Meniscus surgery
Dr. med. Fabian Sinowatz is a freelancer in the medical editorial team.
More about the experts All content is checked by medical journalists.The meniscus operation is one of the most frequently performed surgical interventions in Germany. The aim of meniscus surgery is to fully restore the ability to move in the knee. Whenever possible, attempts are made to reconstruct the normal anatomical relationships as well as possible during meniscus tear therapy with meniscus refixation. Surgery is not necessary in all cases of meniscus injury. In many cases, conservative meniscus therapy without surgery is sufficient. Read everything you need to know about meniscus surgery here.
ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. S83M23
When is meniscus surgery necessary?
Experts differ widely about the benefits of meniscus surgery. Some doctors argue that any meniscal tear requires surgery or arthroscopy. Almost as often, however, it is argued that most cases of meniscus injuries are not as pronounced and that an operation is usually unnecessary.
What is certain is that the treatment method for a meniscus tear depends on various influencing factors and there is no general recommendation for meniscus damage treatment. The choice of form of therapy depends on the severity of the pain, the age and the demands on the resilience of the menisci. The goal of meniscus surgery is always to preserve as much meniscus tissue as possible and to restore mobility to the fullest possible extent.
Meniscus tear without surgery
Sometimes a meniscus tear can be treated without surgery. This is the case, for example, with rather small cracks. Injuries in the outer zone of the meniscus that is well supplied with blood (outer edge of the meniscus on the joint capsule) can sometimes heal on their own. In this case, doctors speak of conservative (non-surgical) meniscal tear therapy. The meniscus tear is treated with pain relievers, cortisone injections and physiotherapy. The knee should be spared as much as possible in the first time after the meniscus injury. After a few weeks, light exercise exercises are started. Your doctor or physiotherapist will show you exactly how to proceed. Even with degenerative changes in the meniscus, a meniscus tear is treated without surgery. If, however, pain repeatedly occurs in the meniscus or if the examination reveals that parts of the meniscus have loosened from the tear and are now in the joint space, there is no way around meniscus surgery.
Before the meniscus operation
Before a meniscus tear operation, the affected knee must be thoroughly examined. In addition to the physical examination, magnetic resonance imaging (MRI) is usually performed. The attending physician can use the images to determine where the meniscus is damaged. In addition, it can be used to rule out that the pain in the knee originates from other structures such as ligaments or cartilage tissue. Depending on the result of the MRI, we choose the appropriate treatment method. In many cases, however, only an arthroscopy can show how great the damage actually is. Then the surgeon decides during the arthroscopy which method of meniscus surgery to use.
Meniscal surgery: surgical methods
With the arthroscopic and the open meniscus operation, two types of meniscus operation are available. While the operation was mostly open in the past, arthroscopic meniscus surgery is the method of choice today. The procedures are performed under regional anesthesia or sometimes under general anesthesia.
Arthroscopy
Arthroscopy (joint mirroring) is a so-called minimally invasive method. This means that during meniscus surgery, instead of making a single large incision, instead two to three smaller incisions are made. A rod-shaped camera is inserted through the first incision, which transmits live images from inside the knee joint to a monitor. The surgeon's surgical instruments are inserted through the other incisions and are used to remove torn parts or to create a meniscus suture. The advantage of an arthroscopy is that the small injuries to the skin heal more quickly and that no large scar remains after the meniscus operation.
Open method
In some cases, open meniscus surgery is preferred to arthroscopy. The open method is used, for example, when not only a meniscus tear treatment is to be carried out, but also damage to ligaments in the knee joint or to the joint capsule has been found. In the open surgical method, the knee is opened with an approximately five centimeter long incision, which is sutured again after the meniscus operation. As a rule, the sutures can be removed about ten days after the meniscus operation.
Meniscus Surgery: Surgical Techniques
Regardless of whether the operation is arthroscopic or open, the following surgical techniques are available for meniscus surgery:
- Meniscus refixation (meniscus suture)
- Partial meniscus removal (partial meniscus resection)
- Meniscus replacement (installation of an artificial meniscus)
Meniscus refixation (meniscus suture)
During meniscus refixation, the torn meniscus tissue is sutured back to healthy parts of the meniscus and the knee joint capsule. For this purpose, the edges are smoothed, the tissue is brought into its original position and held in this position by special absorbable materials. A distinction is made between different procedures for meniscus refixation (outside-in, inside-out, all-inside and refixation with resorbable arrows).
A meniscus refixation is only possible if the meniscus tear does not extend through the entire meniscus and the meniscus is still attached to the capsule so that it can be sutured on there again and continues to be supplied with blood vessels. A meniscus suture is basically the best method, as it can largely restore normal anatomical relationships. Unfortunately, the meniscus suturing is not possible in all cases, as the damage at diagnosis is often too great.
After a meniscus refixation, the knee may only be moved very carefully for a few weeks so that the meniscus tissue can completely heal again. Overall, the build-up of load is much slower and more dosed than after a meniscus resection. In the first time after a meniscus refixation, you will receive a splint. After about three weeks, you can begin to partially put weight on the knee again. After about two months, light sporting activities such as swimming, cycling or weight training can be resumed.
Meniscus surgery: meniscus resection
In meniscus resection, either only the torn off piece of the meniscus (partial meniscus resection) or the entire meniscus (meniscus resection) is removed. A meniscus resection is used in meniscus surgery if individual parts of the meniscus have completely detached, if degenerative changes can be seen in the knee or if the tear is older and the torn off parts are no longer supplied with blood vessels. A meniscus resection can be done on an outpatient basis, as those affected can walk cautiously again on the same day with the help of forearm crutches. Physiotherapy exercises are started in the first few weeks after the operation. In the case of mostly sedentary activities, work can be resumed after one to two weeks.
Meniscus surgery: meniscus replacement
A method of meniscus resection that has been known for a long time, but is constantly being developed, is meniscus replacement. The damaged meniscus is completely removed and a replacement model made of polyurethane, collagen or from a human donor (meniscus transplant) is used. Before such a meniscus replacement is implanted, it is precisely adapted to the size of your own meniscus. The implantation is minimally invasive as part of an arthroscopy.
The advantages of this method are that, in the best case, the removed meniscus tissue can regenerate itself. The disadvantage is the very long follow-up treatment of this special meniscus operation, which takes several months. To date, there is not enough study data available to be able to definitively assess the quality of this procedure. Meniscus replacement is therefore not (yet) one of the standard procedures in meniscus surgery.
A donor meniscus is particularly recommended for young patients who are likely to have osteoarthritis of the knee (joint wear) and other knee problems due to the meniscus damage. Donor menisci mostly come from fatally injured people who agreed to donate before their death.
Risks of meniscus surgery
As with all other operations, meniscus surgery involves certain risks. Postoperative bleeding can occur during meniscus surgery, especially with the open surgical method. In addition, during an operation there is always the risk of germs getting into the wound and causing an infection. An infection in the knee joint is a very unfavorable complication, as the inflammation can also seriously damage the knee joint cartilage. In meniscus surgery, however, such cases are rare, as the procedure is performed under sterile conditions.
In rare cases, the pain persists even after meniscus surgery or returns after a certain period of time. With a meniscus replacement, there is also the risk that the implant will also tear. In addition, a meniscus replacement after meniscus surgery can result in an effusion in the knee that requires a puncture of the knee. Overall, however, such aftereffects are very rare. Of course, even after a one-time meniscus operation, there is still the risk that the meniscus will tear again. That must be treated surgically again.
Course of the disease and prognosis
In many cases, meniscus surgery can be done on an outpatient basis, so that you can usually go home yourself on the day of the operation. Depending on the type of meniscus operation and the size of the meniscus damage, a longer or shorter healing phase is required.
In the case of meniscus refixation, it takes months before a full load on the knee is possible again. If you put weight on the knee too soon, the scarring will be disturbed and healing will be delayed. In addition, you risk another tear in the not yet fully healed tissue. After about four to six weeks, you can put full weight on the knee again. Usually it takes a total of two to three months for the knee to be almost as resilient as it was before the meniscus operation. After removing part of the meniscus, only a few days are necessary before you can put weight on the knee again. With a meniscus replacement, on the other hand, you should plan a period of a few weeks as with the meniscus suture.
After each meniscus operation, individual physiotherapy takes place, during which your knee slowly gets used to the movement again and the muscles are strengthened. The exercises that you learn in physiotherapy should also be performed at home to better aid healing. After a successful meniscus operation and a structured follow-up treatment without further complications, you can usually put the weight on your knee after the meniscus operation almost as it was before the injury.
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