Meniscectomy for a meniscus tear
Surgery Overview
Meniscectomy is the surgical removal of all or part of a torn meniscus. A meniscus tear is a common knee joint injury. Surgeons who perform meniscectomies (orthopedic surgeons) will make surgical decisions based on the meniscus's ability to heal, as well as your age, health, and activity level.
The location (zone
) of the tear is an important factor in a decision about surgery.
- Tears at the outer edge of the meniscus (red zone) tend to heal well because there is good blood supply. Minor tears may heal on their own with a brace and a period of rest. If they do not heal or if repair is necessary, the tear can be sewn together using dissolvable stitches. This is successful 90% to 95% of the time in this outer edge area.1
- The inner two-thirds (white zone) of the meniscus does not have a good blood supply and therefore does not heal well either on its own or after repair. If torn pieces dislocate into the joint space, which may result in a "locked" knee or cause other symptoms, the torn portion is removed (partial meniscectomy) and the edges of the remaining meniscus are shaved to make the meniscus smooth.
- When the tear extends from the red zone into the white zone, there may be enough blood supply for healing. The tear may be repaired or removed. This is something the orthopedic surgeon decides during the surgery.
The pattern of the tear may determine whether a tear can be repaired. Horizontal and flap tears generally require surgical removal of at least part of the meniscus. See an illustration of different types of tears
The choice of type of surgery is based on the size and location of the tear, your age and activity level, the surgeon's experience, and your preferences. Orthopedic surgeons most often perform meniscus surgery with arthroscopy, a procedure used to both examine and repair the inside of a joint. A thin tube (arthroscope) containing a camera and light is inserted through small incisions near the joint; surgical instruments are inserted through other small incisions. Arthroscopic surgery may limit knee damage due to surgery and may promote fuller recovery.2 However, some tears may require open knee surgery.
In a total meniscectomy, the entire meniscus is removed. In a partial meniscectomy, the surgeon removes as little of the meniscus as possible. Unstable meniscal fragments are removed, and the remaining meniscus edges are smoothed so that there are no frayed ends.3
You may have general or regional anesthesia for a meniscectomy.3 Arthroscopic partial meniscectomy is commonly performed in an outpatient surgical centre.1
What To Expect After Surgery
Rehabilitation varies depending on the injury, the type of surgery, your orthopedic surgeon's preference, and your age, health status, and activity demands. Time periods often vary, although in general, meniscus surgery is usually followed by a period of rest, walking, and selected exercises. Most people who have arthroscopic meniscectomy can bear weight a day or two after surgery and can return to full activity within 2 to 4 weeks.4 After the full range of motion without pain is possible, you can return to your previous activity level.
The timetable for returning to walking, driving, and more vigorous activities will depend on the type and extent of the surgery and your success in rehabilitation. For some exercises you can do at home (with your health professional's approval), see:
Rehabilitation for a meniscus tear.
Why It Is Done
A decision to remove all or part of your meniscus will take into consideration the location, length, tear pattern, and stability of the tear, as well as the condition of the whole meniscus. Your surgeon will also consider the condition of the entire knee, any age- or injury-related degeneration, and your age.5
If a meniscus tear is causing pain or swelling, it probably means that torn pieces of the meniscus need to be removed and the edges surgically shaved to make the remaining meniscus smooth. Your orthopedic surgeon will try to preserve as much meniscal tissue as possible to prevent long-term degeneration of your knee and allow you to return to full activities.
How Well It Works
Partial or total meniscectomies, whether open or arthroscopic, appear to be effective in removing torn pieces of the meniscus to prevent them from causing pain and interfering with knee action. Partial meniscectomy will maintain more of the knee's stability and allow a faster and more complete recovery. One review reports that 24% of those who had total meniscectomies, compared to 14% of people who had partial meniscectomies, still had symptoms 6 or more years after surgery.2
Compared to a total meniscectomy, partial meniscectomy requires shorter operating times and results in a faster recovery, better post-operative functioning, and a better self-assessment of outcome.2
Risks
Meniscectomy is generally well tolerated and does not usually cause complications. However, there is a risk of damaging the nerves during surgery.
There is a direct relationship between the amount of meniscus tissue that is surgically removed and the load distribution across the knee. If more tissue is removed, the knee is less able to sustain the load of walking, running, or other activities. With uneven load distribution, degeneration of the knee joint may happen at a faster pace than it would with an intact meniscus.5
In any surgery, there is risk of infection or bleeding, and there are risks with general or regional anesthesia.
What To Think About
Surgical repair is generally favoured over a partial or total meniscectomy. If the meniscus can be repaired successfully, it reduces the risk of knee joint degeneration that may occur with removal of all or part of the meniscus.
A recent study reports that the development of arthritis in the knee after meniscectomy may be influenced by heredity and environmental factors. This finding is significant because surgical removal of meniscal tissue has been considered the cause of osteoarthritis in the knee. If this study's findings are correct, surgery may be a factor, but not the only factor, in eventual osteoarthritis in knees.6
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| Author: | Kathe Gallagher, MSW Carrie Henley | Last Updated: November 28, 2006 |
| Medical Review: | William M. Green, MD - Emergency Medicine Tom Bailey, MD - Family Medicine David Bardana, MD, FRCSC - Orthopedic Surgery/Sports Medicine Kathie Hummel-Berry, PT, PhD - Physical Therapy | |
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| Topic Contents | |
| Surgery Overview | |
| What To Expect After Surgery | |
| Why It Is Done | |
| How Well It Works | |
| Risks | |
| What To Think About | |
| References | |