Meniscectomy is a surgical procedure which is designed to remove a part or all of torn meniscus. Meniscus tear is one of the most common knee joint injuries. Orthopedic surgeons who generally perform meniscectomies will determine surgical intervention based upon the ability of meniscus to heal while keeping in mind the age, activity level & health of the patient. Surgeons are most likely to suggest this treatment if they think it will work best for the patient based upon the location & pattern of the tear & how big or small it is. Moreover, in some cases surgeons will make the final decision during surgery.
- When patients have small tear located at the outer edge of meniscus, in which area the doctors call the ‘red zone’, home treatments would be a good option as these tears quite often heal by themselves with rest.
- When the patient is having moderate to large tear located at the outer edge of meniscus (red zone), surgery can be a good option. This type of tear is found to heal well following surgical intervention.
- When the patient is having tear which has spread from red zone into inner two-thirds of meniscus, called the white zone, it is quite hard to make a decision. Surgery for repairing these types of tears, usually do not work out well.
- When patients are having tears in the white zone of meniscus, surgery for repair is usually not done because meniscus is unlikely to heal. However, partial meniscectomy may be performed in case torn pieces of meniscus are causing swelling & pain.
There are many different types of meniscus tears. However, it is the pattern of tear which usually determines whether the tear can be repaired or not. Flap & horizontal tears typically require to be surgically removed of at least some part of the meniscus.
Decision to remove part or all of meniscus will take into consideration, length, location & pattern of tear along with stability of tear & the condition of whole meniscus as well. Orthopedic surgeons will also consider the age of patient, condition of the entire knee alongside age or injury related degeneration. In case meniscus tear is causing swelling or pain, it would most probably mean that torn pieces of meniscus are required to be removed & edges to be surgically shaved in order to smoothen, the remaining portion of meniscus. In such a situation, orthopedic surgeons will try & preserve as much as meniscus tissue as is possible in order to prevent long-term degeneration of the knee & to allow the patient to be able to return to full level of activity.
There are three types of surgeries for torn meniscus, though complete meniscectomy is avoided wherever possible. Partial meniscectomy accounts for a large majority of surgeries. Moreover, nowadays almost all types of meniscectomy procedures are performed arthroscopically. Arthroscopic meniscectomy involves small incisions which are made for inserting a flexible tube with an attachment of miniature camera & a light source. The arthroscopic procedure is guided by images provided by the camera. Tiny surgical instruments are also placed at the tip of another tube inserted through other tiny incisions for performing the surgical procedure.
- Partial Meniscectomy – Involving removal of torn meniscus tissue, partial meniscectomy is an ideal surgical intervention for knee meniscus tears. However, it is best to save as much meniscus as possible since it serves an important function in knee. This is why partial meniscectomy involves removing only the torn piece of meniscus, while keeping the undamaged piece of meniscus in place. Typically performed arthroscopically, a tiny shaver is used for removal of torn part of the meniscus. This procedure is however different than surgery for meniscus repair which involves suturing together torn portions of meniscus & allowing it to heal.
- Meniscus Repair – Involving repairing torn meniscus tissue which can heal, meniscus repair surgery is far less common than partial meniscectomy since repair can only be done when tear are in the ‘red zone’ outer edge area of meniscus (area having blood supply). Moreover, there are other factors which can also limit success of this surgical procedure. Like for example, tears in cartilage which are very thin or worn or complex tears are less likely to respond well to repair. Spine surgeons will either use sutures or small bio-absorbable tacks to put together & sew pieces of meniscus.
- Complete Meniscectomy – Complete meniscectomy involves total removal of meniscus. This used to be a common procedure in the past, but now it is avoided as far as possible since absence of meniscus is found to lead to bone-on-bone friction & which results in arthritis. Moreover, there are some physicians who also believe that there is an open issue as to whether partial meniscectomy also causes or accelerates arthritis.
Since there are important limitations to meniscus repair & other factors like longer time for recovery, partial meniscectomy is a common procedure when compared with meniscus repair. This is a major reason as to why a large majority of meniscal tear surgery procedures involve partial meniscectomy. Out of more than 850,000 meniscus surgeries performed each year in the United States, only about 7 percent of these involve meniscus repair.
Choice of type of surgery is normally based upon the age & activity level of the patient, size & location of tear, the surgeons’ experience & the preference of the patient. Orthopedic surgeons quite often perform meniscus surgery as an arthroscopic procedure which involves both examination & repair inside the joint. An arthroscope which is a thin tube containing light & camera is inserted through a small incision near the knee joint. Surgical instruments are inserted through other small incisions near the operating site. Arthroscopic surgery can limit damage to knee from surgery & can effectively promote full recovery. However, there may be some tears which will require open knee surgery. Entire meniscus is removed in total meniscectomy while partial meniscectomy involves removing as little meniscus as possible. The partial meniscectomy procedure removes only the unstable meniscal fragments & the remaining meniscus edges are only smoothed so as to leave no frayed ends. Regional or general anesthesia is administered for meniscectomy procedure. Moreover, arthroscopic partial meniscectomy is commonly performed as an outpatient procedure.
Rehab generally varies depending upon the injury & the type of surgery which was performed along with the patients’ activities, health status, age & the orthopedic surgeons’ preference. Though time periods for recovery vary, but meniscus surgery is normally followed by a period of rest, then walking & selected exercises. Most patients who have undergone arthroscopic meniscus surgery can generally bear body weight within a day or two following surgery & can also return to full activity within 2 – 4 weeks of time. Most patients can usually return to previous level of activity after full range of motion is possible without pain. However, time frame for returning to walking, driving & vigorous activity will depend upon type & extent of surgery & the patients’ success in rehabilitation. Nevertheless, all patients must learn to perform some regular exercises at home with the doctors’ approval.
Meniscectomy surgery is generally well tolerated by patients & normally does not cause any complications. But then there is risk of damaging nerves during operation. Moreover, there is a direct relationship between amount of meniscus tissue which is surgically removed & distribution of load across knee. Therefore, when more tissue is removed, lesser will the knee be able to sustain load of walking, running & of other activities. With uneven distribution of load, degeneration of knee joint may also happen faster than it would normally have with intact meniscus. Finally, there is risk of bleeding or infection or with regional or general anesthesia, like it is with any other type of surgery. Surgical repair is however most often favored over total or partial meniscectomy. Whenever it is possible to successfully repair meniscus would be the best option since it reduces risk of knee joint degeneration which may invariably occur with removal of part or all of meniscus.
Complications can be classified as those relating to knee arthroscopy in general & those which are specifically associated with arthroscopic partial meniscectomy. However, complication rates are extremely low, about 1.78 percent & 1.48 percent for medial & lateral meniscectomy, in the hands of experienced arthroscopy surgeons. Some enumerated complications include ligament injury, accidental damage to chondral surfaces, injuries to blood vessels & nerves & breakage or instrument failure. Instrument failure rates have also significantly dropped (18.1% to 2.9%) over the years due to better skill levels of surgeons, better designs & considerable improvement in surgical techniques. Moreover, medial collateral ligament can also get injured due to excessive valgus forces while attempting access to medial compartment. Similarly, blood vessels & nerves may get damaged while inserting sharp instruments. Clumsy & improper handling of instruments during operation can gouge articular surface & cause damage. Incomplete removal of torn pieces of meniscus can also cause persistent pain along with coexisting knee pathology. Therefore, proper adherence to basic principles governing partial meniscectomy will be immensely helpful in avoiding all of the above complications.
Although removing complete meniscus generally reduces some of the symptoms, but losing whole meniscus reduces stability & cushioning of the joint. Most of the patients, especially the ones who are young & active are not satisfied with total meniscectomy. This is the reason as to why orthopedic surgeons try to remove as little of meniscus as is possible. Studies conducted on partial meniscectomy show that 78 to 88 percent patients have good results following partial meniscectomy. Effectively, this means that about 78 to 88 people out of one hundred, who underwent meniscectomy surgery, had experienced decreased symptoms, & were able to return to all or most of their activities.
Rising costs of healthcare in developed countries due to a variety of reasons has pushed the common man to seek good quality & yet affordable medical procedures elsewhere. Many countries across continents have grabbed this opportunity & have made it a state policy to adopt measures which can promote healthcare tourism. They have provided incentives to private hospitals & softened rules & regulations within the healthcare sector. Many of them have also eased laws to enable international patients avail medical visas for health care travel quite simple. After over a decade or so now, capitalizing on the world-wide-web boom & convenience of comfortable travel options, patients seeking medical solutions abroad have grown multifold. Nowadays, it is common for people to look around for excellent & low-cost medical solutions which are available anywhere in the world.
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