Meniscal tears rarely heal by themselves. If they are to heal, they generally require key hole surgery (arthroscopy) to repair the tear. However, meniscal tears closer to the joint lining have a much higher chance of healing. The menisci have a very limited blood supply. Thus, a meniscal tear at the edges of the meniscus on the inside of the knee have a very low chance of healing. It is important to remember that not all meniscal tears can be repaired and many tears do not require surgery.
Description of Meniscus Surgery
In general, Mr Sethi will always try to preserve the meniscal tissues to prevent further development of osteoarthritis, especially if there is a concurrent ACL reconstruction performed to prevent the graft from stretching out over time. He has found the use of multiple sutures allows the meniscus to be put back into its anatomic position and also provides extra stability to the meniscus such that early range of motion can be implemented.
In the case of a non-repairable tear, Mr Sethi will try to preserve as much meniscal tissue as possible and will trim and contour the area of the tear such that it has a lower risk of tearing further over time. In all patients who have meniscal tissue removed, they must be educated to make sure if they have any problems with pain or swelling that they return to be evaluated.
The rehabilitation program for postoperative meniscus surgery depends upon the other concurrent surgeries. It has been well demonstrated for patients with a meniscus repair and a concurrent ACL reconstruction that one can start early weight bearing and range of motion and have a very high chance of healing. We believe this is because of the growth factors and stem cells that are released from drilling the ACL reconstruction tunnels.
In the case of an isolated meniscus surgery repair, we have patients work on a range of motion from 0-90° for the first six weeks and then increase their knee flexion as tolerated. However, they are partial-weight bearing for six weeks. In order to maximise healing of the meniscus.
In general, we recommend patients who have meniscus repairs avoid deep squatting, sitting cross-legged or performing any heavy lifting or squatting activities for a minimum of three months postoperatively to give the the meniscus the best chance for healing.
A well guided physical therapy protocol is essential to maximise outcomes after a meniscus surgery repair. It is important for the patient to follow the protocol, avoid participating in certain high impact, contact, or twisting activities and to closely follow the rehabilitation program recommended to maximise their surgical outcomes.
Meniscal Root Injury
The root attachments of the posterior horns of the medial and lateral meniscus are very important for joint health. When these are torn, the loading of the joint is equivalent to having no meniscus on the affected side. Thus, these patients can often have early onset arthritis. For this reason, much research has gone in to meniscus root repairs over the last several years.
Description of a Meniscus Root Repair
The technique of a meniscus root repair involves isolating the root, placing a minimum of 2 sutures in the remaining meniscal attachment, and trying to reposition it back to a more anatomic position.
After sutures are placed arthroscopically into the meniscal attachment, a small diameter tunnel, is drilled to the meniscal root attachment site, the sutures are pulled down the tunnel, and tied over a button on the anterior cortex of the tibia.
Post-Operative Protocol for Meniscus Root Repair
Progression of range of motion is more limited than for a standard meniscus root repair, usually limiting patients to 0-60 or 0-90 degrees range of motion for the first 4 weeks and then slowly increasing range of motion as tolerated. Patients are allowed to initiate weightbearing at 6 weeks, but should avoid any significant squatting, squatting and lifting, or sitting cross-legged for a minimum of 5-6 months. They may start the use of a stationary bike, and may slowly wean off crutches starting at 6 weeks post-operatively.