Partial Meniscectomy

Anatomy of the Meniscus

Two wedge-shaped cartilage pieces are present between the thighbone and the shinbone. These are called menisci. They stabilize the knee joint and act as shock absorbers. 

What is Partial Meniscectomy?

Partial meniscectomy is a surgical procedure to remove the torn portion of the meniscus from the knee joint. 

What are Meniscal Tears?

Meniscal tears can occur at any age, but are more common in athletes playing contact sports. These tears are usually caused by twisting motion or over-flexing of the knee joint. Athletes who play sports, such as football, tennis, and basketball are at a higher risk of developing meniscal tears.

Symptoms of Meniscal Tears

You may have pain over the inner and outer side of the knee, swelling, stiffness of the knee, restricted movement of the knee, and difficulty in straightening your knee. If conservative treatments such as pain medications, rest, physical therapy and use of knee immobilizers fail to relieve pain, surgery may be recommended. Surgical treatment options depend on the location, length, and pattern of the tear. 

Meniscectomy Procedure

There are two surgical procedures for meniscal tears: total and partial meniscectomy. In total meniscectomy, the entire meniscus is removed, but in partial meniscectomy, your surgeon will remove only the torn meniscus. Total meniscectomy will help in relieving symptoms, but because the entire meniscus is removed, the cushioning and stability between the joints will be lost. Hence partial meniscectomy is considered.

Partial Meniscectomy Procedure

Partial meniscectomy is performed with arthroscopy, where several small incisions are made around the knee. Through one of the small incisions, a miniature camera is inserted to view the inside of the knee. Tiny surgical instruments are inserted through other small incisions to repair the tear. During the procedure, the torn meniscus is removed and the remaining edges of the meniscus are smoothened so that there are no sharp ends. Any unstable fragments causing locking and catching sensation will also be removed.

Partial meniscectomy helps in restoring or maintaining knee stability and offers faster and complete recovery. After surgery, rehabilitation exercises may help to restore knee mobility, strength and improve range of motion.

Complications of Partial Meniscectomy

The possible risks and complications of partial meniscectomy include infection, bleeding, and injury to blood vessels or nerves.

 

 

 

 

Meniscal Surgery

Anatomy of the Meniscus

Two wedge-shaped cartilage pieces are present between the thighbone and shinbone. These are called menisci. They stabilize the knee joint and act as shock absorbers. 

What are Meniscal Tears?

A meniscus tear is the commonest knee injury in athletes, especially those involved in contact sports. A sudden bend or twist in your knee can cause the meniscus to tear. This is a traumatic meniscal tear. The elderly are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age. 

Symptoms of Meniscal Tears

A torn meniscus causes pain, swelling, stiffness, catching or locking sensation in your knee, making you unable to move your knee through its complete range of motion. 

Diagnosis of Meniscal Tears

Your orthopedic surgeon will examine your knee, evaluate your symptoms and medical history before suggesting a treatment plan. 

Treatment of Meniscal Tears

The treatment of a meniscal tear depends on the type, size, and location of the tear, as well as your age and activity level. If the tear is small, with damage limited to the outer edge of the meniscus, non-surgical treatment may be sufficient. However, if the symptoms do not resolve with non-surgical treatment, surgical treatment may be recommended.

Surgical Treatment of Meniscal Tears

Knee arthroscopy is the commonly recommended surgical procedure for meniscal tears. The surgical treatment options include: 

  • Meniscus removal (meniscectomy)
  • Meniscus repair 
  • Meniscus replacement 

Surgery can be performed using arthroscopy where a small camera will be inserted through a small incision, which enables your surgeon to view the inside of your knee on a large screen. 

The surgery will be performed through other small incisions. During meniscectomy, small instruments called shavers or scissors may be used to remove the torn meniscus. 

In arthroscopic meniscus repair, the torn meniscus will be pinned or sutured depending on the extent of the tear. 

Meniscus replacement or transplantation involves the replacement of a torn cartilage with the cartilage obtained from a donor or a cultured patch obtained from the laboratory. It is considered as a treatment option to relieve knee pain if you have undergone meniscectomy.

 

 

Meniscal Tears

What is Meniscus?

The two wedge-shaped cartilage pieces present between the thighbone and the shinbone are called meniscus. They stabilize the knee joint and act as shock absorbers. What is a Meniscal Tear?

What is a Meniscal Tear?

A meniscal tear is a common knee injury in athletes, especially those involved in contact sports. A sudden bend or twist in your knee causes the meniscus to tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age. 

Symptoms of Meniscal Tears

A torn meniscus causes pain, swelling, stiffness, or catching or locking sensation in your knee, making you unable to move your knee through its complete range of motion. 

Diagnosis of Meniscal Tears

Your surgeon will examine your knee and evaluate your symptoms and medical history before suggesting a treatment plan. 

Treatment of Meniscal Tears

The treatment depends on the type, size, and location of the tear, as well your age and activity level. If the tear is small with damage only in the outer edge of the meniscus, non-surgical treatment may be sufficient. However, if the symptoms do not resolve with non-surgical treatment, surgical treatment may be recommended.

Surgical Treatment for Meniscal Tears

Knee arthroscopy is a commonly recommended surgical procedure for meniscal tears. 

Surgery can be performed using arthroscopy where a very small camera will be inserted through a very small incision to enable your surgeon to view the inside of your knee on a large screen. The surgery will be performed through other small incisions. 

The surgical techniques include meniscus removal (meniscectomy), meniscus repair, and meniscus replacement. During meniscectomy, small instruments called shavers or scissors may be used to remove the torn meniscus. In arthroscopic meniscus repair, the torn meniscus will be pinned or sutured depending on the extent of the tear. Meniscus replacement or transplantation involves the replacement of a torn cartilage with the cartilage obtained from a donor or a cultured patch obtained from a laboratory. It is considered as a treatment option to relieve knee pain if you have undergone meniscectomy.

 

 

Meniscal Injuries

Anatomy of the Knee Joint

The knee is one of the most complex and largest joints in the body and is very susceptible to injury. The meniscus is a small, C-shaped piece of cartilage in the knee. Each knee consists of two menisci, medial meniscus on the inner aspect of the knee and the lateral meniscus on the outer aspect of the knee. The medial and lateral menisci act as a cushion between the thighbone (femur) and shinbone (tibia). 

Meniscal Injuries

Meniscal tears are among the commonest injuries to the knee joint. It can occur at any age but are more common in athletes involved in contact sports. The meniscus has no direct blood supply and for that reason, when there is an injury to the meniscus, healing is difficult.

Causes of Meniscal Injuries

Meniscal tears often occur during sports. These tears are usually caused by twisting motion or over-flexing of the knee joint. Sports such as football, tennis, and basketball involve a high risk of developing meniscal tears. They often occur along with injuries to the anterior cruciate ligament, a ligament that crosses from the femur (thighbone) to the tibia (shinbone).

Symptoms of Meniscal Injuries

Meniscal tears can be characterized into longitudinal, bucket handle, flap, parrot -beak and mixed or complex tears.

The symptoms of a meniscal tear include:

  • Knee pain when walking
  • A popping or clicking that may be felt at the time of injury
  • Tenderness when pressing on the meniscus
  • Swelling of the knee
  • Limited motion of the knee joint
  • Joint locking, if the torn cartilage gets caught between the femur and tibia, preventing straightening of the knee.

Diagnosis of Meniscal Injuries

A thorough medical history and a physical examination can help diagnose meniscal injuries. 

The McMurray test is an important test for diagnosing meniscal tears. During this test, your doctor will bend the knee, then straighten and rotate it in and out. This creates pressure on the torn meniscus. Pain or a click during this test may suggest a meniscal tear. 

In addition, your doctor may order imaging tests such as X-ray and MRI to help confirm the diagnosis.

Treatment of Meniscal Injuries

The treatment depends on the pattern and location of the tear. If the meniscal tear is not severe, your child's doctor may begin with non-surgical treatments that may include:

  • Rest: Avoid activities that may cause injury. You may need to temporarily use crutches to limit weight-bearing.
  • Ice: Ice application to reduce swelling
  • Pain medications: Non-steroidal anti-inflammatory drugs (NSAIDs) to help reduce swelling and pain
  • Physical therapy: Physical therapy for muscle and joint strengthening

If the symptoms persist and conservative treatment fails, you may need surgery to repair the torn meniscus. 

 

 

Lateral Meniscus Syndrome

Anatomy of the Lateral Meniscus

The knee joint is formed by the union of two bones, namely the femur (thighbone) and the tibia (lower leg bone). At the junction of these two bones is a cartilage called meniscus, which acts as a shock absorber. There are two menisci – the lateral and medial menisci. The lateral meniscus is the outer meniscus of the knee joint and gives a cushioning effect during weight-bearing activities. 

What is Lateral Meniscus Syndrome?

Lateral meniscus syndrome is characterized by an injury caused by the tearing of the cartilage tissue or a rare case of a congenital abnormality called a discoid meniscus, which results in knee pain. 

Causes of Lateral Meniscus Syndrome

Lateral meniscus syndrome often occurs due to excessive weight-bearing and twisting motions to the knee. This occurs usually due to sports activities such as football, basketball and snow skiing, which require a lot of changes in directions and twisting movements. It can also occur due to the gradual wear and tear of tissues that occurs over time. As you grow older, degenerative changes may occur in the knee joint, causing injury with even small movements. Discoid meniscus, a congenital abnormality, is more prone to injuries while performing twisting activities.

Symptoms of Lateral Meniscus Syndrome

The common symptoms of lateral meniscus syndrome may include: 

  • Sharp pain associated with weight-bearing activities, twisting movements, climbing stairs, kneeling or squatting
  • Audible popping or clicking of the knee on the front or back
  • Swelling
  • Weakness 
  • Locking of the knee during certain movements 
  • Feeling of giving way of the knee
  • Tenderness
  • Significant restriction of knee range-of-motion in severe cases
  • Inability to straighten the knee completely

Diagnosis of Lateral Meniscus Syndrome

A thorough medical history and physical examination are performed by your doctor to diagnose lateral meniscus syndrome. Other imaging techniques, such as X-ray and magnetic resonance imaging (MRI), are ordered to confirm the diagnosis. Sometimes, arthroscopy, a procedure where a fiber-optic tube with a light and camera attached, is inserted into the knee to provide your doctor with a better view of the damage and confirm the diagnosis of lateral meniscus syndrome. 

Treatment of Lateral Meniscus Syndrome

Lateral meniscus syndrome is treated with physical therapy and surgery.
Physical therapy: This treatment includes soft tissue massage, use of crutches, electrotherapy (use of electrical energy for healing), hydrotherapy (use of water for treatment), ice or heat treatment, and progressive exercises to enhance strength, balance, and flexibility of the knee joint. Physical therapy helps to optimize the healing process and is recommended before surgery.
Surgery: Severe meniscal injuries would require surgery, especially when you experience locking of the knee. Surgery is performed through arthroscopy, a minimally invasive surgery, by which the torn cartilage is removed or repaired. 

Recovery Following Treatment of Lateral Meniscus Syndrome

If you have a minor lateral meniscus syndrome that is managed conservatively, you can return to sports activities in 2 to 4 weeks. If your condition is treated through surgery, it will take about 4 to 6 weeks for you to fully recover. Your leg will be placed in a soft bandage wrap or brace, and you may be prescribed crutches to help you walk. Surgically treated meniscus syndrome will require 6-8 weeks of physical therapy.

 

 

Articular Cartilage Injury

Articular Cartilage

Articular or hyaline cartilage is the tissue lining the surface of the two bones in the knee joint.  Cartilage helps the bones move smoothly against each other and can withstand the weight of the body during activities such as running and jumping. Articular cartilage does not have a direct blood supply to it so has little capacity to repair itself. Once the cartilage is torn it will not heal easily and can lead to degeneration of the articular surface, leading to the development of osteoarthritis.
 
The damage in articular cartilage can affect people of all ages. It can be damaged by trauma such as accidents, mechanical injury such as a fall, or from degenerative joint disease (osteoarthritis) occurring in older people.

What are the treatment options for articular cartilage injury?

Patients with articular cartilage damage experience symptoms such as joint pain, swelling, stiffness, and a decrease in range of motion of the knee. Damaged cartilage needs to be replaced with healthy cartilage and the procedure is known as cartilage replacement. It is a surgical procedure performed to replace the worn out cartilage and is usually performed to treat patients with small areas of cartilage damage usually caused by sports or traumatic injuries. It is not indicated for those patients who have advanced arthritis of the knee.
 
Cartilage replacement helps relieve pain, restore normal function, and can delay or prevent the onset of arthritis. The goal of cartilage replacement procedures is to stimulate the growth of new hyaline cartilage. Various arthroscopic procedures involved in cartilage replacement include:

  • Microfracture
  • Drilling
  • Abrasion Arthroplasty
  • Autologous chondrocyte implantation (ACI)
  • Osteochondral Autograft Transplantation

Microfracture: In this method, numerous holes are created in the injured joint surface using a sharp tool. This procedure stimulates a healing response by creating a new blood supply. Blood supply results in the growth of new cartilage.
 
Drilling: In this method, a drilling instrument is used to create holes in the injured joint surface. Drilling holes creates blood supply and stimulate the growth of new cartilage. Although the method is similar to microfracture, it is less precise and the heat produced during drilling may damage other tissues.
 
Abrasion Arthroplasty: High-speed metal-like object is used to remove the damaged cartilage. This procedure is performed using an arthroscope.
 
Osteochondral Autograft Transplantation: Healthy cartilage tissue (graft) is taken from the bone that bears less weight and is transferred to the place of the injured joint. This method is used for smaller cartilage defects.
 
Osteochondral Allograft Transplantation: A cartilage tissue (graft) is taken from a donor and transplanted to the site of the injury. Allograft technique is recommended if a larger part of cartilage is damaged.
 
Autologous Chondrocyte Implantation: In this method, a piece of healthy cartilage from another site is removed using the arthroscopic technique and is cultured in a laboratory. Cultured cells from a larger patch which is then implanted in the damaged part by open surgery.
 
Following the surgery, rehabilitation procedures are advised to necessitate healing and to restore the normal functioning of the joint.

Chondral or Articular Cartilage Defects

What is an Articular Cartilage Defect?

The articular or hyaline cartilage is the tissue lining the surface of the two bones in the knee joint. Cartilage helps the bones move smoothly against each other and can withstand the weight of your body during activities such as running and jumping. Articular cartilage does not have a direct blood supply to it, so has less capacity to repair itself. Once the cartilage is torn it will not heal easily and can lead to degeneration of the articular surface, leading to the development of osteoarthritis. 

Causes of Articular Cartilage Defects

The damage of the articular cartilage can affect you regardless of your age. It can be damaged by trauma such as accidents, mechanical injury such as a fall or from degenerative joint disease (osteoarthritis) occurring in older people.

Symptoms of Articular Cartilage Defects

The symptoms of articular cartilage damage include joint pain, swelling, stiffness and a decrease in the range of motion of the knee. 

Treatment of Articular Cartilage Defects

The damaged cartilage needs to be replaced with healthy cartilage. The procedure is known as cartilage replacement. It is a surgical procedure performed to replace the worn-out cartilage and is usually performed to treat small areas of cartilage damage usually caused by sports or traumatic injuries. It is not indicated for advanced arthritis of the knee. 

Cartilage replacement helps relieve pain, restore normal function, and can delay or prevent the onset of arthritis. The goal of cartilage replacement procedures is to stimulate the growth of new hyaline cartilage. Various arthroscopic procedures involved in cartilage replacement include:

  • Microfracture 
  • Drilling 
  • Abrasion arthroplasty 
  • Autologous chondrocyte implantation (ACI) 
  • Osteochondral autograft transplantation

 

 

Failed Meniscus Repair

Meniscus

The meniscus is a C-shaped cartilage that functions as a cushion between the long bones of the shin and thigh. Forceful twisting of the knee while bearing weight on it can result in a torn meniscus. Small tears in the meniscus often heal with rest. Moderate tears on the outer edge of the meniscus tend to respond favorably to surgical repair. However, the deeper the tear, the less likely it is to heal after surgical repair. This is because the center of the meniscus has no blood supply when compared to the outer one-third of the meniscus. 

Failed Meniscus Repair

Meniscal repair may be performed either by open surgery under direct vision or minimally invasively using an arthroscope, which is a thin tube fitted with a camera that can be inserted into the knee through a very small incision to locate and repair the damaged meniscus.

Three months following meniscal repair if pain and disability persist, a failed meniscal repair may be suspected and can be confirmed by performing a repeat arthroscopy.

Factors that may cause a failed meniscal repair include:

  • Patients older than 40 years of age
  • Delayed treatment
  • Ragged, degenerative and complex tears 
  • Full-thickness tear 
  • Tears in the inner margin that lack blood supply

Following a failed meniscal repair, your doctor will recommend conservative therapy with pain medication and activity modification if the symptoms are minimal. If a residual tear is diagnosed, the meniscus may be trimmed before considering a second surgical repair of the meniscus. 

Meniscal Transplantation

Meniscal Transplantation

Meniscal transplantation is a surgical procedure to replace the damaged meniscus of the knee with healthy cartilage.

The meniscus is a C-shaped cartilage ring that acts as a cushion between the shinbone and the thighbone. Each of your knees has two menisci - one on the inside (medial aspect) and the other on the outside (lateral aspect)of your knee. Apart from the cushioning effect, the menisci also provide stability to the knee.

A meniscal tear is a common knee injury that usually occurs secondary to trauma and is common in athletes. A meniscal tear may also occur in the elderly due to degenerative changes in the knee. A damaged meniscus predisposes you to persistent pain, swelling, and arthritis.
Treatment of a meniscal tear depends on its type, severity, and location of the tear.  Non-surgical options for the treatment of meniscal tears may include ice application, rest, elastic bandage, elevation, and physical therapy. However, a badly damaged meniscus may have to be removed. Knee replacement may be an option to consider in older individuals. However, meniscal transplantation can be an alternative option in younger patients.

Indications and Contraindications

The eligibility criteria for meniscal transplantation include:

  • Young to middle-aged patients (below 50 years of age)
  • Patients with stable, well-aligned knees
  • Patients with intact or minimally damaged articular cartilage in the joint
  • Patients who have already undergone a prior meniscectomy (removal of meniscus)
  • Patients who complain of persistent activity-related pain
  • Meniscal transplantation is not recommended for patients with severe arthritic changes within the joint

Diagnosis

A diagnosis of meniscal tear as a cause of knee pain comprises of a medical history along with the presenting symptoms followed by a physical examination of the knee. Your doctor may also order a few imaging studies such as an X-ray and MRI scan of the knee to rule out other possible diagnoses. X-rays help to identify degenerative changes such as osteoarthritis which can cause knee pain. MRIs help to visualize the menisci and assess the location and severity of the injury.

Procedure

  • The goal of meniscal transplant surgery is to reduce pain and prevent arthritic changes. The surgery is performed under general anesthesia on an outpatient or inpatient basis.
  • The procedure is usually performed with the help of an arthroscope (a fiber optic instrument), which is used to visualize the internal structures of the knee. A tiny camera is attached to one end of the arthroscope which transmits the internal images of the knee to a TV monitor. The arthroscope allows the surgeon to evaluate the entire knee joint including the cartilage, ligaments and the joint lining.
  • The cartilage used for transplantation is derived from a human cadaver donor.  The healthy donor cartilage is preoperatively customized to fit the patient’s knee.
  • For the surgery, a surgical incision is made over the front of the knee in the area of the damaged meniscus. The damaged meniscus is removed and the site is prepared to receive the new meniscal implant. 
  • The new meniscus is implanted at the proper site under arthroscopic guidance. The new meniscus is then sutured to the surrounding tissue, for which an additional small incision is required. Screws or other fixation instruments are used to secure the meniscus in place.
  • Depending on the severity and nature of the damage, additional procedures such as ligament or cartilage repair may also be performed along with the meniscal transplant.

Post-Operative Care

Following the surgery, you will be advised to wear a knee brace to support and protect the knee for the first 1 to 6 weeks. You will be required to use crutches after the surgery, to avoid any pressure or stress over the operated knee. You can start moving soon after the surgery to prevent knee stiffness. Pain relieving medications will be prescribed to control pain. A physical therapy program will help to restore the range of motion and strength of your knee. You may be able to resume work after a few weeks or a few months, depending on the nature of your work. It may take 6 to 12 months for you to return to playing sports.

Risks and Complications

Possible complications associated with meniscus transplantation include:

  • Stiffness of the knee
  • Persistent pain
  • Infection
  • Bleeding
  • Nerve injury
  • A tear of the new meniscus
  • Incomplete healing
  • Transplant dysfunction
  • Small risk of disease transmission from the transplant