Frequently Asked Questions
What Non-surgical treatments are available for meniscal tears?
Non-operative measures should be attempted prior to consideration of arthroscopic knee surgery.
Pain medication: Tylenol is typically recommended as the first-line pain medication. Some patients with liver disease may not be able to tolerate regular Tylenol. Anti-inflammatory medications are also helpful but are not suitable for all patients. Patients with cardiac disease, high blood pressure, kidney disease, and/or stomach ulcers may not be able to take regular anti-inflammatory medications. Regular opioid medications are not recommended due to risk of addiction and development of chronic pain. Patients should consult with their family doctor prior to starting any new medication.
Physiotherapy: Physiotherapy to decrease swelling, improve range of motion, and strengthen your quadriceps and hamstrings are often helpful for reducing symptoms of meniscal tears.
Injections: Local knee injections can be helpful for certain meniscal tears. Consult your surgeon to determine if an injection would be indicated for you.
When is surgery necessary for a meniscal tear?
Arthroscopic meniscal surgery is indicated in patients with unstable meniscal tears who have residual symptoms after attempted non-operative treatment. In addition, there should be no evidence of arthritis in the knee.
In some cases, patients present with a âlocked kneeâ where there is an inability to fully extend the knee. This is usually due to a âbucket handle tearâ of the meniscus where a piece of the meniscus tears and flips into the joint. Patients with a bucket handle tear of the meniscus require urgent surgery order to restore normal knee range of motion.
What is keyhole (arthroscopic) surgery?
A knee arthroscopy is a âkeyholeâ procedure that allows the surgeon to view the knee joint through small incisions (approximately 5-7mm). An arthroscope (small surgical camera) is inserted into your knee joint which displays the images on a video monitor. Sterile fluid is infiltrated into your knee joint to improve the video quality. Special surgical instruments can also be inserted through the small incisions to perform meniscal trimming, shaving, repair, debridement, and ligament reconstruction.
When do you trim the meniscus (partial menisectomy) vs. repair?
The decision to trim (partial menisectomy) or repair the meniscus depends on a type and location of the tear. Unstable flap tears are usually treated with a partial meniscectomy. Longitudinal tears near the periphery of the knee can often be repaired due to improved blood supply of the meniscus in that area. In general, it is preferable to preserve the native meniscus if possible. However, meniscal repair is associated with a higher rate of re-tear and repeat surgery. The success rates of meniscal repair are approximately 70-80%.
I have knee arthritis and a meniscal tear. Can I have keyhole surgery to âclean upâ the knee?
Degenerative meniscal tears are very common in the setting of arthritis. In early arthritis, degenerative tears are successfully treated with non-operative measures. In advanced arthritis, a partial or total knee replacement may be indicated.
Multiple studies that have shown that knee arthroscopy to âclean outâ the knee and trim the meniscus has no benefit in arthritic knees.
What is the expected recovery for an arthroscopic partial menisectomy?
Patients who undergo arthroscopic partial menisectomy are discharged from the hospital the same day of surgery. It is normal to have pain in the knee for several days or even weeks after surgery. During surgery, fluid is infiltrated into the knee joint to improve the video quality. It is normal to have some drainage of clear fluid or small amounts of blood from the incision site for several hours after the procedure.
You will typically be allowed to place weight on your leg and start range of motion exercises in your knee immediately after surgery. Most patients feel comfortable with day-to-day activities 1-2 weeks after surgery. Full recovery is usually 4-6 weeks after surgery
What is the expected recovery for an arthroscopic meniscal repair?
Patients who undergo arthroscopic meniscal repair are discharged from the hospital the same day of surgery. The recovery following a meniscus repair is longer than after a partial menisectomy. After surgery, patients are usually placed in a knee immobiliser to keep their knee straight. Patients are usually partial weight-bearing for 4-6 weeks after a meniscal repair to allow the meniscus to heal. Range of motion is also limited from 0-90 degrees for the first six weeks after surgery.
Most patients feel comfortable with day-to-day activities 6-8 weeks after surgery. Full recovery including return to sport can take up to 6 months.
When can I go back to work?
All patients recover differently after surgery. The decision on when to return to work is variable and depends on you and your type of job. As a guide, most people with âdeskâ type jobs can resume work 1-2 weeks after surgery. People with more âphysicalâ type jobs can resume work 4-6 weeks after meniscal trimming and 8-12 weeks after a meniscal repair.
When can I drive?
In general, you can drive once you regain full power and function in your leg to safely perform an emergency brake. In addition, you must have finished taking any opioid medication. This typically takes a minimum of 1-3 weeks after a meniscal trimming. You should not drive for a minimum of 6 weeks after a meniscal repair.
The risk of a (deep) joint infection is extremely rare following arthroscopic knee surgery. You will receive a dose of IV antibiotics before and after surgery to decrease the risk of infection. Prolonged antibiotics after surgery have not been shown to provide additional benefit and are usually not required.
Symptoms of a knee joint infection include increasing pain, swelling, redness, wound drainage, decreased range of motion, and inability to weight bear. Patients can also experience systemic symptoms such as a fever. Please contact your surgeon and/or go to the emergency department if you believe you are developing an infection.
Deep knee joint infections may require IV antibiotics and repeat surgery to âclean outâ the knee.
Superficial skin infections are more common and can be usually treated with a course of oral antibiotics.
Recurrent meniscal tear
A recurrent tear of the meniscus can occur after both a partial menisectomy (less common), and meniscal repair (more common). Initial treatment usually consists of non-operative measures including pain medication, physiotherapy, and local injections. Some patients may require revision (re-do) surgery to address the recurrent meniscal tear.
Progression of arthritis
Arthroscopic meniscal surgery should not be performed in the setting of arthritis. In some patients with early damage to their cartilage, trimming the meniscus may lead to a progression of arthritis. This is likely related to further loss of the meniscal âcushionâ.
Knee stiffness can be a problem after a knee arthroscopy. It is normal for your knee to be stiff and painful immediately after surgery. However, it is very important to work on your knee range of motion after surgery to prevent permanent stiffness. If you develop permanent stiffness, you may require repeat surgery to manipulate the knee (manipulation under anaesthesia) and arthroscopically release scar tissue (lysis of adhesions).
A deep vein thrombosis (DVT) is a blood clot that can develop in the leg veins after surgery. DVTs that occur above the knee can be dangerous as they can dislodge and form a blood clot in the lungs called a pulmonary embolism (PE). This is a rare but serious condition which can be life threatening.
A DVT is a rare complication after a knee arthroscopic procedure. Routine use of medication to reduce the risk of a blood clot is generally not required after surgery. If you have had a blood clot in the past it is important to inform your surgeon prior to surgery.
Damage to major nerve or blood vessels
Damage to major nerves, such as the common peroneal nerve, is extremely rare following surgery. It is normal to have a small patch of numbness around the incisions after surgery. This typically improves over time.
Major blood vessel damage is also extremely rare but can necessitate emergency blood transfusion and vascular repair in some cases.