Menisectomy

Menisectomy

Meniscectomy is a surgical procedure indicated in individuals with torn meniscus where the conservative treatments are a failure to relieve the pain and other symptoms. Meniscectomy is recommended based on the ability of meniscus to heal, patient’s age, health status and activity level.

Meniscus is the C-shaped two pieces of cartilage located between thighbone and shin bone that act as shock absorbers and cushion the joints. Meniscus distributes the body weight uniformly across the joint and avoids the pressure on any one part of the joint and development of arthritis. Being the weight bearing part, meniscus is prone to wear and tear and meniscal tear is one of the common knee injuries. Meniscal tear may be developed by people of all ages and is more common in individuals who play contact sports.

 

On the pattern of tear, meniscal tear may be of different types such as longitudinal, parrot-beak, flap, bucket handle, and mixed/complex tear. Sudden twist, squat, or tackle may be the cause for meniscal tear in adults and ageing may cause the tear in elderly individuals. Meniscal tear may cause severe pain, stiffness and swelling, catching or locking of the knee, and may limit the movement. Meniscal tear is often diagnosed with the presenting symptoms and imaging techniques such as X-rays or magnetic resonance imaging scan.

Conservative treatments for meniscal tear include R.I.C.E (Rest, Ice, Compression, and Elevation) and use of nonsteroidal anti-inflammatory medications. Surgery is recommended in severe cases and may be performed using arthroscopic technique. Depending on the extent of tear, your surgeon will decide on whether to perform total meniscectomy (complete removal of torn meniscus) or partial meniscectomy (unstable meniscal fragments are removed and intact tissue is left in place and the edges are smoothened. Your surgeon may also order for rehabilitation program following the surgery for better and quicker recovery.

Arthroscopic Meniscectomy

The arthroscope is a small fiber-optic viewing instrument made up of a tiny lens, light source and video camera. The surgical instruments used in arthroscopic surgery are very small (only 3 or 4 mm in diameter), but appear much larger when viewed through an arthroscope.

The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the knee at cartilage and ligaments, and under the kneecap.

Then the surgeon makes two small incisions (about 1/4 of an inch), around the knee joint area. Each incision is called a portal.  In one portal, the arthroscope is inserted to view the knee joint.  Along with the arthroscope, a sterile solution is pumped into the joint which expands the viewing area, giving the surgeon a clear view and room to work. The other portal is used for the insertion of tiny surgical instruments.  

With the images from the arthroscope as a guide, your surgeon can look at the menisci and confirm the type, location, and extent of the tear.  Once your surgeon has located the meniscal tear, surgical scissors and shavers are inserted into the portals to remove the torn menisci. In total meniscectomy entire menisci is removed and in partial meniscectomy only the torn part of the tissue is removed leaving the intact tissue in place with edges smoothed.  

Shaver device removes torn, nonviable portion of meniscus, contours remaining meniscus to smooth edge

Menisectomy

Case Example #1

42yo active male cyclist unable to walk or cycle for 4 weeks after sudden twisting injury with swelling and clicking/catching of the knee.

Complex medial meniscus tear of body and posterior horn

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Partial menisectomy performed with arthroscopic shaver device

Menisectomy

PMM complete with smooth contour and stable margins to remaining meniscus; patients symptoms resolved immediately after surgery and he began walking for exercise 2 weeks after surgery, and cycling hilly terrain after 4 weeks postoperative rehabilitation

Menisectomy

Case Example #2

49yo active male runner unable to run for 3 months after sudden twisting injury with swelling and clicking/catching of the knee.

Probe identifying meniscal flap tear with poor healing capacity, amenable to resection with partial menisectomy

Menisectomy

Arthroscopic biter to remove majority of torn meniscus tissue

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Partial menisectomy completed after contouring to a smooth tapered edge with arthroscopic shaver

Menisectomy
Knee Procedures