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The Orthopaedic Center, P.A.
2112 F Street NW, Suite 305
Washington D.C. 20037

Phone: (202) 770-1447
Appointments: (202) 912-8480
Fax: (202) 912-8484

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Meniscus Procedures

Meniscus Repair

The meniscus is the C-shaped piece of cartilage located between thighbone and shin bone that act as shock absorbers and cushion the joints. The two meniscus distribute the body weight uniformly across the joint, increases the stability of the knee and avoids the pressure on any one part of the joint and development of arthritis. Being the weight bearing part, the meniscus is prone to wear and tear and a meniscal tear is one of the common knee injuries. Meniscal tears may occur in people of all ages and is more common in active individuals or whom play sports.

On the pattern of tear, meniscal tear may be of different types such as longitudinal, parrot-beak, flap, bucket handle, and mixed/complex tear. Sudden twist, squat, or tackle may be the cause for meniscal tear in adults and ageing may cause the tear in elderly individuals. Meniscal tear may cause severe pain, stiffness and swelling, catching or locking of the knee, and may limit the movement. Meniscal tear is often diagnosed with the presenting symptoms and imaging techniques such as X-rays or magnetic resonance imaging scan.

Symptomatic and immediate treatment for meniscal tear is the R.I.C.E (Rest, Ice, Compression, and Elevation) and use of nonsteroidal anti-inflammatory medications. Surgery is recommended in severe cases and may be performed using arthroscopic technique. Your surgeon may also order for rehabilitation program following the surgery for better and quicker recovery.

Meniscectomy Surgery is performed in a hospital operating room under general, regional, or local anesthesia. The arthroscope is a small fiber-optic viewing instrument made up of a tiny lens, light source and video camera. The surgical instruments used in arthroscopic surgery are very small (only 3 or 4 mm in diameter), but appear much larger when viewed through an arthroscope.

The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the knee at cartilage and ligaments, and under the kneecap.

Then the surgeon makes two small incisions (about 1/4 of an inch), around the knee joint area. Each incision is called a portal. In one portal, the arthroscope is inserted to view the knee joint. Along with the arthroscope, a sterile solution is pumped into the joint which expands the viewing area, giving the surgeon a clear view and room to work. The other portal is used for the insertion of tiny surgical instruments.

With the images from the arthroscope as a guide, your surgeon can look at the menisci and confirm the type, location, and extent of the tear. Once your surgeon has located the meniscal tear, surgical scissors and shavers are inserted into the portals to remove the torn menisci.

Meniscus Transplantation

Meniscal transplantation is a surgical procedure to replace a missing or severely injured meniscus of the knee with healthy cartilage from an organ donor.

The meniscus is a C-shaped cartilage ring that acts like 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. Nonsurgical 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 a 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.

Postoperative 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
  • Tear of the new meniscus
  • Incomplete healing
  • Transplant dysfunction
  • Small risk of disease transmission from the transplant
  • Weakness of the knee

Meniscal transplantation involves replacement of the damaged meniscus with cartilage from a donor. Meniscal transplantation cannot be performed in all patients with a meniscal tear. If you already have arthritic changes in your knee, a meniscal transplant may not be helpful. It is considered in young patients with stable, well-aligned knees. In the eligible group of patients a meniscal transplant can offer significant pain relief.

Meniscectomy

Meniscectomy is a surgical procedure indicated in individuals with torn meniscus where the conservative treatments have failed to relieve the pain and other symptoms. Meniscectomy is recommended based on the ability of meniscus to heal, patient’s age, health status and activity level.

Meniscus is the C-shaped two pieces of cartilage located between thighbone and shin bone that act as shock absorbers and cushion the joints. Meniscus distributes the body weight uniformly across the joint and avoids the pressure on any one part of the joint and development of arthritis. Being the weight bearing part, meniscus is prone to wear and tear and meniscal tear is one of the common knee injuries. Meniscal tear may be developed by people of all ages and is more common in individuals who play contact sports.

On the pattern of tear, meniscal tear may be of different types such as longitudinal, parrot-beak, flap, bucket handle, and mixed/complex tear. Sudden twist, squat, or tackle may be the cause for meniscal tear in adults and ageing may cause the tear in elderly individuals. Meniscal tear may cause severe pain, stiffness and swelling, catching or locking of the knee, and may limit the movement. Meniscal tear is often diagnosed with the presenting symptoms and imaging techniques such as X-rays or magnetic resonance imaging scan.

Conservative treatments for meniscal tear include R.I.C.E (Rest, Ice, Compression, and Elevation) and use of nonsteroidal anti-inflammatory medications. Surgery is recommended in severe cases and may be performed using arthroscopic technique. Depending on the extent of tear, your surgeon will decide on whether to perform total meniscectomy (complete removal of torn meniscus) or partial meniscectomy (unstable meniscal fragments are removed and intact tissue is left in place and the edges are smoothened. Your surgeon may also order for rehabilitation program following the surgery for better and quicker recovery.

Arthroscopic Meniscectomy

The arthroscope is a small fiber-optic viewing instrument made up of a tiny lens, light source and video camera. The surgical instruments used in arthroscopic surgery are very small (only 3 or 4 mm in diameter), but appear much larger when viewed through an arthroscope.

The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the knee at cartilage and ligaments, and under the kneecap.

Then the surgeon makes two small incisions (about 1/4 of an inch), around the knee joint area. Each incision is called a portal. In one portal, the arthroscope is inserted to view the knee joint. Along with the arthroscope, a sterile solution is pumped into the joint which expands the viewing area, giving the surgeon a clear view and room to work. The other portal is used for the insertion of tiny surgical instruments.

With the images from the arthroscope as a guide, your surgeon can look at the menisci and confirm the type, location, and extent of the tear. Once your surgeon has located the meniscal tear, surgical scissors and shavers are inserted into the portals to remove the torn menisci. In total meniscectomy entire menisci is removed and in partial meniscectomy only the torn part of the tissue is removed leaving the intact tissue in place with edges smoothed.

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