Meniscus Root Repair
What is Meniscus Root Repair?
Meniscus root repair is a surgery performed to repair a torn meniscus root. Meniscal repair may be performed either by open surgery under direct vision or minimally invasively using an arthroscope that can be inserted into the knee through a very small key-hole incision to locate and repair the damaged meniscus.
Meniscal root tears are characterized as soft tissue or bony root avulsion injuries or radial tears located within 1 cm of the meniscus root attachment. They can be either a tear which disconnects the root area completely from the body of the meniscus (complete radial tear) or a disruption of the meniscus attachment directly from the bone (true meniscus root tear) that can cause the whole meniscus to lose its capacity to safeguard the underlying cartilage.
Meniscal root tears are one of the most common injuries to the knee joint. They occur in younger patients as a result of high energy trauma, but most cases occur in individuals above the age of 40 years following a minor traumatic event due to degeneration of the meniscus with age. A torn meniscus causes pain, swelling, stiffness, and a catching or locking sensation in your knee making you unable to move your knee through its complete range of motion.
Anatomy of Meniscus
The meniscus is a small, "C" shaped piece of cartilage in the knee joint. Each knee has two menisci, the medial meniscus on the inner aspect of the knee and the lateral meniscus on the outer aspect of the knee. The medial and lateral menisci act as a cushion between the thigh bone (femur) and shin bone (tibia). The main function of the menisci is to improve load transmission. A fairly round femur sits on a fairly flat tibia to form the knee joint. Without the menisci, the area of contact force between these 2 bones would be small, increasing the contact stress. The menisci also provide lubrication, shock absorption, and joint stability.
Preparation for Meniscus Root Repair
Preoperative preparation for meniscus root repair will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a week prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Meniscus Root Repair
Meniscus root repair is most commonly performed arthroscopically under regional anesthesia. Surgical management involves either repairing by stitching the root of the meniscus or trimming the root of the meniscus and reestablishing the connection with the bone. Suturing or repairing the meniscus root will need a period of 4 to 6 weeks of crutch use as well as physical therapy. Surgery is arthroscopic in either situation.
In general, the arthroscopic procedure will involve the following steps:
- After adequately sterilizing the surgical area, your surgeon makes 2 to 3 small key-hole incisions around the knee.
- An arthroscope, a narrow tube with a tiny video camera on the end, is inserted through one of the incisions to view the knee joint. The scope is connected to an external video monitor and the structures inside the knee are displayed in the monitor for your surgeon to view.
- Small miniature instruments are inserted through other small incisions and the supporting structures of the knee are gently moved out of the way to access the torn meniscus root area.
- The extent of meniscus root damage and severity of the injury is assessed, and suitable repair is carried out accordingly.
- Once the repair is complete, the scope and instruments are withdrawn, and the incision is closed and covered with a bandage.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after meniscus root repair will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may notice some pain, swelling, and discomfort in the knee area. Pain and anti-inflammatory medications are provided as needed.
- Antibiotics may be prescribed to address the risk of surgery-related infection.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- You will be placed on crutches with instructions on restricted weight-bearing. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
- You are advised to keep your leg elevated while resting to prevent swelling and pain.
- Refrain from smoking as it can negatively affect the healing process.
- Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
- Refrain from strenuous activities and lifting heavy weights for the first couple of months. Gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol may be designed to help strengthen your knee muscles and optimize knee function.
- You will be able to resume your normal activities in a couple of months; however, return to sports may take 4 to 6 months.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Meniscus root repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Hemarthrosis (bleeding inside a joint)
- Arthrofibrosis (thick fibrous material around the joint)
- Damage to nerves and blood vessels
- Blood clots or deep vein thrombosis (DVT)
- Allergic or anesthetic reactions