Meniscal Repair Surgery
Learn everything about your treatment
What is Meniscal Repair Surgery?
The knee is made of three bones: the femur, the tibia, and the patella. These bones are held in place by bands of dense, fibrous connective tissue called ligaments. To help them slide over one another smoothly, the bones have layers of firm connective tissues called cartilage between them. Cartilage comes in various forms and compositions, one of these is the meniscus. Made of fibrocartilaginous tissue, the menisci are semi-circular or crescent-shaped pads that sit between the femur and tibia. They act as shock absorbers during movement, allow for even weight distribution throughout the joint, help with balance, and prevent the leg bones from rubbing together during movement.
The meniscus is thick on the outer edge and becomes slimmer towards the centre. The menisci become avascular by adulthood meaning they have no or little blood supply, particularly at the inner edges. For this reason, injuries of the meniscus are difficult if not impossible to heal, especially if they are extensive or located near the inner edge.
The meniscus can be damaged in several ways. This damage is often referred to as a tear. Tears may be full, meaning the meniscus has been split entirely or partial, and are divided into two types:
- Acute, often as a result of a sudden movement during sports
- Chronic or degenerative related to wear and tear
What Can Meniscal Repair Surgery Achieve?
Not everyone with a meniscus tear needs surgery. The decision to have surgery should be based on several factors including overall benefit weighed against the discomfort and healing time associated with surgery. Other factors include age, activity level, and the degree or area of damage to the meniscus. Your surgical team may request further tests and scans like an x-ray, MRI, or arthroscopy (a surgical procedure that uses a small camera to look inside the knee) to help decide if meniscus repair surgery is right for you.
While there are many potential benefits to meniscus repair surgery for the right candidates, preservation of healthy meniscal tissue is often one of the primary goals of surgery. This is particularly motivating for active patients.
Who is an Ideal Candidate for Meniscal Repair Surgery?
The ideal candidate for meniscus repair surgery is someone younger and generally healthy with no significant medical conditions. People with arthritis in the knee or a history of difficult-to-manage diabetes may not be suitable for meniscus repair surgery. It is ideal for candidates to be as fit and healthy as possible before the procedure to reduce recovery times and improve outcomes. If you smoke or use nicotine products like an e-cigarette, you will be advised to stop at least 2 weeks before surgery and continue to refrain during recovery as nicotine is known to impair wound healing.
You may be recommended for meniscus surgery if:
- The injury is affecting your quality of life
- You have strong muscles in your legs or are able to build their strength before surgery
- You are a very active person or activity is important for you
- You have a physical or active occupation and immobility would negatively affect your income
- The meniscus injury has not healed or responded to non-surgical treatments
- Your knee becomes misaligned or feels unstable
- Your knee locks up
- You are able to adhere to a strict physiotherapy regimen
- You have healthy meniscus tissue with a strong blood supply
Who Is Not Suitable for Meniscal Repair Surgery?
Not every patient needs surgery for a tear in their meniscus. If the tear is degenerative, attempting to repair it can be compared to tying frayed rope together: the resulting structure is more likely to be weak and more vulnerable than the original structure.
If you are not experiencing significant difficulties or your quality of life is not impacted too greatly, surgery may not be your best treatment option.
In general, you may not be recommended for meniscus repair surgery if:
- You have a degenerative meniscus tear
- Prolonged rehabilitation would be difficult for you
- You have an injury that is responding well to physiotherapy or non-surgical treatment
- Your knee is stable
- You are generally inactive
- You are an older person
Meniscal Repair Technique
Meniscus surgery is usually performed as an elective procedure meaning you decide when to have surgery because it’s not an urgent medical necessity. This generally means there is a period of time between when the initial meniscus injury happens and the day of surgery.
Certain techniques can be used first to help reduce the pain and symptoms of a meniscus injury. To reduce swelling, rest, elevation, and ice packs may be advised alongside anti-inflammatory painkillers. It is important to know that pain relievers including ibuprofen are associated with excess bleeding risk during surgery so your surgeon will likely suggest you stop taking these 1 to 2 weeks before surgery.
You may be given a course of exercises to strengthen your leg muscles and knee, as this can help with your recovery. If the pain is more severe, physiotherapy or an earlier surgery date may be advised.
There are several surgical treatment options for a meniscus tear including:
- Partial removal called partial meniscectomy
- Total removal called total meniscectomy
- Transplantation meaning replacement with a donor graft
- Knee replacement
As a brief overview:
Repair uses various techniques to suture the damaged parts of the meniscus back together and encourage healing.
Partial meniscectomy involves removing the damaged parts of the meniscus then reshaping the remaining tissue to make smooth surfaces. This can mean simply trimming off the outer edge.
Total meniscectomy wherein the entire meniscus is removed. Surgeons generally attempt to avoid this technique as it can cause permanent swelling
Transplantation means implanting the meniscus from a donor into the knee after a total meniscectomy. A donor is someone who has chosen to give parts of their body to help others after they have died. The replacement meniscus is known as an allograft, which means it is a graft taken from someone else’s body. This is not a commonly used technique.
Knee replacement involves replacing the damaged parts of the knee with prosthetic (artificial) parts. This would likely only be considered for people with significant injuries or who are not suitable candidates for the above surgical options.
Whether or not meniscus surgery will benefit you is based on many factors including the type of tear and the severity of the injury. For example, if the tear is in the middle of the meniscus it is much less likely to heal on its own than an injury towards the outer edge. A severe tear may mean you are not a suitable candidate for repair surgery because this type of injury is more likely to be very deep or go through the entire meniscus.
There are two techniques used for meniscus repair: arthroscopic or open.
For an arthroscopic procedure, fine tools and a camera are inserted through small incisions (around 1 cm) at a few locations around the knee.
An open technique requires an incision down the front of the knee.
Either of these methods may be performed under a general anaesthetic meaning you are given medication to help you sleep during surgery or under a spinal anaesthetic called an epidural with sedation. For this, numbing medication is injected into the spine to numb the lower half of the body and another medication is administered to help you feel relaxed throughout the surgery.
Below, is a broad overview of how meniscal surgery is performed after the anaesthetic is administered:
- Your knee is cleaned and prepared
- Incisions are made
- Your knee and surrounding structures are examined
- The damaged meniscus is removed, trimmed, or repaired
- The knee is checked for movement
- Wound closed and bandaged
How Is Meniscal Repair Surgery Performed?
The length of the operation largely depends on the type of injury and the techniques used to repair it. In general, meniscus repair surgery takes between 1 and 3 hours to complete.
On the day of surgery, you will meet with the surgeon performing the procedure. They will go over the details of the operation again and ask you to sign a consent form. This is a legal document showing you understand the risks associated with surgery and give consent to allow the surgeon to operate on you.
The anaesthetist will then administer medication that puts you into a deep sleep which is called general anaesthesia, or will inject anaesthetic into your spine called a spinal block or epidural that blocks all feeling in the lower half of your body. In addition to the spinal block, you will also be given a sedative to ensure you are relaxed and somewhat sleepy during the procedure.
If you are having an arthroscopic procedure, your surgeon will make two or three small cuts around 1cm long called incisions at different locations around the knee.
For an open procedure you will have a larger single incision made down the front of the knee.
During an arthroscopic procedure, a fine camera is inserted into the knee to allow the surgeon to examine the meniscus and surrounding structures of the knee carefully. This examination helps ensure there are no other parts of the knee that need repair. If the surgeon finds that repair is not possible during this inspection they may need to instead proceed with a meniscectomy or complete removal of the meniscus. If this is a possibility, your surgeon will discuss this with you before your surgery.
There are multiple potential techniques your surgeon may use to repair the meniscus. One of these is to sew long stitches through the meniscus and secure them at the back of the knee. Another is to use multiple small stitches and specialised knots to secure the meniscus in place.
If a meniscectomy is required, either just the torn portion or the entire meniscus is removed from the knee. Your surgeon’s goal will be to leave as much of the healthy meniscus as possible. Once the pieces of meniscus are removed, the remaining tissue is then smoothed and balanced.
Closing the Incisions
Before closing the wound or wounds, your surgeon will ensure the knee can securely achieve a full range of movement. The wounds are then stitched closed with sutures or stapled closed with medical staples. Finally, wound dressings and bandages are applied to protect the area as the skin heals.
Return to the Ward
After surgery, you will be returned either to your room or a recovery area so you can be monitored as you recover from anaesthesia. If you are staying overnight you may be moved to another ward for the evening. If you are going home the same day as your surgery, you will be reviewed by your surgeon or a member of their team. They will make sure you are well enough to go home before you are discharged.
- Your consultation
What Should I Expect from my Meniscal Repair Consultation?
You must meet with your surgeon for a consultation before scheduling a meniscus repair surgery. A physical examination will be performed during this meeting so your surgeon can assess your overall health. You will also be asked questions regarding your medical history, medications you regularly take, occupation, activity level, lifestyle, and how your injury impacts your daily life. All these answers will allow your surgeon to decide what the best course of treatment is for you. It may be necessary for you to have extra checks such as blood tests or an x-ray.
After the physical exam and medical history, your surgeon will explain the procedure to you in more detail and give you an opportunity to ask any questions you may have. You will discuss the type of anaesthetic that may be suitable for you, the options for surgery and what can be expected afterwards, including physiotherapy and what that entails during recovery. You may also be measured for a leg brace to use after the operation.
What Questions Should You Ask During Your Meniscal Repair Consultation?
It can be understandably difficult to remember everything you wanted to ask on the day of your consultation. You may find it helpful to take notes regarding what to ask and bring these with you to your consultation.
Here are some questions that may be useful to have answered during your consultation:
- Will I need to stay in hospital after surgery?
- Will my meniscus surgery last a lifetime?
- How long do I need to take off work?
- How long will I need to avoid sports?
- Will I have any scars & where will they be located?
- Will I be able to take care of my children or pets during recovery?
- What happens when I need to take a shower?
- Risks and Complications
What are the Main Risks and Complications of Meniscal Repair Surgery?
Like with any surgery, meniscus repair or reconstruction has potential risks and complications. Below are some general risks associated with surgery as well as those specific to meniscus repair surgery.
Unfortunately, meniscus repair surgery is not guaranteed to resolve knee pain issues for every patient. Sometimes pain can continue after surgery and eventually becomes chronic. This can be more common for full or partial meniscectomy patients. The support of a chronic pain specialist may be required longer-term.
Ongoing or Worsening Issues with the Knee
Some people find their symptoms continue, change, or get worse after meniscus repair surgery. Some find their knee cannot move as well or the same as it did before the initial injury or eventual surgery. Partial meniscectomies are associated with a higher risk of knee weakness called joint laxity and in the longer term, osteoarthritis of the knee. Some patients may still need a knee replacement in the future in spite of early meniscus repair or replacement.
The inside of the knee can scar just like the outside of the knee. Internal scarring is different for every individual, however, for some patients, this scarring can lead to pain or sensations of the knee locking, grinding or popping. Scarring may also contribute to certain arthritic conditions such as chondromalacia commonly known as runners knee. Internal scarring may eventually require corrective surgery.
There is potential for the repair to fail, meaning the surgery did not fix the meniscus tear entirely. Signs of repair failure include pain and a feeling that the knee is locking or catching. You may need a scan of your knee to help determine the problem. A meniscectomy may be needed to resolve the issue.
General Surgical Risks
Bruising is a normal part of the recovery process and can be expected after meniscus repair surgery. While it varies from person to person, bruising often develops at the knee and in surrounding areas. This bruising may be visible for several weeks.
Infection is a risk of any operation but strict methods are used to ensure the risk is reduced as much as possible. Only sterile instruments are used and the theatre is cleaned rigorously. To help keep the air as clean as possible, a special kind of air conditioning is used. While open meniscus repair techniques are associated with a higher risk of infection when compared to arthroscopic knee surgery, even this risk is still relatively low.
Signs of infection can include:
- Feeling unwell or feverish
- Having a temperature higher than 38° C
- Redness or swelling at or around your wound.
- Fluid coming from your wound that is yellowy, thick or smells foul
- Increased pain that is not relieved by your pain medication
You must seek urgent medical attention if you have any of these symptoms.
Coagulation, or the clotting ability of blood, is part of your body’s natural response to injury. For example, blood clots are what help stop the bleeding naturally if you nick yourself on a knife. These clots also are a part of what makes scabs which work to protect the body from infection as the skin heals. Clots can form all over the body, but not always where they are needed. An example of this is when they form in the back of the legs when you have not moved for a long time. In this situation, clots can be dangerous as they can move from your legs up to your lungs or brain. This can potentially cause life-threatening injury. These sorts of clots can develop during surgery and recovery. Overall, they are more likely to occur after orthopaedic surgery like meniscus repair surgery because of the relative lack of mobility during the recovery process. To reduce the chance of blood clots, your surgeon will advise you before surgery as to what you can do to best protect yourself. This may include tips on how to keep mobile, instructions to wear compression socks, and injections to thin the blood.
- Preparing for Your Treatment
How Can I Prepare for Meniscal Repair Surgery?
To prepare your knee for surgery and recovery, you may be prescribed a course of physiotherapy that will help ensure the muscles in your leg are as strong as they can be. Leg strength and overall good health are a great way to give yourself the best chance at the quickest and easiest recovery possible.
It is very important you do not take ibuprofen or medicines in the Nsaid category for at least 1 to 2 weeks before the operation because they are related to an increased risk of excessive bleeding during and after surgery. You may also need to avoid taking them for a period after surgery. Your surgeon will give you specific advice on this.
You will likely be advised by your surgeon to stop smoking or using any nicotine products for at least 2 weeks before surgery and throughout your recovery. This is because nicotine restricts blood flow which can delay healing and lead to less than perfect results.
You may be advised not to shave your knee before surgery. Shaving causes microscopic damage to the skin which can harbour bacteria. This can put you at a higher risk of infection.
What Can I Expect After Meniscal Repair Surgery?
Please also see ‘is there anything I need to do in the first 24 hours?’
Depending on the technique used during your meniscus repair surgery, you will be advised not to bear weight on your knee for some time. This may last for several weeks. To make your daily life easier, you will be given a mobility aid like crutches to use during this period. You will also be given advice on how to gradually reduce the amount of time you use them as you recover.
You may be required to wear a brace on your knee for between 4 to 6 weeks after surgery, especially if other knee repairs were performed on your knee. Wearing the brace helps ensure your knee only flexes a certain amount and prevents injury. Your surgeon or physiotherapist will set this brace and it is very important you do not alter the settings yourself.
You will be given guidance on how to perform day-to-day activities with the brace, for example, using stairs, the ideal sleeping posture, and how to bathe.
A physiotherapy programme will be individually designed for you and your needs after meniscus repair surgery. This will likely last between 2 and 6 months. This programme is vital to how you recover and how well your knee functions in the long-term.
You will likely have gentle exercises to do at home before physiotherapy starts. These may include things like walking with your mobility aid. A typical physiotherapy programme begins a 1 or 2 weeks after surgery.
Rehabilitation after a meniscectomy is often intensive to ensure the internal structures of the knee are not over-protected as they heal. Some programmes may also include hydrotherapy meaning exercises are performed in a pool to reduce strain on the joint.
Course contents will vary depending on your needs, but all physiotherapy programmes focus on:
- Building strength in the leg muscles
- Ensuring the knee’s range of movement as good as possible
- Keeping you and your knee active
Wound Care, Ice Packs, and Wound Dressings
You will have a wound dressing and a bandage on your knee when you wake up from surgery. It is important that you keep these clean and do not get them wet or remove them yourself.
Wounds are usually closed with stitches or staples. If staples or non-dissolvable stitches are used, you will be given an appointment to see your surgeon 7 to 14 days later to have them removed. Sterilised wound tape is often used after this to support the skin as it heals completely.
You may be advised to apply ice packs or special ice dressings to your knee after surgery to help reduce swelling. Take care not to keep ice in contact with your bare skin.
Showering and Bathing
You may be advised to use a special plastic cover on your leg when you shower to prevent the wounds on your knee from getting wet. You will likely be advised not to wash your wounds until they are healed. After this point, often gentle soap and clean water are all that is needed to clean them. Carefully pat (never rub) wounds dry with a clean towel after bathing.
You will likely experience some pain and discomfort after your meniscus repair surgery. This is normal after a surgical procedure and you will be given advice on how to manage the pain. You may be given medication to take home with you or be advised on the best type of pain-relief to use as you recover.
How will I feel after surgery?
It is normal to experience some pain both after surgery and during recovery, but this should ease over time. Your surgeon will give you advice on what pain relievers are suitable for you as you may need to avoid ibuprofen and similar drugs because of bleeding risk.
Surgery can be quite tiring emotionally and physically so it is normal to feel tired and out of sorts for some time after. Anaesthesia, especially general anaesthesia, may add to these feelings as it can take several days to ensure the effects are completely worn off.
Is there anything I need to do in the first 24 hours after meniscal repair surgery?
Some patients are able to go home on the day of surgery, but others may need to stay a night in hospital. As anaesthesia can affect your judgement and coordination for up to 48 hours after surgery, you must arrange for someone to take you home from hospital and to stay with for at least the first 24 hours.
After this, you will likely need a friend or family member to help you take care of yourself as well as any dependents such as children or pets for some time because your mobility will be limited.
Before going home you will be given a mobility aid like crutches and you may be fitted for a brace. You will be given explanations on how to use these things as well as advice on how to safely do daily activities like washing and driving.
To help prevent blood clots you will be advised on special exercises and be fitted for compression socks. Some people may need injections to help thin the blood. You or someone who is caring for you will be shown how to do this.
Elevation and icing is a vital part of recovery and you will be given an icing schedule to follow.
Everything you need to know or do in the first 24 hours after surgery will be explained to you by your surgical team in the hospital before you are discharged. Always follow the advice given to you by your surgeon or their team.
How much time do I need to take off work?
When you go back to work will depend largely on the kind of meniscus surgery you had and what you do for work. For a sedentary position that mainly involves sitting at a desk, you may be able to return after 2 to 3 weeks. More strenuous jobs that involve standing or walking may require a 4 to 6 week break. Jobs involving manual work, physical labour, or a long journey to work may need to be avoided for anywhere between 3 and 6 months.
When can I return to exercise and sport?
The length of time it takes to return to sports or physical activity varies from person to person and is largely dependant on the type of meniscus surgery performed. A period of 3 to 6 months is expected for a typical patient. Elite athletes may need to take 8 to 12 months or longer to return to competitive training.
What other points should I consider?
Your surgeon will advise you not to drive for some time after surgery. Driving against your surgeon’s advice may impact your insurance coverage. Often it is recommended that you do not drive for several weeks or until you are able to bear weight comfortably on your knee.
Will I need to stay in hospital after meniscal repair surgery?
This depends heavily on the type of techniques used during your meniscus repair surgery. For more precise information, ask your surgeon if they believe you will be able to go home the same day as your surgery.
Will my meniscal repair last a lifetime?
It is difficult to predict how long a meniscus repair will last. Sometimes patients with tears to the meniscus need future surgeries like a full knee replacement that are.
How long do I need to take off work after meniscal repair surgery?
The amount of time needed away from work varies depending on your job but it can be anywhere from 2 weeks to several months. The surgeon will be able to give you a specific recommendation based on your vocation and physical state.
How long do I need to take off sports after meniscal repair surgery?
Again this varies given your athletic abilities, the kinds of sports you enjoy and the kind of surgery you had. Recovery periods can take anything from 3 months to over a year.
Will I have any scars after meniscal repair surgery?
After arthroscopic meniscus surgery, you will usually have several small scars around the knee.
After open surgery, you are very likely to have a larger single scar running down the front of the knee. Your surgeon will give you advice on how to care for your wounds and minimise scarring during recovery.
Will I be able to take care of my children or pets after meniscal repair surgery?
Given you will be unable to bear weight on your knee for some time, you will need to arrange for support caring for children and pets. It may be necessary to arrange for someone to take your children to school or to drive you to appointments until you are able to do these unaided.
Are there any special steps I need to take when showering or bathing after meniscal repair surgery?
There are plastic covers with special cuffs that can help you keep your knee and wound dressings dry when showering. You will be given advice regarding how to safely shower until your wounds are healed and no longer covered in bandages. It may be necessary to avoid baths until you can bend your knee and your dressings are removed.