Arthroscopic resection of the knee meniscus

Meniscus injury is one of the most common in sports and at the same time unpleasant; it is accompanied by severe pain, even with a partial tear or minor damage. If proper treatment is not carried out in time, the patient will face constant relapses and complications. One of the most dangerous consequences is a degenerative change in cartilage tissue, which is irreversible. The result sometimes is first a partial reduction in the range of motion, and then a complete blockade of the knee joint. Moreover, the joint can “block” at any time and in any position. The main reason for this clinical picture is constant overload during sports or a consequence of heavy physical work. Injuries are also the cause of the pathology (especially important for contact sports).

Treatment for a torn meniscus of the knee

In some cases, conservative therapy is allowed - temporary limitation of exercise, medication, intra-articular injections of hyaluronic acid, physiotherapeutic procedures, rehabilitation measures. However, if there is a fairly pronounced injury, confirmed during examination (examination by a doctor, magnetic resonance imaging), characterized by certain symptoms, then surgical intervention cannot be avoided. Modern knee arthroscopy surgery has an ideal balance of effectiveness and safety, as well as ease of patient tolerance.

You can read more about treatment for a torn meniscus of the knee joint on our website: https://sportklinika.ru/povrejdeniye-i-razriv-meniska-kolennogo-sustava.html

What are menisci

The knee joint has a complex structure, including the articular surfaces of the femur, tibia, articular capsule, and a cavity with synovial fluid, which improves the gliding of the articular surfaces during movement and is responsible for nourishing the cartilage.

The surfaces of the joints of the bones do not exactly correspond to each other in shape, so between them there are thin plates of cartilage - menisci, which fill the empty space between the bones. They protect the articular surfaces from wear, play the role of shock absorbers - soften shocks and impacts during movements. Taking into account the structure, the plates have a body and 2 horns - anterior and posterior. Most of the menisci are intertwined collagen fibers of different types that form a dense network. Due to this, cartilage is provided with good resistance to various mechanical influences.

There are 2 types of meniscus in the knee:

1. Lateral – located outside. It has a semicircular shape and covers almost the entire lateral articular surface of the tibia. The anterior cruciate ligament is fixed near the anterior horn. The meniscofemoral ligaments are attached to the posterior horn. In some people, the meniscus may have a slightly different shape and larger area, in this case it is called discoid. This is not considered a pathology, but simply a variant of the norm. Compared to regular shaped menisci, discoid menisci are more susceptible to damage.
2. Medial – fixed on the inside of the joint. Has a crescent shape. On one side it is adjacent to the tibia, on the other to the outer edge of the joint capsule. The tibial collateral ligament runs to the center of its body. Due to its tight attachment, mobility is limited, so tears of the medial meniscus are more common than lateral ones.

Fiber-cartilage plates divide the knee joint into 2 parts and evenly distribute the load on the knee, limiting the range of motion taking into account the physiological norm to prevent damage.

Benefits of meniscal arthroscopy

The method has gained popularity due to the abundance of positive aspects, including the following:

• Accurate diagnosis - even if other types of diagnostic measures do not allow determining the extent of damage, arthroscopy will cope with this without problems - today there is no more effective diagnosis of pathologies of the intra-articular cavity;
• There is no need for general anesthesia, which means the operation is more suitable for patients with problems with the cardiovascular system;
• Quick recovery - already on the day of the procedure (sometimes within a day), the patient can go home, returning to sports occurs in a few weeks;
• Low level of complications - after conventional operations they appear many times more often;
• Diagnosis and treatment are carried out simultaneously, there is no need to wait for repeated interventions, the decision on the need for resection/suturing of the meniscus is made during the process;
• Low trauma – virtually no damage to surrounding tissues;
• No large scars - only two small marks remain on the sides of the kneecap;
• Adequate cost - despite the fact that the price of arthroscopy is slightly higher than for a conventional operation, you can save on hospital stay fees, which ultimately results in a significant reduction in costs.

Who will benefit from this technique?

Arthroscopy is usually performed in cases where the diagnosis is unclear and other diagnostic methods do not clarify the clinical picture. They may prescribe a similar manipulation to evaluate and monitor the effectiveness of the therapy just performed. In rare cases, arthroscopy is prescribed when a patient complains of pain, complications and discomfort in the joint after previous interventions.

A direct indication for this procedure is damage to the meniscus of any nature. In this case, diagnostic or therapeutic arthroscopy is prescribed, depending on the nature of the complaints and the course of the disease. In addition, the procedure may be prescribed for a combination of disorders in the menisci and ligaments, for any inflammatory processes in the joint, for recent injuries, as well as for developing arthritis and osteoarthrosis. In general, any change in the knee joint, whether traumatic or inflammatory, is an indication for arthroscopy.

Contraindications to arthroscopy

Despite the usefulness of the procedure, as with any other manipulation, there are contraindications for arthroscopy. It can be:

• Infections of a ongoing or chronic nature, especially localized near the damaged joint;
• Inflammatory processes in the skin near the intended site of intervention;
• Pathology of internal organs in serious condition;
• Adhesions and ankylosis, in which the joint cannot bend normally;
• Knee injuries in which the ligaments are exposed and the knee is damaged;
• Heavy bleeding due to injury, purulent processes in the wound.

How to prepare for the procedure

Initially, as with any other interventional procedure, the patient is sent for a series of standard diagnostic tests. These include general blood and urine tests, fluorography, blood tests for pathologies, ECG, and a general examination by a doctor. Next, after passing all the tests, the patient is given a referral for the procedure. In this case, the doctor must clarify with the patient a number of nuances, the presence of which may complicate or reduce the effectiveness of the manipulation. This includes taking anticoagulants and other medications, as well as menstruation in women. Since the procedure as a whole does not involve dissection, intervention still takes place, so it is important to exclude the occurrence of thrombosis and bleeding during arthroscopy .

Before the procedure itself, the patient undergoes a short consultation with the surgeon and an appointment with the anesthesiologist. If general anesthesia is planned, then the day before the patient adheres to a light diet, prepares clothes for the operating room, and shaved the joint area. It is advisable to take care of the postoperative period in advance, that is, purchase crutches or a wheelchair, and consider transportation home.

Stages of arthroscopy

In general, all stages of the procedure are the same for both diagnostic and therapeutic interventions. Only some nuances may vary. The general picture of the procedure is as follows:

1. The patient is placed on the table with his back, the operated knee is bent at a right angle and fixed;
2. The patient is given anesthesia or general anesthesia;
3. The operated area is treated with antiseptics, then symmetrical punctures are made on both sides of the knee. A camera is inserted into one puncture, and instruments are inserted into the second through a trocar;
4. To improve visibility, saline may be injected to expand the field of view. After these manipulations, the surgeon begins an examination or medical work; the latter may require additional tools in the form of a scalpel, forceps, and scissors. If complete removal of the meniscus is required, instruments can be inserted into two punctures at once;
5. After surgical procedures, another solution is injected to wash away any remaining tissue. If the meniscus has been excised or parts of it have been removed, sutures are applied to it;
6. Next, the instruments are removed, and sutures are applied to the punctures. The wounds are washed with an antiseptic and the knee is bandaged.

The procedure generally takes no more than 3 hours, even in difficult situations. Usually the patient can be discharged from the clinic the next day.

Postoperative period

Often this procedure is quite simple and does not require much time or effort for recovery. But a number of recommendations for rehabilitation still exist:

• Physical activity must be prescribed for the entire recovery period, and aimed specifically at the operated leg;
• On the first day, cold may be applied to the affected joint to reduce swelling;
• Painkillers may be prescribed to relieve pain after surgery;
• For the first few days, you should not heat or overcool the joint or sunbathe, as this can cause the development of an inflammatory process;
• You should not squat or kneel until the joint has fully recovered, otherwise this may result in re-injury of the meniscus;
• The doctor prescribes various procedures for faster joint restoration, including current stimulation, massage, magnetic therapy, and also prescribes complexes of vitamins and minerals for tissue restoration;
• Physical therapy is prescribed with an emphasis on the operated limb;
• The patient can be discharged the next day, but they are issued a sick leave certificate for 1-2 weeks. The overall recovery period varies within a month.

If all recommendations are followed correctly, the knee joint quickly recovers and allows the patient to soon return to their normal lifestyle.

Resection of the meniscus of the knee joint

Resection of the meniscus involves removing only the damaged parts in case of a complete rupture, prolonged compression, unfavorable localization of the rupture, or other situations. It is advisable to carry out such an operation as soon as possible after the injury. All healthy meniscus tissues are preserved, their surface is leveled for better gliding in the joint. Restoration of joint function occurs partially or completely in a relatively quick time. Rehabilitation measures after surgery contribute to the most favorable outcome.

Causes and types of injuries leading to meniscus removal

Meniscus injuries lead to emergency surgery:

• meniscal rupture of varying degrees of complexity, accompanied by severe pain;
• joint locking or tearing of part of the meniscus.

Removal of the meniscus is a radical measure for injury with tissue rupture over 50%. This surgical intervention is due to the fact that such injuries do not heal on their own and are accompanied by limited mobility of the knee.

Meniscectomy is the removal of a meniscus damaged with several types of tears:

• complete fragmentation;
• in the form of shreds;
• tearing off part of the cartilage.

Removing the meniscus is not always an adequate response to injury. Minor damage to the knee meniscus and bruises are usually treated until complete recovery.

Meniscectomy

If resection is not possible, the specialist completely removes the meniscus (performs a meniscectomy). Often the decision is made already during the arthroscopic intervention. After meniscectomy, competent comprehensive management of the postoperative period plays a key role in returning all motor functions and preventing complications. Monitoring of the patient by a specialist after meniscectomy should be carried out on a regular basis. If necessary, an implant is subsequently installed to replace the removed meniscus. However, such operations are performed quite rarely.

Read more about arthroscopic diagnosis and treatment: “Knee joint arthroscopy.”

Rehabilitation after resection of the knee meniscus

If necessary, the doctor prescribes the following rehabilitation measures:

1. Kinesiotherapy is one of the key ways to quickly recover.
2. Therapeutic massage - the number of sessions depends on the characteristics of the body, surgical procedures performed and other factors.
3. Magnetotherapy.
4. Electrophoresis.
5. Mechanotherapy – from us you can rent a device for your home.
6. Monitoring and regulation of the progress of rehabilitation by doctors and rehabilitation specialists.

If there are complaints from patients, the doctor prescribes repeat arthroscopy to identify and eliminate complications - such cases are very rare, but if they occur, you should immediately inform the doctor about it.

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