Meniscal Injury and Knee Arthroscopy

What is the meniscus?
The meniscus is a “C-shaped” cushion pad in the knee between the thigh bone (femur) and the lower leg bone (tibia). It acts as a shock absorber and makes the motion of the knee smooth.

How is it injured?
It may be torn by twisting or bending in sports or daily activities.

How is it diagnosed?
A meniscal tear results in knee swelling, locking and giving way. It may cause pain with bending, squatting, twisting, stair climbing or getting up from a seated position. A meniscal tear is best diagnosed by a physical examination by the orthopedist. An MRI (magnetic resonance imaging) may be obtained to confirm a meniscal tear.

How is a meniscal tear treated?
A small percentage of meniscal tears may heal on their own within about 6 weeks. If symptoms continue, then it is unlikely that the meniscal injury will heal and arthroscopy is necessary. The arthroscope shows a picture of the location and anatomy of the tear. These factors help determine if a tear is repairable (meniscal repair) or removable (partial meniscectomy).

What is the difference between meniscal repair and partial meniscectomy?
If the tear is in the outer third of the meniscus and is smooth and straight, then there is usually an adequate blood supply to allow repair of the tear with small stitches. If however, the meniscal tear is in the inner two-thirds or is shredded, then minimal blood supply is present. These tears require removal. The removed portion of the meniscus does not grow back, but if the damaged portion is left in the knee joint, it can cause further joint destruction. In the past, the entire meniscus was removed for tears and patients had good knee function for many years. The arthroscope allows the orthopaedic surgeon to minimize the amount of meniscal tissue removed resulting in normal knee function for even longer. This surgery takes about 20-40 minutes to perform and is done on an outpatient basis (without spending the night in the hospital.)

How is the knee cared for after the surgery?
An ace wrap is applied to the knee and a brace may be required if the meniscus is repaired. Crutches are used for comfort; patients can bear weight on the leg immediately and crutches may be put aside as soon as one is comfortable. The ace wrap is removed 48-72 hours later. There may be some bruising and swelling. The patient will see 2-3 small incisions each with a stitch. If a meniscal repair is performed, there may be an additional 1-1.5 inch incision. Patients return for follow-up visit in 7-10 days; stitches are removed at that time and an exercise program is started. Patients may do exercises by themselves or with a physical therapist, depending upon the seriousness of the injury and whether the meniscus was repaired or removed.

How long is the recovery period?
Patients return to work within several days. If however, their job requires heavy lifting or climbing, then return may be delayed several weeks. Full recovery and return to pre-injury athletic activities occurs in 3-6 weeks for a partial meniscectomy and 8-12 weeks for a meniscal repair.