The menisci is a medical term referring to two crescent shaped, discs which are located on either side of the knee joint.
The menisci are attached to the joint surfaces of the lower leg bone (tibia) and are commonly referred to as the knee cartilage.
The two menisci (medial meniscus and lateral meniscus) act as a shock absorber for the knee joint surfaces and also aid the stability of the knee joint with tasks involving rotation and other lateral movements.
Given their key role for a healthy knee joint correct management is vital. In the common event that a torn meniscus does not heal to an adequate state itself, two forms of surgery are available.
Specialist orthopaedic knee surgeons can either perform a direct repair for the torn meniscus or a meniscus transplant operation can be offered. The type of surgery offered may depend on several factors including:
- The general health of the knee
- The type and extent of the meniscal tear
- The activity level of the patient
- The age of the patient
Before the surgical procedure itself commences your surgical team will position appropriate equipment to monitor vital signs. These will include a blood pressure cuff to monitor blood pressure, ECG leads to monitor the electrical activity of the heart and a monitor to measure oxygen levels.
A meniscal repair is carried out using keyhole surgery (arthroscopy). This involves making very small incisions on either side of the knee and inserting a small tube known as an endoscope into the knee joint. Throughout an arthroscopic knee procedure fluid is pressurised into the joint which aids visualisation of certain parts of the knee joint and also reduces any chances of infection.
Via special instrumentation on the end of the endoscope the surgeon is able to visualise the knee joint and specifically the damaged meniscus. Depending on the exact state of the meniscus the surgeon will make a decision how to proceed.
If the tear is amenable to repair this will be attempted. A meniscal repair involves carefully stitching the torn edge of the meniscus via further specialised tools on the end of the endoscopes.
If the meniscal injury is unrepairable or there is a high likelihood that a repair may fail at a later date, there are two further surgical options.
The first is a surgical removal of the damaged portion of meniscus (debridement).
The second is a meniscus transplant. A meniscal transplant is a relatively new procedure which our specialist knee orthopaedic surgeons are able to offer. This relies on a suitable donor being found which specifically mimics the tissue type and size of the original meniscus in the knee.
General complications which can occur with any type of invasive surgery can occur in a small number of patients who undergo a meniscal repair. These can include:
- Reaction to undergoing a general anaesthetic can be highly variable among individuals. Drowsiness is common and some individuals may experience some nausea and vomiting following surgery.
- A blood clot (deep vein thrombosis - DVT) can occur after any type of surgery due to the reduced time spent being active (Activity normally helps to pump the blood around the legs). Our physiotherapists will encourage bed and chair exercises to help keep the blood moving in the lower legs.
- In rare cases if a blood clot develops it can travel to the lungs which is known as a pulmonary embolism (PE) or travel to the brain which can be life threatening or cause permanent neurological damage.
- The medication/s used as part of the general anaesthetic reduce the sensation of the nerves and muscles around the bladder which can lead to urinary retention. In a small number of cases individuals may need catheterization for a short period after their surgery until they are able to pass urine properly.
- Due to general activity being reduced following surgery as well as the effects of some general anaesthesia and pain controlling medication individuals will tend to breath in a shallower pattern. For this reason, patients are encouraged to complete regular breathing exercises to circulate the air in the lungs and prevent chest infections following a meniscal repair.
There is also some specific information to be aware of if undergoing knee meniscal surgery:
- If the meniscus is stitched the repair can fail at a later date which can lead to the need for further surgery.
- A meniscus transplant too can fail at a later date.
- If a meniscus transplant is undertaken, there is a very small risk of immune system rejecting the tissue.
Following your meniscal repair surgery you will be returned to your room and monitored by members of our nursing staff.
Immediately after surgery, you will have a tight bandage on the knee which will limit the movement available to your knee. Prior to initially weight bearing our specialist physiotherapists will visit you and supervise your transfer out of bed in to sitting and standing as well as supervise you walking for the first time.
If a meniscal repair has been undertaken, there will often be a period of 2-4 weeks following surgery when you are asked to remain partial weight bearing on the operated leg. If a meniscal transplant has been undertaken, there may also be a brace applied to your knee for the first 2 weeks. Both of these protocols are adhered to protect the repair or transplant during the healing process.
Our physiotherapists will visit you, assess your pain levels, assess the activity in your thigh muscles (quadriceps), as well as discuss any weight bearing protocols with you prior to assisting you in transferring from your bed. Our experienced physiotherapists will issue you with some elbow crutches for offloading your weight appropriately and controlling your pain levels when walking.
Depending on the time of your surgery and the exact nature of the surgery undertaken you will often be discharged home on the day of your surgery or the following day. Some patients may opt to stay as an inpatient for longer to continue in house rehabilitation at our state of the art Circle Rehabilitation centre.
Our specialist surgeons will review you prior to your discharge from hospital and approximately two weeks following your surgery. At this appointment, patients will also see a member of Circle Health’s orthopaedic nursing staff which will examine the wound and extract any stitches remaining.
Once your weight bearing status is unrestricted and your pain levels are under control, our specialist physiotherapists will advise you how to progress your flexibility and strengthening exercises appropriately.
Progressions of the strengthening exercises will normally involve some light exercising on a static cycle in the gym and progressing exercises to those involving weight bearing. These exercises, known as compound exercises more quickly achieve strength in the operated knee to enable you to walk, sit to stand and climb stairs more effectively. Some examples of these exercises are listed below:
- Sit to stand repeats
- Wall squats
- Low step up
Depending on your specific goals around your occupation or return to sports, our physiotherapists will advise you on further specific rehabilitation and fitness drills to enable you to safely achieve your goals.