Meniscus Surgery: What to Expect?

The bones in your knee are in constant motion, which is why they have cartilage to cushion the loading and allow for smooth motion. The meniscus is a special type of cartilage which sits on top of the cartilage of the shin bone. It is like a washer, only on the outer rim of cartilage. It’s main function is to give the knee more stability.  When the meniscus cartilage gets injured, it is called a torn meniscus and it might require a meniscus surgery.

Each of the knees has two menisci, at the outer edge of the medial (or inside) and lateral (or outside) shin bone, called the tibial plateau. They keep your knee steady, and when they are torn, you’ll experience pain and struggle with the motion.

There are many reasons why this happens, ranging from twisting motions, changing dynamics in motion, and even heavy lifting. In other words, it often occurs during activities that cause these motions, like sudden shifts in direction, pivots, or anything along these lines.

In some cases, this is a result of a direct impact on the knee. Still, it can also be something like aging and normal degeneration.

Here’s what you need to know about meniscus injury and surgery!

What are torn meniscus symptoms?

Symptoms of a torn meniscus are:

• Pain

• Swelling

• Stiffness

• Locking
• Instability

All of these have to happen in the knee region.

Now, symptoms, on their own, are not indicative of a torn meniscus. However, if you are familiar with some of the causes and can identify that this is what happened to you, self-diagnosing becomes a little easier.

Nonetheless, you should avoid self-diagnosing. You should seek professional medical advice, and do it as soon as possible. After all, there are so many knee conditions, and identifying the exact one without adequate tests or medical knowledge wouldn’t give the best outcome.

You should go straight to the doctor and ask them to perform an exam. A physical exam with special tests (like the McMurray test or Thessaly test) and an MRI scan will give the doctor a definitive answer to the state of your cartilage.

Can a torn meniscus heal without surgery?

Depending on the severity, a torn meniscus can improve without surgery in some patients. There are, however, many factors involved. It all depends on the location and the severity of the injury, and can not be determined just by observing the symptoms. However, most of the time the meniscus does not heal but the pain subsides. This is not well understood. If the pain does not dissipate then you need to talk to the doctor and get all the necessary imagery and examinations done.

It’s also important to ask for their advice. You can’t just assume that it will heal on its own because “it doesn’t hurt badly” or “swelling is not terrible.” You need to ask your doctor about the treatment.

Generally speaking, a conservative treatment for a meniscus tear that you would try first is rest, applying ice, compression, elevation, physical therapy, and sometimes injections. Typically, this would go alongside activity modification and even some over-the-counter pain relievers. This can help you manage pain and control inflammation.

Torn meniscus surgery

The two most common types of meniscus surgery are meniscectomy (which can be total or partial) and meniscus repair.

• Meniscectomy: During the first procedure, the surgeon removes the damaged portion of the meniscus (or an entire meniscus). This happens in a scenario where the tear not in a location that is amenable to healing. This is the case in a lot of adult meniscus tears.
• Meniscus repair: Here, the surgeon tries to stitch the torn pieces of meniscus together. This is usually done when the affected area has a good blood supply so that it can facilitate healing. These types of tears tend to occur in adolescents and young adults. It is important to know that not every meniscus tear is repairable. An MRI can sometimes show a surgeon where the tear it is not always conclusive as to whether a tear if “fixable” to a surgeon.  Sometimes the decision is made during surgery (intra-operatively). A repair procedure is preferred to a meniscectomy in young patients whose tears are in the vascular healing zone of the meniscus (outer zone).

As far as the procedure goes, it’s usually performed under general anesthesia (you are asleep). Also, most meniscus surgeries are performed arthroscopically and typically take less than an hour.  They are done as a “same-day” or outpatient surgery, usually in a surgical center.

While you are asleep, the meniscus is addressed arthroscopically through small incisions.  Once the procedure is complete, the incisions are  closed, and the process of recovery and rehabilitation can start.

How painful is meniscus repair surgery?

The majority of people are concerned with the level of pain. Now, while the procedure is ongoing, you’ll be under anesthesia.

After the anesthesia has worn off, some discomfort or pain is expected. A lot of times, local numbing (anesthetic) medication is injected into or around the knee to help with pain afterwards.

Though doctors frequently prescribe pain relievers to help you with the postoperative pain, a majority of meniscus surgery patients will not require post-operative narcotics and can control their pain with ice, anti-inflammatories, and/or Tylenol (acetominophen).

In other words, there will be pain, but its management will start as soon as the surgery is completed.

What to expect after meniscus surgery?

Immediately after the surgery, you’ll still feel some pain and discomfort, you will be swollen and have a reduced range of motion. In other words, the symptoms will be exactly what you would expect from a knee surgery (even if you don’t have a medical degree). In some cases, you won’t be able to walk on the leg until the healing is complete.

Torn meniscus surgery recovery time

This depends on the surgery, but generally speaking, partial meniscectomy can recover in 6 weeks, while meniscus repair recovery might take a while longer. Generally speaking, after a meniscus repair, it may takes 4-6 months to return to high-impact sports.

Many things will affect rehabilitation. This can range from the type of tear to adherence to rehabilitation. For instance, exercising properly after meniscus surgery will help you heal faster.

Long-term side-effects of meniscus surgery

Removing a part of the meniscus could lead to an increased risk of arthritis, though this risk started once the meniscus tear occured. This is because the joint wear and tear will increase since you no longer have the full meniscus to stabilize the knee as you walk or jump or run. The extra sliding of the knee joint can cause the cartilage to then tear, leading to arthritis.

Meniscus tears could also return (become symptomatic again or a repair could re-tear).. A recurrent meniscus tear is possible, especially with meniscus repair. In this scenario, there could be a need for further surgery. This is especially likely to happen if the original injury isn’t properly rehabilitated. You can even get another meniscus tear in a completely different location.

As long as you regularly monitor your condition and take care of your body weight, you can minimize some of the worst outcomes.

Wrap up

Overall, if your doctor tells you that you need a meniscus surgery, you should seriously consider it. In some cases, when there’s a meniscus tear present, you won’t be able to regain knee stability and avoid persistent pain in any other way. If all conservative treatments fail, your doctor will likely recommend that you take this route. This is advice you should heed.

„

Meniscus tears are very common knee injuries. With proper diagnosis, treatment (nonoperative and operative), and rehabilitation, many patients return to their pre-injury sports activities with less pain.

William Sayde, MD, Orthopedic Surgeon
The Orthopedic Institute of New Jersey