Arthroscopic Meniscectomy

What is Arthroscopic Menisectomy?

Arthroscopic meniscectomy is a modern procedure that is used in treating meniscal tears in the knee. This procedure involves the use of an arthroscope which is a thin long tube with an attached camera. This device is inserted through small incisions over the knee to access the meniscus. The arthroscope has an attached camera that provides a live view of the knee joint during the procedure. It along with other surgical instruments is employed for trimming and removing the torn parts of the meniscus. The procedure is less invasive, and as a result, causes less post-operative, less scarring, and results in a quicker recovery compared to an open surgery. The decision to undergo an arthroscopic meniscectomy should be taken in consultation with a qualified healthcare provider.

Who Needs Arthroscopic Menisectomy?

Arthroscopic meniscectomy might be advised for those who:

• Have been diagnosed with a meniscal tear in your knee
• Are experiencing chronic pain, swelling, and limited range of motion 
• Have mechanical symptoms such as catching, locking, or giving way of the knee.
• Are unable to function normally in everyday life or play sports because of the injury.
• Have a torn meniscus that is causing perceived knee instability or interfering with normal knee function.
• Don't respond to nonsurgical treatment, such as physiotherapy or medications.

If you are experiencing the above-mentioned symptoms and are not finding relief with conservative treatments, then you might need an arthroscopic menisectomy.

Does Every Meniscus Injury Need Surgery?

Not every individual with a meniscus injury requires surgery. Appropriate treatment of a meniscus injury depends on several factors, such as the type of tear, where it is located, how big it is, and specific symptoms. The damage in many cases of meniscus tears can be repaired by a well-planned rehabilitation program alone. Other treatment options include:

• Rest and activity modification.
• Physical therapy to strengthen the muscles around the knee.
• Medication for pain and inflammation.
• Ice and elevation for swelling.
• Injections followed by rehabilitation e.g. corticosteroids or hyaluronic acid.
• Bracing the knee or crutches.

The choice of treatment or procedure that would suit you will be recommended by your doctor after a thorough examination of your knee.

Anatomy of the Meniscus

The meniscus is a C-shaped cartilage that acts as a cushion and stabilizer in the knee joint. Each knee has two menisci, one on the inner side of the knee (medial meniscus) and the other on the outer side (lateral meniscus). 

• Shape: The menisci are often referred to as the “C-shaped” menisci because they are `in the shape of the crescent and they conform to the corresponding surface of the relatively flat tibial condyles. 
• Composition: They are composed of tough, elastic fibrocartilage that functions to stabilize the joint and also to spread the pressure out of the synovial joints.
• Attachment: The menisci are each attached to the tibia below and are anchored in places by ligaments such as the anterior and posterior horns.
• Shock absorption: To spread the weight of the body across the entire surface of the tibial articular cartilage, and to act as shock absorbers, thereby decreasing peak forces transmitted through the joint and increasing contact time between the femur and tibia
• Lubrication: This plays a big role in lubrication that happens at the synovial joint. They provide nourishing and protective functions to join surfaces. 
• Stability: The menisci work to stabilize the knee joint by increasing the surface area of the tibia. This improves the fit of the femur.

How is an Arthroscopic Menisectomy Performed?

Arthroscopic Meniscectomy is a minimally invasive procedure, and the procedure typically involves the following steps:

• Anesthesia: The patient is given either general or regional anesthesia to ensure a pain-free procedure.
• Preparation: The area around the knee is cleaned and sterilized. The leg is typically placed in a leg holder to maintain stability and positioning during the procedure.
• Incision: Small incisions approximately 0.5 to 1 centimeter in length are made around the knee joint.
• Arthroscope insertion: An arthroscope is inserted through one of the incisions.
• Examination: The surgeon takes a closer look at the meniscus using the arthroscope. The body of the meniscus is examined along with the location and the size of the tear.
• Other instruments: Surgical instruments such as graspers, shavers, or scissors may be introduced into the knee joint through other incisions. They aid the surgeon in manipulating and treating the meniscus.
• Meniscectomy: Depending on the type, size, and location of the tear, the surgeon may trim away the damaged portion of the meniscus using specialized instruments, or attempt to repair the tear using sutures or other techniques.
• Closing the incision: After the necessary repair or removal is completed, the instruments are withdrawn, and the incision is closed with stitches or adhesive strips.
• Dressing and bandage: A dressing and bandage are placed over the incision sites to promote healing and reduce the risk of infection.

Risks / Benefits

Benefits

• Pain management: A surgical repair of the torn meniscus, arthroscopic meniscectomy, is often successful in alleviating pain often felt by patients with torn menisci, allowing them to return to their daily routines with lesser discomfort.
• Better physical activity: The surgery helps improve knee function, thus improving the stability and rotation of the knee joint. These restorative results lead to better mobility and a healthier lifestyle.
• Less-invasive process: Arthroscopic meniscectomy requires only a few minor incisions, which results in less post-operative pain or discomfort and a faster recovery.
• Diminished risk of hazards: Here chances of complications like infections, hemorrhaging, and cosmetic issues are less compared to an open knee surgery.
• Short hospital stay: Arthroscopic menisectomy is an outpatient procedure and therefore you can return home on the same day of the procedure. 

Risks

• Infection: There is a risk of infection at the surgical site, which may require antibiotics or further medical attention.
• Bleeding: A possibility of bleeding exists during or after the surgery, which may lead to more complicated problems necessitating additional treatment.
• Nerve or blood vessel damage: Damage to nerves or blood vessels near the site of the surgery is possible, but very uncommon. This can result in a lack of sensation, weak limbs, or other nerve-associated symptoms temporary or permanent.
• Knee stiffness: Stiffness in the knee after the surgery may limit mobility and require further therapies once out of surgery.
• Recurrence: Even if the surgery is successful, there is a possibility that the meniscus may tear again or that some future knee problems may arise, especially if proper treatments and precautions are not followed.

It is important to note that arthroscopic menisectomy is a safe and effective procedure and complications or risks associated with the procedure are rare.