What Is the Meniscus?
Meniscus Tear Surgery: The menisci are crescent-shaped structures located in the knee joint, with two in the inner and outer parts of the knee. They perform several vital functions in the knee joint, the most important of which is to absorb loads during movement, protecting the cartilage from damage. Another function is to increase the surface area of the joint, ensuring that pressure on the cartilage is distributed evenly. They also play a significant role in stabilizing the knee joint.
What Is Arthroscopic Meniscus Surgery?
Arthroscopic meniscus surgery is a procedure performed to repair or clean damage to the meniscus caused by trauma or wear and tear, typically accessed through two small incisions in the knee using a special camera called an arthroscope. The entire knee joint is not opened; rather, the surgery is completed through small incisions of about 1 cm each.
Meniscus tears can occur after trauma or due to gradual wear over time. Traumatic tears are more common in high-activity athletes and adults under 30-40 years old, while degenerative tears typically appear in older age groups as increasing pain over time.
Patients with traumatic meniscus tears may describe their knee as “locked,” indicating severe pain during movement and difficulty in bending or straightening the knee. Additionally, pain that increases with activity—such as walking, running, or excessive bending—may raise suspicion of a meniscus tear. Swelling in the knee after increased activity can also be a symptom of a meniscus tear.
Patients with degenerative meniscus tears usually present with long-lasting pain. They experience less locking or catching sensations, but may complain of quick fatigue and worsening pain as walking distance increases.
Diagnosis of a meniscus tear can be made through specific physical tests, followed by knee X-rays and MRIs. MRI imaging can provide information about the location and configuration of the tear, but the actual diagnosis and treatment will be determined by your doctor during the arthroscopy. If there are accompanying issues with your cartilage or ligaments, these will also be assessed, and your doctor may intervene in those areas during the same procedure if deemed necessary.
There are two main objectives in arthroscopic meniscus surgeries. The first is to clean and remove the degenerated meniscus segment using special instruments. The goal of this surgery is to relieve early pain and enable better movement. Because some meniscus tissue is lost after this surgery, some of its functions are also diminished. Therefore, patients are advised to avoid strenuous physical activities, lose weight, and protect their knees in the long term.
In cases of traumatic meniscus tears, the meniscus is repaired using specially designed stitches during the surgery. The rehabilitation period for these patients is generally longer than for those who have had the meniscus removed. However, since there is usually no loss of meniscus tissue, knee functions and rates of osteoarthritis are much better in the long term. Repair of the meniscus is recommended whenever the quality of the meniscus and the configuration of the tear allow it.
Preparation Before Meniscus Surgery
You should consult with the anesthesiologist 2-3 days before the surgery to plan the most suitable anesthesia method for you. Arthroscopic meniscus surgery can be performed under general anesthesia (fully asleep) or with spinal anesthesia (numbing only the lower part of your body) using an injection in the lower back. Your doctor will adjust any blood-thinning medications for a certain period before the surgery to minimize your risk of bleeding during the procedure. You will need to refrain from eating and drinking for about 6-8 hours before the surgery. To prevent infection after surgery, antibiotics will be administered through an IV beforehand.
During the Surgery
After anesthesia, your knee will be positioned on the operating table, usually bent at 90 degrees. Two small incisions of about 1 cm will be made on either side of your kneecap, allowing the insertion of an arthroscopic camera and tools to assess the configuration and location of the meniscus tear. Necessary interventions will then be performed on your meniscus. In many cases of arthroscopic meniscus surgery, these two small incisions are sufficient. However, in cases of larger tears, an additional incision of about 2-3 cm may be needed on the inner or outer side of your knee to secure the special stitches used during the repair.
If there are accompanying lesions in your ligaments and cartilage, those may also be addressed during the same surgery.
After Meniscus Surgery
After the surgery, you will be taken to a recovery area where cold compresses will be applied to your knee. If you have undergone arthroscopic meniscus debridement, you will generally be allowed to put weight on your knee the day after surgery, as tolerated. Range of motion exercises will begin, along with strengthening exercises for the quadriceps muscle above the knee. A compression bandage or simple compression stocking should be worn on your knee for about 15 days to help prevent swelling. The goal during the first 15 days is to regain full joint movement and enable independent mobilization. During the second 15-day period, the focus shifts to strengthening the muscles above the knee and restoring your daily activity level.
In arthroscopic meniscus repair, the recovery process is somewhat slower. Because the stitches used during the meniscus repair are quite fine, you will be advised not to put full weight on your foot until biological healing occurs (approximately 6 weeks). Mobility will be assisted with a pair of crutches. Range of motion exercises and quadriceps strengthening exercises will begin immediately after surgery. The initial goal in the first 4 weeks is to achieve 90 degrees of knee range of motion, with the aim of having a fully functional knee by the end of the 6th week. Strengthening exercises will commence between weeks 6 and 12. Athletes and elite sportspeople may begin ball drills and straight runs at the 12-week mark.
Results of the Surgery
Patients with degenerative meniscus tears generally return to their daily lives quickly after arthroscopic meniscus surgery. Sometimes, persistent pain and swelling in the knee may occur in the early period following surgery. In such cases, your doctor may adjust your treatment appropriately and slow down or pause your rehabilitation based on your condition. In the long term, wear on your cartilage may occur if the amount of damaged meniscus removed is significant enough to affect its function.
After meniscus repair, biological healing may not be achieved in 10-15% of cases, and some patients may require a repeat arthroscopic meniscectomy. However, since all protective functions of the meniscus are preserved in the long term, the risk of cartilage wear is minimal.
Risks of the Surgery
As with any surgery, complications such as infection and bleeding can occur after knee arthroscopy. The risk of infection is about 1 in 1,000. To prevent complications that may arise during these surgeries, antibiotics will be administered before the surgery, and certain medications may be adjusted as necessary.
In addition to these, there may be specific risks related to your overall medical condition, existing diseases, and medications. Your doctor will inform you about these.
Q&A
Does every meniscus tear need surgery?
The menisci have very important functions in the body. In young patients, especially large tears resulting from trauma should be repaired quickly through surgery. However, in older patients, particularly with degenerative tears, if they do not cause mechanical issues (such as catching or locking), it may be more appropriate to try non-surgical treatment methods first.
I have a ligament injury along with my meniscus tear. Can both be operated on at the same time?
The main function of the ligaments in the knee joint is to provide stability and prevent cartilage and meniscus tears. Therefore, if there is an accompanying ligament tear, it is more appropriate to treat it during the same surgery. The results of meniscus repairs performed alongside ligament repairs are much more successful.
Will a hyaluronic acid injection in my knee help heal my meniscus?
Intra-articular injections like this cannot alleviate mechanical symptoms (such as locking or catching). In cases of degenerative tears without mechanical symptoms, they may provide relief by suppressing inflammation in the knee and increasing intra-articular lubrication. In particular, biological injections can be added to treatment after surgery for traumatic meniscus tears to enhance repair success.
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