Meniscal Repair

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Meniscal Repair

Meniscal repair is a surgical procedure aimed at treating tears in the meniscus, a C-shaped cartilage structure that cushions the knee joint. The meniscus serves to absorb shock, stabilize the knee, and distribute weight evenly across the joint. When a tear occurs, usually due to a sports injury, trauma, or degeneration, it can result in pain, swelling, instability, and limited mobility. Meniscal tears that affect the outer edge of the meniscus, where there is a good blood supply, may heal on their own, but tears in the inner part of the meniscus, where blood flow is limited, often require surgical intervention to restore function and prevent further damage to the knee joint. Meniscal repair aims to preserve as much of the natural meniscus as possible, improving the long-term health of the knee and reducing the risk of developing osteoarthritis.

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When is Meniscal Repair Recommended?

Meniscal repair is typically recommended for individuals who experience symptoms of a meniscal tear, including knee pain, swelling, catching or locking sensations, and instability. It is especially beneficial for younger, active patients who wish to preserve the meniscus and prevent long-term joint degeneration. Meniscal repair is most effective when the tear is located in the outer, vascularized zone of the meniscus, as this area has a higher chance of healing post-surgery. The decision to perform meniscal repair versus meniscectomy (removal of the torn meniscus) depends on factors such as the location, size, and type of tear, as well as the patient's age, activity level, and overall knee health. Diagnostic imaging, particularly MRI, is used to assess the tear and guide the treatment plan.

Preparing for Meniscal Repair

Preparation for meniscal repair involves a comprehensive evaluation by the orthopedic surgeon. This includes diagnostic imaging to confirm the tear and assess the surrounding structures, such as ligaments and cartilage. Blood tests and other assessments may be conducted to ensure the patient is healthy and fit for surgery. Pre-operative counseling helps patients understand the procedure, recovery timeline, and expected outcomes. Strengthening exercises and physical therapy may be recommended prior to surgery to improve the stability of the knee joint and reduce recovery time. Patients are also advised to discontinue certain medications, such as blood thinners, and to make lifestyle adjustments, like managing their weight, to support the healing process.

The Surgical Procedure

Meniscal repair is typically performed using minimally invasive arthroscopic techniques, often under general or regional anesthesia. The procedure generally lasts between 1-2 hours. The surgeon makes small incisions around the knee and inserts a tiny camera (arthroscope) to visualize the tear. Specialized instruments are then used to repair the torn meniscus by stitching the edges together. In some cases, additional procedures such as smoothing rough edges or trimming damaged tissue may be performed to promote healing. The repair is usually done using sutures or anchors that hold the meniscus in place while the tissue heals. After the repair is completed, the knee is tested for stability, and the incisions are closed with sutures or staples.

Recovery and Rehabilitation

Recovery from meniscal repair is typically longer than from meniscectomy, as the goal is to allow the meniscus to heal properly. Patients may need to wear a knee brace and use crutches to limit movement during the initial recovery phase. Physical therapy begins shortly after surgery, with early rehabilitation focused on reducing swelling, improving range of motion, and restoring strength in the quadriceps and hamstrings. Full weight-bearing may be restricted for several weeks, and patients are advised to avoid high-impact activities to protect the repair. A gradual return to sports and strenuous activities is typically allowed after 4-6 months, although it may take up to 9 months for full recovery depending on the extent of the tear and the patient's adherence to rehabilitation.

Benefits and Risks

Meniscal repair offers numerous benefits, including the preservation of the natural meniscus, which helps maintain knee stability and reduces the risk of early-onset osteoarthritis. By repairing the tear instead of removing the meniscus, the procedure aims to restore function and protect the long-term health of the knee joint. Many patients experience a significant reduction in pain, improved mobility, and a return to their regular activities following recovery. However, like any surgical procedure, meniscal repair carries risks such as infection, blood clots, stiffness, re-tearing of the meniscus, and delayed healing. Close post-operative monitoring, a structured rehabilitation program, and patient compliance with activity restrictions are essential to achieving the best possible outcome.