Meniscal Surgery – What To Expect

What is a meniscus?

Each knee has two menisci. They are rubbery, C-shaped cushions that serve as shock absorbers in the knee joint. If your meniscus is injured or torn (often called torn cartilage), your healthcare provider may recommend surgery to remove the damaged part or repair it.

Who needs to have meniscus tear surgery?

Meniscus injury is common especially among people who play sports. A sudden twist, turn or collision can tear a meniscus.
Older people also injure their menisci frequently. The menisci get weak over time and are more likely to tear. In fact, meniscus tears can be a normal occurrence as a part of the aging process and are often associated with arthritic changes at the old age.
Many people with a torn meniscus choose surgery because the injured cartilage can make the knee unstable (buckle and give way), cause pain and swelling or cause the knee to “lock-up” or become “stuck.”
Does every meniscus injury need surgery?
Some people need surgery for a torn meniscus, but some do not surgery. The decision depends on:

  • Type, size and location of the tear.
  • Your age.
  • Your activity level and lifestyle.
  • Related injuries (e.g., ACL tear).
  • Presence of symptoms (pain, swelling, locking, buckling, etc)

As with every injury, your healthcare professional may suggest you first try nonsurgical treatments, such as:

  • RICE (rest, ice, compression and elevation).
  • Physical therapy.
  • Knee injections, such as cortisone (steroid)

Procedure Details

What happens before torn meniscus surgery?
If you and your surgeon decide to move forward with surgery for a torn meniscus, you may have some tests in advance. For example, blood tests, Electrocardiogram (ECG) and chest X-ray can help determine whether you are healthy enough for surgery. (If you are relatively healthy, these tests are usually not needed.)
Your anaesthetist will decide what type of anaesthesia is best for you:

  • Regional anaesthesia (also called spinal anaesthesia) where an injection is given in the back to numb your body from waist down.
  • General anaesthesia is medication that puts you to sleep.

If you receive regional anaesthesia, you may also be sedated to help you relax. Most often you will have a general anaesthetic for this type of procedure.

What happens during arthroscopic meniscus surgery?
Most arthroscopic meniscal procedures take less than an hour.
First, you receive anaesthesia. The surgical team cleans the skin on your knee and covers the rest of your leg with a surgical drape. The team might place a clamp on your upper thigh to help with positioning during surgery.
The surgeon makes a few small stab incisions (cuts) in your knee called portals. The team then fills the knee joint with a sterile fluid. The fluid helps control minor bleeding in the joint and washes away debris, which helps the surgeon see inside the joint.
The surgeon inserts a small tool called an arthroscope into the incision. An arthroscope is a thin tube with a small light and video camera at the end. The camera projects video images from inside your knee onto a monitor.
The surgeon uses the arthroscope to look at the tear and decide what surgical technique to perform:

  • Meniscus repair: The surgeon sews torn pieces of cartilage back together so they can heal on their own. However, because of tear type and blood supply, not all tears are repairable.
  • Partial meniscectomy: The surgeon trims and removes the damaged cartilage and leaves healthy meniscus tissue in place.

Your surgeon inserts other surgical tools depending on the technique used. When the meniscectomy or meniscus repair is complete, the surgeon closes the portals with stitches or surgical strips. Then the team will cover your knee with a bandage.

What happens after meniscus repair or meniscectomy?
Most people who have meniscus repair or meniscectomy do not need to stay overnight at the hospital. You will wait in a recovery room for the anaesthesia to wear off. When you are ready to leave, somebody else will need to drive you home.

Risks / Benefits

What are the advantages of knee meniscus surgery?
Meniscus tear surgery can help:

  • Get you back to sports or other activities.
  • Improve mobility.
  • Make your knee more stable.
  • Prevent or slow the development of arthritis.
  • Reduce or completely relieve pain.

What are the risks or complications of arthroscopic meniscus surgery?

  • Arthroscopic knee surgery is very safe, with only rare complications:
  • Arthritis later in life.
  • Blood clots in the legs (DVT) or in the lungs (PE)
  • Bleeding from the portals.
  • Infection (very rare, <1%) leading to joint stiffness
  • Injury to nerves and blood vessels near the knee.
  • Trouble with anaesthesia, such as problems with the heart or lungs.

Recovery And Outlook

What is meniscus surgery recovery like?
The recovery time for meniscus surgery depends on the type of surgery you had. It takes longer for a meniscus repair to heal than a meniscectomy. Full recovery from meniscus surgery can take anywhere from six weeks to three months. Your care after surgery may involve:

  • Crutches to take stress off the knee as it heals.
  • Knee brace to stabilize the joint as you recover.
  • Pain medications.
  • Physical therapy.
  • Rehabilitation exercises at home to restore mobility, range of motion and strength.
  • RICE (rest, ice, compression and elevation).

Will I have pain after meniscus surgery?
You will have some pain immediately after surgery and for several weeks, which is normal. Medications will be prescribed to help you manage the pain. The medications will help you complete the exercises needed to recover.
How long after meniscus surgery will I be able to walk, exercise and work?
Most people can walk with crutches soon after meniscus surgery. Many return to normal activities within six to eight weeks.
Your healthcare provider may recommend low-impact activities rather than high-impact (such as walking rather than running). If you have a physical job, you may need extra time off work to recover.