeon will make a decision on how to proceed.

If the tear is easy to repair then this will be attempted at this time. A torn meniscus surgery involves carefully stitching the torn edge of the meniscus using specialised tools on the end of the arthroscope.

If the meniscal injury is unrepairable or there is a high likelihood that a repair may fail at a later date, there are two further surgical options.

The first is a surgical removal of the damaged portion of meniscus (debridement).

The second is a meniscus transplant. A meniscal transplant is a relatively new procedure that our specialist knee orthopaedic surgeons are able to offer. This relies on a suitable donor being found that specifically mimics the tissue type and size of the original meniscus in the knee.

Immediately after a meniscus repair surgery, you will have a tight bandage on the knee. This is to limit the movement of your knee. Our specialist physiotherapists will then visit you to supervise your transfer out of bed and into a sitting position.

They will assess your pain levels and the activity in your thigh muscles (quadriceps). They will also discuss any weight-bearing protocols with you prior to helping you.

Our experienced physiotherapists will issue you with some elbow crutches to aid you when walking. They will also help you to stand and walk for the first time following your surgery. They will also talk you through the physical therapy available.

Depending on the time of your surgery, you will often be discharged home that day or on the following day. Some patients may opt to stay as an inpatient to undergo in-house rehabilitation.

Meniscus repair recovery time varies depending on what type of surgery you have had:

• If you have had a meniscus repair then you will be expected to remain partial weight bearing on the operated leg for a period of 2-4 weeks.
• If you have had a meniscus transplant, then your leg will be in knee brace for the first two weeks after your surgery.

Both of these protocols are to protect the repair or transplant during the healing process.

Our surgeons will review you approximately two weeks following your surgery. At this appointment, patients will also see a member of our orthopaedic nursing staff who will examine the wound and extract any stitches.

Once your pain levels are under control, our physiotherapists will advise you on exercises to improve your flexibility, range of motion and strengthen your leg muscles.

These exercises, known as compound exercises, help to build strength in the operated knee. Some examples of these exercises are listed below:

• Sit to stand repeats
• Wall squats
• Low step up

Depending on your goals around your occupation or return to sports, our physiotherapists will advise you on further specific rehabilitation and fitness drills.

The success rate of the procedure is high. However, general complications can occur with any type of operation in a small number of patients who undergo a meniscus repair surgery. These can include:

• Reaction to undergoing a general anaesthetic can be highly variable among individuals. Drowsiness is common and some individuals may experience some nausea and vomiting following surgery.
• A blood clot (deep vein thrombosis - DVT) may occur after any type of surgery due to the reduced time spent being active. Activity normally helps to pump the blood around the legs. Our physical therapists will encourage bed and chair exercises to help keep the blood supply moving in the lower legs.
• In rare cases if a blood clot develops it can travel to the lungs, which is known as a pulmonary embolism (PE) or travel to the brain which can be life-threatening or cause permanent neurological damage.
• The medications used as part of the general anaesthetic reduce the sensation of the nerves and muscles around the bladder, which can lead to urinary retention. In some cases, individuals may need catheterisation for a short period after their surgery until they are able to pass urine properly.

Due to general activity being reduced following surgery as well as the effects of some general anaesthesia and pain controlling medication individuals will tend to breath in a shallower pattern. For this reason, patients are encouraged to complete regular breathing exercises to circulate the air in the lungs and prevent chest infections.

If the meniscus is stitched then the repair can fail at a later date, which can lead to the need for further surgery after a meniscal repair.

• A meniscus transplant may also fail at a later date.
• If a meniscus transplant is undertaken, there is a very small risk of immune system rejecting the tissue.