Meniscus Tear Surgery

What is the Meniscus?

The meniscus is a crescent-shaped piece of cartilage that sits on top of the shinbone (tibia) and acts as the knee joint's shock absorber. Each knee has two menisci – one on the inside (medial), and another on the outside (lateral) of the knee joint. They protect the cartilage lining the knee joint by absorbing forces through the knee during walking, running and sports.

What Causes a Meniscus Tear?

Acute meniscus tears occur most often from twisting knee injuries during sports which require sudden changes in direction, such as football, basketball, and rugby. Meniscus tears can also be caused by excessive kneeling or heavy lifting; as well as degenerative changes experienced by among older adults.

How Common are Meniscus Tear Injuries?

Meniscus tears are one of the most common knee injuries. This injury usually affects athletes who engage in contact sports like football and rugby, or other intense activities that require twisting, squatting, and quick shifts of direction.

How do I Know When I Have a Meniscus Injury?

If you injure your meniscus playing sport, you will often feel a ‘pop’ and sudden pain in your knee. Sometimes you will be able to continue playing and only hours later will the knee swell up. I see patients with a meniscus injury where they cannot fully straighten or bend their knee joint (so called ‘locked’ knee), as the torn ends of the meniscus get stuck in between the thigh bone and shin bone, which can be very painful.

What are the Risk Factors of a Meniscus Injury?

Meniscus tears are commonly caused by activities that involve rapid and intense twisting of the knee. Ageing can also increase a person’s risk of incurring meniscus tears, as it causes the meniscus to degenerate and weaken. Obesity is another risk factor as excess weight will increase the amount of strain on the knees.

How will the Surgeon Assess my Knee?

Through taking a careful history (asking relevant questions) and a thorough examination of the knee joint. You may be asked to undergo an X-ray and MRI scan of your knee joint.

What are the Risk Factors of a Meniscus Injury?

Meniscus tears are commonly caused by activities that involve rapid and intense twisting of the knee. Ageing can also increase a person’s risk of incurring meniscus tears, as it causes the meniscus to degenerate and weaken. Obesity is another risk factor as excess weight will increase the amount of strain on the knees.

What are the Types of Meniscus Tears?

• Radial Tear - This is the most common kind of meniscus tear. Radial tears occur within the area of the knee where there is no blood supply. Hence, it will be difficult for the tear to heal on its own. Typically, this would require meniscus tear surgery.

• Horizontal Tear - This type of tear can occur within the vascular portion of the knee on the central location. The vascular portion has blood flow; hence, a meniscus repair is a good option. During the procedure, the surgeon will sew the circumferential fibres of the meniscus together.

• Incomplete Tear - This tear indicates that the meniscus tissue is undergoing early degenerative changes. Generally, incomplete tears do not require surgery.

• Complex Tear - This tear has a combination of tear patterns, usually radial and horizontal tears. Typically, surgeons will not recommend meniscus tear surgery due to its complexity. However, there are a few cases where some of the damaged menisci can be removed.

• Flap Tear - Characterised by an unusual tear pattern, this meniscus tear may cause a latching or locking sensation in the knee. Flap tears can usually be fixed without removing much tissue.

• Bucket Handle Tear - This type of tear is formed in the centre of the meniscus. Bucket handle meniscus tears cause the knee to become stuck as the torn part of the meniscus blocks the normal motion of the knee. Meniscus surgery may be required to allow it to bend again.

What is the Difference Between Acute and Chronic Meniscus Injuries?

Acute meniscus injuries are incurred due to forceful twisting of the knee arising from sports or falls. On the other hand, chronic meniscus injuries are caused by the weakening of the meniscus due to ageing, and can arise even without sudden movements.

Will I Need Meniscus Surgery?

It depends. If you cannot fully straighten or bend your knee (“locking” of the knee joint), have severe pain, or have injured other structures in your knee like a ligament (ACL) you may benefit from meniscus tear surgery.

Non-Surgical Treatments for Meniscus Injuries

Conservative treatments are usually recommended for patients with degenerative meniscus tears, as well as those with smaller and manageable tears:

• RICE (Rest, Ice, Compress, Elevate) - Patients are advised to rest the affected knee, applying ice appropriately, elevating the injured knee, and wearing a compression bandage.

• Over-the-Counter Medication - Doctors may recommend over-the-counter medications like non-steroidal anti-inflammatory medications to reduce pain and the swelling.

• Physiotherapy - This form of meniscus tear treatment includes tailored stretches and exercises to restore strength and functionality to the damaged knee.

Types of Meniscus Tear Surgeries

All surgery is minimally invasive and performed under anaesthesia (you will go to sleep during the operation). The surgery is performed through 2 – 3 small keyhole incisions at the front of the knee. An arthroscope (a tiny instrument with a small camera and light), along with specialised surgical tools, will be inserted through the incisions. This camera will project the inside of the knee on a screen to provide the surgeon with a live and clear view of the internal structures of the knee.

Certain types of meniscus tear can be repaired (meniscal repair) whilst others require the torn part to be removed (partial meniscectomy). Both methods have good to excellent results. Meniscus tear surgery usually takes under an hour and most patients can go home on the same day.

What is the Recovery Like?

You may need crutches and a brace for several weeks. The surgical incisions take 2 weeks to heal. Most people can return to work after 2 weeks depending upon their job. You will need to follow a program of physiotherapy to strengthen your knee. Most can return to sports after 12 weeks, depending upon the sport and level of competition.

How Long Does It Take to Recover from a Meniscus Surgery?

The recovery time varies depending on the type of surgery performed. Patients who have undergone meniscus repair may need a longer time to recover than those who underwent meniscectomy. With proper rehabilitation, full recovery may take anywhere from six weeks to three months.

Can I Walk Immediately After a Meniscus Surgery?

Most patients are able to walk immediately after surgery with the aid of crutches and braces. It is important to start walking early on as it aids in healing.

What are the Risks of a Meniscus Repair Surgery?

The risk of complications after having a meniscus repair surgery is rare, especially in the hands of an experienced surgeon. Some of the potential risks include knee stiffness, infections, and so on. Your doctor will ensure that these risks are kept to a minimal.