Meniscus surgery

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.

Your doctor will suggest the treatment that will likely work best for you based on where the tear is, the pattern of the tear, and how big it is. In some cases, the surgeon makes the final decision during surgery, when the surgeon can see the how strong the meniscus is, where the tear is, and how big the tear is.

Meniscus surgery is usually done as arthroscopic surgery. Your doctor uses a lighted tube called an arthroscope, or scope. The doctor puts the scope and other surgical tools through small cuts in your knee.

If a meniscus tear is causing pain or swelling, your doctor may recommend surgery to have the torn pieces of the meniscus removed. The edges will be surgically shaved to make the remaining meniscus smooth. Your surgeon will try to preserve as much meniscal tissue as possible. This can help prevent long-term degeneration of your knee and allow you to return to full activities.

To decide whether to remove all or part of your meniscus, the doctor will look at 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, your age, and any age- or injury-related degeneration.

Orthopedic surgeons most often perform meniscus surgery with arthroscopy. This is a procedure used to both examine and repair the inside of a joint. A thin tube (arthroscope) is inserted through small incisions near the joint. This scope contains a camera and a light. Surgical tools are inserted through other small incisions. Arthroscopic surgery may limit knee damage from surgery and may promote fuller recovery. But 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.

You may have general or regional anesthesia for a meniscectomy. Arthroscopic partial meniscectomy is commonly done in an outpatient surgical center.

The goal of a meniscus repair is to reduce your pain and improve your knee function. Also, you may be able to prevent long-term complications (such as osteoarthritis).

Successful repair of meniscus tears depends on the size, location, and cause of the tear. Tears that are located near the outer edge of the meniscus have a good blood supply and heal better. Those near the center don't heal as well. Small tears heal better than large ones. Tears caused by sudden trauma heal better than tears caused by wear and tear.

If you have a tear caused by an injury and your surgeon recommends repair, you will probably be able to return to your normal sports and daily activities.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Sleep with your knee raised, but not bent. Put a pillow under your foot.
• Keep your leg raised as much as possible for the first few days.
• You may shower 24 to 48 hours after surgery, if your doctor okays it. When you shower, keep your bandage and incisions dry by taping a sheet of plastic to cover them. If you have a brace, take it off if your doctor says it is okay. It might help to sit on a shower stool.
• You will be able to stand if you have a brace or use crutches. Do not put weight on your leg until your doctor says you can. You can move around the house to do daily tasks.
• If you have a brace, leave it on except when you exercise your knee or you shower. Be careful not to put the brace on too tight. You will use it for about 2 to 6 weeks.
• If your doctor does not want you to shower or remove your brace, you can take a sponge bath.
• Wait 2 weeks or until your doctor says it is okay before you take a bath, swim, use a hot tub, or soak your leg.
• If you drive, ask your doctor when you can drive again.
• How soon you can return to school depends on the type of surgery you had. You may be able to go back in 1 to 2 weeks.
• If you work, how soon you can return depends on your job. If you sit at work, you may be able to go back in 1 to 2 weeks. But if you are on your feet at work, it may take 4 to 6 weeks. If you are very physically active in your job, it may take 3 to 6 months.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• If you have a bandage over your incisions, keep the bandage clean and dry. Follow your doctor's instructions. Some doctors want to see you before you take it off, while others may let you take it off 48 to 72 hours after your surgery.
• If you have strips of tape on the incisions, leave the tape on for a week or until it falls off.
• Keep the area clean and dry.

Exercise

• Knee rehabilitation is a series of exercises you do after your surgery. This helps you get back your knee's range of motion and strength. You will work with your doctor and physical therapist to plan this exercise program. To get the best results, you need to do the exercises correctly and as often and as long as your doctor tells you.

Ice and elevation

• Put ice or a cold pack on your knee for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake). Put a thin cloth between the ice and your skin. If your doctor recommends using a cold therapy machine, follow the instructions that came with the machine.
• Prop up the sore leg on a pillow when you ice your knee or any time you sit or lie down during the next 3 days. Try to keep your leg above the level of your heart. This will help reduce swelling.
• If your doctor gave you support stockings, continue to wear them 24 hours a day for 3 weeks (or as long as your doctor says).