When you tear your meniscus, there are a few possible outcomes. Tears in the white zone, that does not have blood flow usually require a partial meniscectomy which removes some of the torn cartilage. However, when a tear occurs in the blood rich red zone, a meniscus repair is possible. Meniscus repair uses arthroscopic surgical techniques to bond the two edges of the tear together using sutures, tacks or a special use device.
Do I Really Need Surgery?
Meniscus tears that occur in the red zone – the outer 1/3 of the meniscus – have the possibility of healing on their own with rest, ice, compression and elevation – RICE. However, the tear may not heal perfectly or at all. At this point, surgery to repair the meniscus should be considered. If a meniscus tear is left untreated, it can worsen and progress into the white zone which then cannot be repaired. Alternately, a piece of cartilage can break off and damage other structures in the knee increasing the risk of arthritis in the future.
While repairing a meniscus tear is not an urgent procedure, the best outcomes are seen if the repair is performed within two months after the injury. This offer is the best chance of a complete recovery and return to normal activity.
The Surgical Process
Advances in minimally invasive surgery, known as arthroscopy, have allowed a meniscus repair to be performed on an outpatient basis, meaning that patients will not have to stay overnight at the hospital or surgery center. The entire procedure requires about an hour to an hour and a half, unless another knee injury is being repaired concurrently, such as an Anterior Cruciate Ligament or ACL reconstruction. The surgical process begins with a diagnostic arthroscopy. This is where a miniature camera is inserted into the knee to scope out the surgical field and assess the severity of the tear and determine repair options. At this point, Dr. Manning will decide how best to proceed. If we determine that the procedure can continue, minimally invasive devices are inserted into the knee through tiny holes and the tear is repaired using either sutures, absorbable tacks or a specially made meniscus repair device. If any other structures of the knee were concurrently injured, these will often be repaired at the same time.
We estimate approximately 90% of these repairs effectively return the patient back to their normal level of activity. If a concurrent ACL reconstruction is performed, the success rate may be even higher as the ACL procedure increases blood flow to the meniscus as well. Outcomes are also improved if the patient is healthy, the cartilage is healthy and an experienced orthopedic surgeon such as Dr. Manning is employed for the procedure.
While the recovery from a meniscus repair is significantly longer than that of a partial meniscectomy, the benefits are significant. Most importantly, healthy cartilage is maintained and as such, the risk of arthritis 10 or 20 years down the road is significantly reduced versus removing some cartilage.
Risks of a Meniscus Repair
As with any surgical procedure there are risks including infection and the possibility of a less than desirable result. However, success rates in modern meniscus repairs are greater than 90%. The most common complication is temporary injury to the nerves in the skin. Rarer complications include infection, damage to blood vessels or larger nerves and blood clots. An experienced and expert orthopedic surgeon such as Dr. Manning implements mitigation techniques to minimize these risks. A discussion regarding your particular risk as well as expectations and outcomes will be had during consultation.
Recovery from a Meniscus Repair Procedure
Patient will be discharged from the surgery center a few hours after the procedure is complete and will go home with narcotic and anti-inflammatory pain medication, a knee brace and a cryo-cuff that offers cold compression on the knee. Depending on the extent of the injury and the progression of the recovery, patients may be able to put full body weight on the knee or may require crutches for a period of time. Many patients will take narcotic pain medication for up to two or three days at which point anti-inflammatory medication should be sufficient to mitigate any discomfort. Your particular postoperative plan will be detailed in your discharge packet.
Physical therapy will begin immediately after surgery and will progress until the supportive muscles such as the quadriceps have been sufficiently strengthened and the knee’s range of motion has been restored. Physical therapy is not only very important, but also very effective and most patients see excellent results within a few weeks. The length of physical therapy will depend on the patient’s progress.
Every patient will be different, but over the longer-term, many patients will be able to begin running within 4 to 5 months after surgery. Complete restoration of normal activities and even commencement of sporting activities occurs at about the six-month mark.
If you suspect a meniscus tear and want to understand your options about meniscus repair surgery, please contact us for a consultation with Dr. Manning.
Prognosis for a Meniscus Repair
Milder tears that heal on their own with conservative therapy allow for the patient to return to normal activity after several weeks. Tears that can be repaired typically allow the patient to regain their former range of motion and athletic ability in time. Tears in the white zone, that have to be trimmed away, employing a meniscectomy, are typically very successful and lead to improved range of motion and reduced pain. However, the loss of meniscus may lead to arthritis in the knee later on in life.
Overall, the prognosis for surgical and nonsurgical correction of a meniscus tear is excellent.
For more information and to schedule a knee pain consultation, contact us.