Meniscal repair / partial meniscectomy
Deciding whether to have knee surgery can feel overwhelming. This guide will help you understand your knee surgery options, benefits, risks, and recovery so you can make an informed decision about the right treatment for your condition.
The meniscus is an important structure within the knee (see here). Meniscal tears often cause mechanical symptoms and pain. This surgery is to address these symptoms, and may either entail repair or partial removal.
This depends upon the character of the tear, and the quality of the meniscus tissue. If degenerative, then symptoms may settle with time or with an injection. For people with mechanical symptoms (catching/clicking/blocking), there is often no alternative.
The surgery will be explained to you by Mr Smith in clinic, the alternatives, likely recovery period and any associated risks discussed. You will have a pre-operative clinic appointment to ensure that you are safe for surgery, and that there is no aspect of your health that can be optimised prior to having surgery. You will be informed at this stage when to stop any regular medications, and what time you can eat and drink until prior to the surgery.
On the day of surgery you will see Mr Smith and the anaesthetist prior to the surgery, to ensure that all questions have been addressed. The consent form will be checked with you, and the correct leg marked. You will often see a physiotherapist prior to your surgery also.
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The surgery is usually performed under a general anaesthetic (fully asleep). It is done arthroscopically (key hole), and involves making two (sometimes more) small incisions on the knee to allow the insertion of a 4.5mm camera and surgical instruments.
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If a repair is to be performed, you will be given antibiotics into the vein at the time of surgery to reduce the risk of infection.
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The surgery is performed with a tourniquet on the thigh, which temporarily stops the blood to the area, increasing surgical visualisation and minimising bleeding. This may leave you with a sore thigh for a couple of days following the surgery.
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The knee is inspected in a routine sequence, and all structures assessed. Photos are taken within the knee for documentation and discussion. If undergoing a partial meniscectomy, the part of the meniscus causing symptoms is removed.
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Repairs are usually performed using all-inside stitch devices, but sometimes complex tears require alternative techniques which will be discussed prior to the surgery.
-
The incisions are closed with absorbable stitch on the outside, and dressings applied. You will have a heavy crepe bandage for 24 hours, and a sticky dressing over the wounds for two weeks. If you have a complex repair, you may be placed in a hinged knee brace after the surgery.
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Surgical time for a partial meniscectomy is between 10 and 20 minutes. The operative episode, including the anaesthetic and post operative recovery, is usually approximately 60 - 90 minutes.
Meniscus repair takes longer, and can take up to 45 minutes of surgical time.
This is a day case procedure - same day discharge.
The first few days can be a bit uncomfortable, but you will be discharged with appropriate pain relief. The quadriceps muscles often go to sleep after the surgery, and the key to the early recovery is getting them contracting again. This will allow you to start weaning off crutches, and returning towards walking unaided.
If you have had a meniscectomy, there are no restrictions on weight bearing or range of movement. You should ensure the dressings remain dry until the incisions are healed, then can return to activities as you feel comfortable. Often patients have made a good recovery by 6 to 8 weeks.
The recovery for a meniscal repair can vary depending upon the type of tear and thus repair. Some repairs require a period of protected weight bearing to allow healing, and often a restriction to deep flexion (bending) of the knee. For a radial tear or root repair this can be as long as 4 months. You will be able to gently return to activities after this, assisted by a specialist physiotherapy rehabilitation program.
An outline of the rehabilitation timeline and goals can be found here.
You will be seen for a wound check at two weeks, and a follow-up clinic appointment will be arranged for 6-8 weeks following the surgery.
Regards returning to work or studies, I advise to return when ‘no longer distracted by either the pain or pain killers’. If you have an office or home based job, this can be as early as one or two weeks. For more physically demanding jobs, return to work can take longer, but you can be provided with an appropriate fitness to work (sick) note for the period.
Driving is usually permitted once the quadriceps are functioning, and you can perform an emergency stop. I advise you inform your car insurer prior to doing so. Return to full sporting activities with a meniscus repair can be 3-6 months.
Meniscal surgery is generally a safe and effective procedure. However, like all surgeries, it comes with risk. Every effort will be made to minimise these risks, but to allow this it is important that you mention any health issues at the pre-operative assessment. Below is a breakdown of the risks by frequency and approximate percentages, based on clinical literature and large-scale studies. Mr Smith will speak to you in detail about these prior to any surgery.
RiskMeniscal RepairPartial MeniscectomyCommentsOngoing pain5–10%5–10%May persist due to underlying arthritis or incomplete symptom resolutionSwelling5–10%5–10%Common post-operatively; typically settles with timeWound infection (superficial)1–5%1–5%Treated with oral antibiotics; deep infections are rareNumbness around incision5–10%5–10%Usually temporary; due to small nerve irritationDeep joint infection0.1–0.5%0.1–0.5%Serious complication requiring washout surgery and antibioticsKnee stiffness5–10%5–10%Often due to post-op inflammation or scarring; may require physiotherapyBlood clot (DVT)0.5–1%0.5–1%Risk increased with immobility; prophylaxis often givenRepeat surgery5–10%0.5–1%Higher in repairs due to risk of re-tear or failed healingFailure of repair5–10%Not applicableMay require revision surgery or meniscectomyCartilage damage0.5%0.5%From instruments or progression of diseaseNerve or vessel injury<0.1%<0.1%Extremely rare; may cause numbness, weakness, or bleedingCRPS<0.1%<0.1%Chronic pain disorder; mechanism unclearAnaesthetic complication<0.1%<0.1%Includes allergic reactions or cardiorespiratory issuesPlease contact the hospital where your surgery was performed, and they will easily be able to get in contact with Mr Smith on your behalf.
The meniscus is an important structure within the knee (see here). Meniscal tears often cause mechanical symptoms and pain. This surgery is to address these symptoms, and may either entail repair or partial removal.
This depends upon the character of the tear, and the quality of the meniscus tissue. If degenerative, then symptoms may settle with time or with an injection. For people with mechanical symptoms (catching/clicking/blocking), there is often no alternative.
The surgery will be explained to you by Mr Smith in clinic, the alternatives, likely recovery period and any associated risks discussed. You will have a pre-operative clinic appointment to ensure that you are safe for surgery, and that there is no aspect of your health that can be optimised prior to having surgery. You will be informed at this stage when to stop any regular medications, and what time you can eat and drink until prior to the surgery.
On the day of surgery you will see Mr Smith and the anaesthetist prior to the surgery, to ensure that all questions have been addressed. The consent form will be checked with you, and the correct leg marked. You will often see a physiotherapist prior to your surgery also.
-
The surgery is usually performed under a general anaesthetic (fully asleep). It is done arthroscopically (key hole), and involves making two (sometimes more) small incisions on the knee to allow the insertion of a 4.5mm camera and surgical instruments.
-
If a repair is to be performed, you will be given antibiotics into the vein at the time of surgery to reduce the risk of infection.
-
The surgery is performed with a tourniquet on the thigh, which temporarily stops the blood to the area, increasing surgical visualisation and minimising bleeding. This may leave you with a sore thigh for a couple of days following the surgery.
-
The knee is inspected in a routine sequence, and all structures assessed. Photos are taken within the knee for documentation and discussion. If undergoing a partial meniscectomy, the part of the meniscus causing symptoms is removed.
-
Repairs are usually performed using all-inside stitch devices, but sometimes complex tears require alternative techniques which will be discussed prior to the surgery.
-
The incisions are closed with absorbable stitch on the outside, and dressings applied. You will have a heavy crepe bandage for 24 hours, and a sticky dressing over the wounds for two weeks. If you have a complex repair, you may be placed in a hinged knee brace after the surgery.
-
Surgical time for a partial meniscectomy is between 10 and 20 minutes. The operative episode, including the anaesthetic and post operative recovery, is usually approximately 60 - 90 minutes.
Meniscus repair takes longer, and can take up to 45 minutes of surgical time.
This is a day case procedure - same day discharge.
The first few days can be a bit uncomfortable, but you will be discharged with appropriate pain relief. The quadriceps muscles often go to sleep after the surgery, and the key to the early recovery is getting them contracting again. This will allow you to start weaning off crutches, and returning towards walking unaided.
If you have had a meniscectomy, there are no restrictions on weight bearing or range of movement. You should ensure the dressings remain dry until the incisions are healed, then can return to activities as you feel comfortable. Often patients have made a good recovery by 6 to 8 weeks.
The recovery for a meniscal repair can vary depending upon the type of tear and thus repair. Some repairs require a period of protected weight bearing to allow healing, and often a restriction to deep flexion (bending) of the knee. For a radial tear or root repair this can be as long as 4 months. You will be able to gently return to activities after this, assisted by a specialist physiotherapy rehabilitation program.
An outline of the rehabilitation timeline and goals can be found here.
You will be seen for a wound check at two weeks, and a follow-up clinic appointment will be arranged for 6-8 weeks following the surgery.
Regards returning to work or studies, I advise to return when ‘no longer distracted by either the pain or pain killers’. If you have an office or home based job, this can be as early as one or two weeks. For more physically demanding jobs, return to work can take longer, but you can be provided with an appropriate fitness to work (sick) note for the period.
Driving is usually permitted once the quadriceps are functioning, and you can perform an emergency stop. I advise you inform your car insurer prior to doing so. Return to full sporting activities with a meniscus repair can be 3-6 months.
Meniscal surgery is generally a safe and effective procedure. However, like all surgeries, it comes with risk. Every effort will be made to minimise these risks, but to allow this it is important that you mention any health issues at the pre-operative assessment. Below is a breakdown of the risks by frequency and approximate percentages, based on clinical literature and large-scale studies. Mr Smith will speak to you in detail about these prior to any surgery.
RiskMeniscal RepairPartial MeniscectomyCommentsOngoing pain5–10%5–10%May persist due to underlying arthritis or incomplete symptom resolutionSwelling5–10%5–10%Common post-operatively; typically settles with timeWound infection (superficial)1–5%1–5%Treated with oral antibiotics; deep infections are rareNumbness around incision5–10%5–10%Usually temporary; due to small nerve irritationDeep joint infection0.1–0.5%0.1–0.5%Serious complication requiring washout surgery and antibioticsKnee stiffness5–10%5–10%Often due to post-op inflammation or scarring; may require physiotherapyBlood clot (DVT)0.5–1%0.5–1%Risk increased with immobility; prophylaxis often givenRepeat surgery5–10%0.5–1%Higher in repairs due to risk of re-tear or failed healingFailure of repair5–10%Not applicableMay require revision surgery or meniscectomyCartilage damage0.5%0.5%From instruments or progression of diseaseNerve or vessel injury<0.1%<0.1%Extremely rare; may cause numbness, weakness, or bleedingCRPS<0.1%<0.1%Chronic pain disorder; mechanism unclearAnaesthetic complication<0.1%<0.1%Includes allergic reactions or cardiorespiratory issuesPlease contact the hospital where your surgery was performed, and they will easily be able to get in contact with Mr Smith on your behalf.