Operation of a torn meniscus


Meniscal lesion, meniscus tear, meniscus tear, meniscus rupture, meniscus damage

English: meniscus tear

Arthroscopy and open surgery

A real one Meniscal tear is such a serious injury that carries a high risk of consequential damage, which is why, with the exception of a few exceptional cases, where conservative therapy is used physiotherapy and administering Medication is sufficient, an operation can hardly be avoided. Especially younger patients and people who sporty are active, surgical treatment of the meniscus tear is strongly recommended.

Today most operations can be performed using a Knee arthroscopy (Arthroscopy) perform which both the Diagnosis and then the definitive one therapy serves. Such an arthroscopy can be done either in General or partial anesthesia respectively. Often times it is possible to have the procedure outpatient takes place, so the patient does not have to be admitted to the hospital at all. Should this be necessary, the stay will only be longer than a week in exceptional cases.

Open operations are still preferred today if there are other injuries to the knee joint in addition to the meniscus tear, such as damage to the surrounding ligaments or bones.

Surgical methods

Nowadays it is possible to perform operations with the help of a knee joint specimen (arthroscopy). Arthroscopies are used for both diagnosis and definitive therapy.

In principle, there are different ways of treating a meniscus tear surgically. Either you repair the damage (meniscus refixation or meniscus suturing) or you take out the damaged part of the meniscus (meniscus (partial) resection) and then possibly replace it with an implant. Restoration of the meniscus is only possible if the tear or other injury is not too large. For this variant, the crack should also be in the area near the edge. The reason for this is that this part of the cartilage disc is still supplied by vessels and can therefore usually heal well after an operation.
The repair is done either with the help of screws, special pins or arrows, sometimes the area can simply be sewn. With such a meniscus suture, the edges are first smoothed and then the meniscus is returned to its original position and shape. This option should always be sought initially. If this is not possible, however, a major operation must take place. If a part of the meniscus is actually torn off, it has to be removed. Depending on the type of damage, a small piece may be partially removed, and in severe cases the entire meniscus may have to be removed. Depending on the size of the removed piece and how the remaining functionality of the knee joint after the surgical procedure is assessed, it may be necessary to insert an implant. This implant is typically made of collagen, but sometimes synthetic materials such as polyurethane. The collagen ensures that the missing piece of meniscus does not rub bone against bone, which in the further course would massively increase the risk of osteoarthritis of the knee joint.
In extreme cases there is also the option of performing a meniscus transplant, which is particularly useful in younger patients. A donor meniscus from a deceased person is transplanted into the patient. The benefits of this, however, are not yet fully understood. Some still doubt a long-term improvement of the condition with regard to the wear and tear of the cartilage.

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
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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.

You can find me in:

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    Kaiserstrasse 14
    60311 Frankfurt am Main

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

Anesthesia during meniscus surgery

With general anesthesia, the patient is unconscious and accordingly feels no pain. Artificial ventilation and airway protection are necessary.

A knee endoscopy can either be performed under regional anesthesia close to the spinal cord (Epidural anesthesia) or under general anesthesia (general anesthetic) be performed.
An epidural anesthesia only numbs the lower half of the body, the patient remains with it awareness. Usually with a hunched back while sitting or lying on your side, local anesthesia is performed on the skin over the spine after disinfection of the puncture site. This is followed by anesthesia close to the spinal cord, which inhibits pain, sensations and active mobility in the lower half of the body for the duration of the procedure.
Complications of this type of anesthesia are one example Drop in blood pressurewhich, however, can usually be avoided through hydration. In some cases, the anesthesia near the spinal cord can cause it to become too much after the operation a headache come.
In rare cases, when performing a complicated epidural anesthesia, a deeper anesthesia than desired can be used (so-called total spinal anesthesia), resulting in a drop in blood pressure, respiratory paralysis and a slowing of the heartbeat. In this situation it may be necessary to switch to general anesthesia with artificial ventilation.
An extremely rare complication is injury to the Backmarks, with the risk of permanent Paraplegia. Systemic side effects of the local anesthetic can also occur, for example as allergic reaction.

With general anesthesia, on the other hand, the consciousness is switched off together with the pain sensation that the patient is not awakenable. A artificial respiration and airway management is necessary.
After general anesthesia, nausea and vomiting, coughing, hoarseness and difficulty swallowing as side effects.
Sometimes you may experience muscle tremors or a sensation of coldness. In very rare cases, general anesthesia can lead to complications such as damage to the teeth, the vocal cords or a lung infection come.
After induction of anesthesia, a blood pressure cuff is attached to the thigh and inflated during the arthroscopic meniscus operation, creating a so-called Tourniquet is achieved. This means that there is hardly any blood loss during the jointoscopy.

After the operation

Usually, an outpatient arthroscopic operation is performed for a meniscus tear. This means that the operated patient can leave the recovery room and be discharged home a few hours after the operation, accompanied by someone else. You shouldn't drive a car yourself. For some time after the surgery, the knee should be using Forearm crutches be relieved, but it is possible to support the operated leg with part of its body weight on the first day after the operation (approx. 20-30 kg) to charge.
For the time when the crutches are needed is one Thromboembolism prophylaxis (so-called "abdominal injections") necessary. The attending physician also often prescribes anti-inflammatory and pain reliever Medications that should be taken regularly. The small puncture sites can be a bit tender for a while. After the operation, some people feel a feeling of "splashing" of fluid in the knee joint. This can happen and is triggered by residual fluid from the arthroscopy.
The seams should be with waterproof A band-aid must be provided to protect the wound until the sutures are pulled (after about one to two weeks). Careful showering is usually possible, bathing and swimming should be avoided for about two weeks.
If a drain was placed in the knee joint during the operation to allow the wound secretion to drain, it is usually pulled after a day or two.
So as little as possible Kneesswelling occurs should the knee in the first few days spared, elevated and be cooled with ice.

Sauna and tanning beds increase the risk of severe knee swelling, which is why these things should be avoided for a few weeks. The protection of the affected leg after the operation is important and must be observed, but it will be quick Thigh muscles reduced.
In consultation with the attending physician, muscle training should be started as soon as possible physiotherapy to be started. For the first six weeks after meniscus surgery, the knee should not be under strain 90 degrees be bent over, so one shouldn't crouch.
There can be individual differences, so all loads should be increased slowly, even if the knee no longer hurts, as the tissue being built is still in the process of maturation.
It is important that the knee is in the first few weeks after the meniscus operation no shock loads exposed (e.g. by hard shoe heels). Especially in older people it can lead to so-called Fatigue fractures in the Tibial head come.

Duration after a meniscal tear operation

The meniscus tear operation as part of a knee joint surgery usually takes between 30 and 60 minutes in claim. When a Partial meniscal resection carried out, the wound healing takes about two weeks, then the knee can be fully loaded. From this point on, moderate sporting activities can be started again.
The cure one Meniscus suture or one Meniscus replacement an implant usually takes longer, usually around that six months. After about four weeks, full knee load while running should be possible again, and sporting activity after about two to three months. If only a small part of the meniscus has been removed, office work can be resumed after one to two weeks, jobs involving knee loads should only be resumed after two to three weeks.
When parts of the meniscus sewn must have been the knee spared longer otherwise the seams could tear. In individual cases, a gradual reintegration into working life can also be useful. An optimal operation result and a quick healing require the cooperation of the person concerned. If aggressive load-building is started too soon after the meniscus operation, it can lead to inflammatory irritation come with swelling and pain. In addition, the threads of the meniscal suture can tear.
The moderate physiotherapeutic follow-up treatment However, it is necessary and very useful, as muscles are built up and the mobility of the knee joint is restored. Failure to perform follow-up treatment can lead to restrictions in sporting activities and in everyday life.

When to do sports again?

Of the Meniscal tear can be severe or uncomplicated.
Depending on the extent of the tear and the subsequent surgical treatment, the ability to move can be regained quickly, or in the worst, very rare case, a lifelong restriction can be expected, whereby no sport can be practiced.

However, this also depends on the type of sport the patient wants to practice. For sports that are very stressful for the affected knee, you should wait a few more weeks after the regular time of the sports ban and start again slowly.
Here is a break from 4-6 months makes sense.

In the case of an uncomplicated meniscus tear, relative mobility is regained after 2-3 weeks, after 6-8 weeks the knee should be fully resilient again.
The damage and the extent of the meniscus tear depend primarily on the duration of the tear before the operation and the impairment of the surrounding structures. In addition to these influencing factors, age, weight and general physical condition also play a role in assessing when the patient should exercise again.

When can you drive a car again / how long will you be unable to work?

The incapacity for work also depends on the workload of the person concerned and the severity of the injury.
If the meniscus tear is sutured intraoperatively, a significantly longer healing time is necessary than with a partial meniscus resection.

After a arthroscopic surgery a professional break of at least 1-4 weeks should be observed. Driving a car after knee surgery should only be restarted after the knee has been completely healed, as both muscle strength and reaction speed are reduced by the operation.
Also come Aftermath of anesthesia and the side effects of pain medication. The patient should definitely no longer have to rely on walking aids or rails before he gets back behind the wheel.
It is also important to do some exercises to regain muscle strength and responsiveness before you start driving. Drying exercises on the parked car can also be useful.

There is no clearly defined period of time from which you can drive a car again after a knee operation, but it is at the discretion of the insurance company to classify the driver of the car and his behavior as grossly negligent in the event of an accident and thus not to guarantee the assumption of costs .

Risks of meniscus surgery

If there is a meniscus tear, it should in most cases be treated with an early surgical measure in order to minimize and, if possible, avoid late complications and long-term consequences for the patient.
If the meniscus is torn, it often interferes in the knee joint gap like a kind of foreign body and it leads to friction and irritation of the articular cartilage and the joint surfaces.

This can in the long run reduce the joint space through to the symptoms of the Osteoarthritis of the knee to lead. This can also lead to unspecific knee joint swelling and inflammatory reactions.
However, the removal of a part of the meniscus also leads to an increased risk of wear, since the stabilization and damping of the meniscus is reduced by a reduction in its surface area.

Only in rare cases is one conservative therapy of the meniscal tear indexed. The reasons include age, difficult follow-up treatment, lack of cooperation on the part of the patient or intolerance to anesthesia.
Then the symptoms should be treated as far as possible with increased muscle building and stabilization of the knee joint.

The meniscus operation can be done as an open operation or through an athroscopic procedure. In addition, the athroscopy can be performed as an outpatient or inpatient procedure.
Above all, with open surgery there is a risk of secondary bleeding, hemorrhage and intraoperative or postoperative infection of the operating area. This infection can spread to the entire knee joint and damage the cartilage. Inflammation occurs, which may have to be punctured to drain the pus or to be treated surgically and with antibiotics.

There is also a low risk of vascular or nerve damage as well as cartilage, ligament or mucosal injuries during meniscus surgery and the postoperative immobilization of the leg can lead to the formation of blood clots in the leg veins, so-called Thrombosis, come.
If one of these thrombi loosens, mostly from the leg veins, there is a risk of one Pulmonary embolism.

However, this risk can be minimized through preventive anticoagulant therapy. To do this, the patient is given injections or tablets that inhibit blood clotting.
After every meniscus operation, there is a risk that the meniscus will tear again in the same or in a different place. Even after inserting an artificial meniscus, a so-called meniscus implant, it can tear.

It is also possible to replace a completely destroyed meniscus with a donor meniscus from an organ donor. This can lead to immunological rejection reactions, because the tissue is considered foreign to the body.
However, this type of meniscus surgery is very rarely performed.

Long-term consequences of a defective meniscus are primarily pain, restricted or reduced functionality and movement, and the onset of osteoarthritis. In rare cases, however, these can persist even after surgical treatment.
Overall, the success rate of meniscus surgery with a good result is around 90%. However, the necessary cooperation of the patient, intensive follow-up treatment and the acceptance of short-term and permanent restrictions, such as in sports, are important.

As with any surgical procedure, meniscus surgery also carries a risk of side effects and after-effects of anesthesia. The procedure can be performed under regional anesthesia, in which the patient is only numb down the waist and is otherwise awake and responsive, or using general anesthesia in general anesthetic be performed.

After the operation, general anesthesia can lead to postoperative nausea and vomiting, for example.