Internal meniscus surgery

introduction

If the medial meniscus is torn, there are several ways to operate on it. All operations (OP) are usually carried out by a Knee joint endoscopy (arthroscopy) performed minimally invasive.
The meniscus can be sutured or removed. If a decision is made to remove the meniscus, this can be done partially or completely (menisectomy). In this case, the meniscus must be replaced.

Knee joint endoscopy (arthroscopy)

In the case of an endoscopy of the knee (arthroscopy = OP), a small incision is first made on the edge of the Knee joint made to provide access to the knee joint space. This is used to introduce the camera.
A second access is then created under sight, which is used as a working access for instruments. Furthermore, a small tube is used for irrigation and suction of the knee joint in order to maintain visibility. Once the access points have been made, the knee joint and the Medial meniscus first examined closely in the operating room. The stability and extent of the injury must be assessed in order to be able to decide on the best therapy method. The Duration of an arthroscopy on the knee depends on the underlying damage to the medial meniscus.
You can also find out more about this topic at: Knee joint endoscopy (arthroscopy)

Meniscus suture

Of the Medial meniscus can be reassembled (sewn) with the help of a special thread (refixation). The material consists of high quality sutures or meniscus arrows made of absorbable material. However, it is not possible to preserve or maintain the meniscus with every injury pattern Medial meniscus suture perform. The blood supply is inadequate, especially in the inner part of the medial meniscus.
In the case of an inner meniscus suture, there is a risk that the meniscus suture will not grow back together sufficiently at that point.
In the outer third of the inner meniscus, however, the blood flow situation is very good if the damage is not too great. In order to optimize the chances of recovery, the crack zone is first freshened up. This increases blood flow and allows better healing.
Since the rehabilitation of a meniscus suture takes a relatively long time, a lot of patience and a slowly increasing load is necessary in order not to damage the inner meniscus again.
Usually a Inner menicus seam be loaded again after 6 weeks, a good result can be expected after 12 weeks at the earliest.

Appointment with a knee specialist?

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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The knee joint is one of the joints with the greatest stress.

Therefore, the treatment of the knee joint (e.g. meniscus tear, cartilage damage, cruciate ligament damage, runner's knee, etc.) requires a lot of experience.
I treat a wide variety of knee diseases in a conservative way.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Further information about myself can be found at Dr. Nicolas Gumpert

Partial meniscus removal (partial meniscus resection)

A Partial removal of the meniscus is possible in the operating room if the tear is too large to be sewn, but the injured piece of the meniscus is small enough to keep the meniscus working.
Will be a Partial resection carried out, the injured part of the meniscus is removed with the help of a small cutting device. Since the function of the inner meniscus must not be restricted too much, this type of operation is only possible for minor damage.
Loses the Inner meniscus its functionality (Shock absorption), knee joint osteoarthritis (gonarthrosis) develops quickly, as the gliding ability of the knee joint is lost.
The advantage of this operation (OP) is that it can be loaded quickly. Depending on the pain situation, the knee can be loaded again on the day of the operation.

Meniscus removal (menisectomy)

Is the injury of the medial meniscus big, it must be completely removed. This operation is also carried out as part of a knee joint specimen.
However, the knee joint cannot function properly without the medial meniscus as a slide rail. If the inner meniscus were missing, the first signs of the Osteoarthritis of the knee and Cartilage damage occur. This causes a lot of pain and ultimately makes one Knee replacement necessary. For this reason, a removed meniscus must be replaced in the operating room.

Artificial meniscus

There are different materials for you artificial meniscus in question. This can be artificially made from different materials or come directly from a corpse.
The donor tissue is usually provided by internationally active tissue banks and comes from deceased accident victims. To optimize the chances of recovery, the size, side, and shape of the meniscus must fit exactly. Rejection reactions as with internal organs, such as the lungs, occur with a meniscus donation not on.
The donor meniscus will be replaced in the operating room in the same place as the original Medial meniscus and ideally enables a new formation of the body's own meniscus tissue. Although a donor meniscus transplant has a good chance of success, the waiting times are often very long.
For this reason, an artificial meniscus is often chosen in urgent cases. This consists of either synthetic polyurethane or off biological collagen. No study results are currently available on the synthetic meniscus implants. In contrast, there are very good results after implantation of a biological collagen implant from cattle. It has been shown that after approx. 2 years the biological material is broken down and replaced by the body's own meniscus tissue.
The disadvantage of this form of therapy is a very long follow-up treatment. In contrast to removing a part of the meniscus with direct loading capacity, an implantation of an artificial meniscus requires long post-treatment and very careful loading. For this reason, athletes have to reckon with stress breaks of one year until full stress is possible again.

OP: yes or no?

The operation of the medial meniscus is one of the most frequently performed operations in Germany.
Exactly when an operation after cartilage damage makes sense is the subject of current medical discussions and has so far been possible not clearly clarified become.
Depending on the type of cartilage damage, a conservative therapy suffice to treat this and achieve complete healing of the knee joint without surgery. This is especially true if only small cartilage defects exist and these occur in areas which well supplied with blood and therefore have a good chance of a healing process. In the case of larger defects in the cartilage, conservative therapy is often unsatisfactory, as symptoms often remain and complete healing cannot be achieved.

One is particularly important comprehensive diagnostics to determine how much damage the Medial meniscus and thus be able to assess whether conservative therapy is superior to surgical intervention.

Individual factors of the person concerned play a role in the decision as to whether a surgery The medial meniscus is another important role. Pre-existing illness, Risk factors as well as that Age of the person concerned are among these factors.

To be certain that an operation is actually necessary, it is advisable to get a second opinion from another doctor.

How long sick?

The Duration of the healing process after an operation of the Medial meniscus depends on a number of different factors and can be individual vary greatly. The time in which those affected are ill and cannot work is highly dependent on the healing progress.
This healing process differs especially between the Surgical methods. The days after the operation should be one general protection take place, with a Partial load beautiful after 3-5 days can be possible.
This should initially take place under the guidance of the treating physiotherapist. The time to a possible Full load of the knee joint, depending on the healing time and the surgical method between 6 weeks and 3 months be.

In addition, the length of a sick leave depends very much Type of occupation exercised depends. Working with a substantial burden of the knee joint should go hand in hand avoided longer are considered work that does not involve strain on the knee.

In summary, the individual takes place Sick leave thus according to the occurring Symptoms and is checked in short periods of time. Depending on the selected surgical method and the individual findings as well as the profession practiced, the attending physician can estimate the duration of the entire sick leave.

Healing time

The time it takes to heal after an internal meniscus operation is influenced by a number of different factors. The Type of injury as well as the chosen Surgical method however, decide decisively about that Durationwhich claims a complete healing of the knee joint. Risk factors such as obesity and little physical activity as well as underlying diseases such as knee osteoarthritis or diabetes mellitus can have an unfavorable influence on the healing process.

This should be done immediately after the operation Knee joint be spared, in many cases a Partial load beautiful after a few days can be done. The time until the cartilage heals completely can be between 6 weeks and 3 months, with longer and shorter healing processes being possible.

The healing time at Cartilage transplants as well as with a refixation of the cartilage are usually relatively high with a few weeks and months, whereas with Partial cartilage removal Complete healing can be assumed after a few weeks.

Aftercare

The follow-up treatment after an operation on the medial meniscus is an important part of the therapy Cartilage damage and significantly influences the healing process. The individual follow-up treatment can be very different from case to case and is determined by the selected surgical method and individual influencing factors.

As a rule, the knee joint should be removed for the first few days and weeks after the operation spared become. A full load is usually only after a few weeks recommended. Crutches can help avoid overstressing the knee joint and thus not endanger the healing process.

Since no comprehensive movement is achieved due to the protection and the low load on the knee, the risk of a blood clot developing in the leg increases. To avoid such a clot, heparin is usually prescribed, a drug that prevents the Blood clotting and should be injected for the first few weeks.
In addition, targeted exercises and movements help increase mobility in the knee joint and accelerate the healing process of the joint. These exercises are explained by the treating physiotherapist and can also be performed at home.

Furthermore you can special post-treatment measureshow about wearing special rails have a positive influence on the healing process.
The attending physician can advise on which follow-up treatment is considered to be useful in the individual situation, who will monitor the healing process during the follow-up treatment phase.

At occurring problems The attending physician should always during the follow-up treatment informed so that treatment methods can be adjusted if necessary.

Summary of OP medial meniscus

A Medial meniscus tear usually has to be treated surgically (through an operation) in younger people. Due to the high daily stress on the knee joint, the inner meniscus does not heal itself back together. Diagnosis is available to every therapy Knee joint endoscopy (arthroscopy) before.
This is used to precisely assess the damage and enables direct therapy. To the Medial meniscus To make it functional again, this can be sewn, partially removed, or completely removed. The seam of the Mensikus is only possible with special forms of injury and requires a relatively long period of follow-up treatment. If the meniscus is partially removed, the knee joint can be loaded again on the day of the operation.
However, there is a risk of one Osteoarthritis of the kneebecause the medial meniscus has lost part of its ability to slide. In the case of a complete removal of the inner meniscus (menisectomy), this must be followed by a artificial or biological meniscus (usually in the same operating theater, sometimes in a second procedure). If this does not happen, massive cartilage damage and knee joint osteoarthritis develop within a short time Implantation of an artificial knee joint make necessary.
Data on the transplantation of a synthetic meniscus replacement (artificial meniscus) are not yet available. The chances of success after using a biological or human meniscus transplant, however, are very good. In this case, too, a long follow-up treatment period and sports break must be planned.