Menisectomy

Meniscectomy is a surgical procedure that involves the partial or complete removal of the meniscus, a crucial structure within the knee joint. This procedure is commonly performed to alleviate pain and improve knee function in individuals who have sustained meniscal injuries or degenerative changes.

Meniscal injuries can occur because of traumatic events, such as sports-related injuries, or due to degenerative changes over time. The primary indications for meniscectomy include:

• Meniscal Tears: Meniscal tears are one of the most common reasons for undergoing meniscectomy. These tears can be caused by sudden twisting motions or repetitive stress on the knee joint. Depending on the location and severity of the tear, a partial or complete meniscectomy may be recommended.
• Degenerative Changes: As individuals age, the meniscus can undergo degenerative changes, becoming more brittle and prone to tearing. In cases where conservative treatments fail to provide relief and mechanical symptoms exist, a meniscectomy may be considered to manage pain and discomfort.
• Loose Fragments: Sometimes, small fragments of the meniscus and/or cartilage can become dislodged within the joint, causing pain and limited mobility. Surgical removal of these loose fragments through meniscectomy can alleviate these symptoms.

When symptoms persist with conservative management, arthroscopic knee surgery may be needed. Arthroscopy, a minimally invasive surgical technique, is commonly used for meniscectomy. During arthroscopy, small incisions are made, and a tiny camera is inserted into the joint, allowing the surgeon to visualize and perform the procedure with precision. The advantages of arthroscopic meniscectomy include smaller incisions, reduced scarring, and quicker recovery times.

There are two primary approaches to meniscectomy: partial and total (complete) meniscectomy.

• Partial Meniscectomy: In a partial meniscectomy, the surgeon removes only the damaged or torn portion of the meniscus, leaving as much healthy tissue intact as possible. This approach aims to preserve the meniscus’s function in stabilizing the knee joint and distributing forces. A partial meniscectomy for the treatment of degenerative meniscus tears may be recommended when conservative management fails to provide relief and especially when patients exhibit mechanical symptoms.
• Total (Complete) Meniscectomy: A total meniscectomy involves the complete removal of the meniscus. This approach is typically reserved for cases where the meniscus is severely damaged and cannot be salvaged. While it may provide short-term relief, it can increase the risk of long-term joint degeneration.

Rehabilitation plays a crucial role in the success of meniscectomy. Patients typically undergo a structured rehabilitation program to optimize knee function and minimize the risk of complications. The rehabilitation process typically follows these general stages:

• Immediate Postoperative Period: In the first few days after surgery, the focus is on pain management, swelling reduction, and regaining knee mobility. Crutches are usually not required unless a concomitant procedure such as ACL reconstruction was performed.
• Early Mobilization: As the knee heals, physical therapy begins to improve range of motion and strength. Exercises may include gentle flexion and extension movements and isometric exercises to maintain muscle tone.
• Progressive Strength Training: Over several weeks, the rehabilitation program progresses to include more intensive strength and stability exercises. These aim to rebuild the muscles around the knee joint, as well as core muscles to provide better knee and pelvic support.
• Functional Training: The final stage of rehabilitation involves functional training, which includes activities that mimic real-life movements. This phase aims to restore normal daily activities and may include agility drills and sports-specific exercises for athletes.
• Return to Activity: The timing for a return to sports or strenuous activities varies depending on individual healing and the extent of meniscectomy but is in the range of 6-8 weeks.