Orthopedics-Online

Surgical options for a meniscus tear

Synonyms in a broader sense

Meniscus lesion, meniscus tear, meniscus rupture, meniscus damage, arthroscopy, keyhole surgery, damage to the meniscus

definition

For therapy of a Meniscus lesion, or one Meniscal tear, several options can be considered. In addition to the type of damage and the location of the crack, the individual circumstances such as age and professional and / or sporting ambitions are always decisive.

The operation

Since the meniscus as such was previously given little importance, it was widespread to completely remove the meniscus in the event of a tear. This is known in medicine as a menisectomy.

However, since the meniscus takes on important functions such as stabilization, cartilage nourishment and cartilage protection for the knee joint, we now know that a menisectomy is not always appropriate and that the possibility of knee osteoarthritis increases many times over.

Appointment with a knee specialist?

I would be happy to advise you!

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".
But now enough is indicated ;-)

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:

Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main

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

Because of these important functions for the knee joint, among other things, attempts are now being made to preserve the meniscus in its original form as far as possible. The meniscus is therefore either sewn with a so-called meniscus suture or newly formed using a replacement product based on collagen.

Various forms of therapy are listed below. Which form of therapy is suitable for you depends - as already mentioned above - on the individual circumstances. The attending physician knows these individual circumstances and can - with your help - initiate the best form of therapy for you.

Conservative Therapy
A conservative therapy in the form of immobilization is only possible in exceptional cases. For this, it must be ensured that the length of the longitudinal crack is no longer than 1 cm. Immobilization is usually carried out over a period of three to four weeks and is often not very promising without surgical therapy. (please refer: Duration of a meniscus tear)
Conservative therapy is only possible if there is a fresh crack in the outer zone, which is well supplied with blood vessels. Rail bearings and decongestant measures are best suited for a period of a few days.

Operative therapy

With the help of an arthroscopy, damage to the meniscus can be detected.

The advantage of arthroscopy is that surgical intervention can be carried out immediately if there is visible damage. The arthroscopic operation is often referred to as a keyhole operation, as large incisions (wounds) are avoided and, in principle, interventions are made in the smallest of spaces.

Partial removal of the meniscus (partial resection)

If the meniscus tear is a so-called base tear (see Forms of cracks in the meniscus) and / or if the patient is young, it should first be decided whether suturing the meniscus appears possible or whether parts of the meniscus must be surgically removed.
As already mentioned above, the blood flow to the meniscus is very poor in some areas, so that healing without any intervention usually seems impossible. The figure on the left shows the meniscus perfusion ratio. You can see that only the parts near the capsule are well supplied with blood and thus have good healing potential and chance (red zone in the right image). It can therefore be said that healing is usually only possible in the red, and to a limited extent also in the red-white zone, and cracks in the white zone almost always have to be repaired as part of a partial removal. The rear portion of the Medial meniscus is relatively often affected by the formation of cracks, partial menisectomies are usually very well tolerated here.
In addition, one should know that the External meniscus is very important for the distribution of the pressure and preservation should always be in the foreground.
In the case of a meniscus suture, there are two different options available.
These are:
1. The Meniscus suture, either with so-called absorbable (= self-dissolving) or non-absorbable threads.
2. The Meniscus nailing with absorbable (= self-dissolving) arrows, the so-called arrows.

Parts of the meniscus distant from the base are not supplied by blood vessels, but by the synovial fluid. If cracks appear in these areas remote from the base, such as the Basket handle tear so these parts can no longer grow. The joint function and stability should, however, be preserved as far as possible, so that a so-called partial resection is carried out here.
Such a partial resection (= partial menisectomy) is also usually carried out for cracks that occur as a result of the aging process and thus wear (= meniscus degeneration). As part of this procedure, the dead parts of the meniscus are removed. The aim of such an intervention is always to maintain the Meniscal remnants and avoiding the creation of new cracks. This means so much meniscus is removed as necessary so that no damaged, dead parts remain in the meniscus. But it also means that as little as possible is removed from the meniscus. Finally, as mentioned above, important functions are ascribed to the meniscus.
In the case of a partial meniscus removal, loading can usually be carried out immediately after the operation. After the procedure, physiotherapeutic follow-up treatment is usually prescribed. An exercise program for independent training is also intended to promote mobility and healing. Crutches are usually not necessary after the procedure. However, this depends on the patient and his or her individual safety when walking.

The suture of the meniscus

In both operations, the edges of the wound are first “freshened up”. This means that the edges of the Meniscal tear roughening up to open vessels and thus improve the supply of nutrients and allow growth factors to get into these areas.
A targeted one Bleeding is therefore a basic requirement for a bless you!

As part of the meniscus suture, a U-shaped thread is then passed through the meniscus and joint capsule (from inside to outside). In cases in which the tear is located relatively far back, an injury cannot be ruled out due to the many nerves and vessels. Under certain circumstances, the thread of the meniscus suture could even extend out from the hollow of the knee. In these cases, the second method described above, so-called meniscus nailing, is preferred. Torn parts of the meniscus are fixed with resorbable arrows (Arrows, Biofix, etc.).
The follow-up treatment after a meniscus suturing or nailing is much more tedious than with a partial resection: a 6-week follow-up treatment must be expected.
Depending on the individual circumstances and especially depending on the type of occupation, an inability to work for around 2 to 8 weeks must be assumed. The possible stress in the context of the occupation has a lengthening effect on the incapacity for work.

Opportunities of the operation

Total removal of the meniscus (menisectomy)

Nowadays, a total removal is only arranged for very extensive meniscus damage. The aim is to avoid removing the “buffer” between the two bony joint parts, as studies have shown that this contributes to the development of early osteoarthritis (= signs of wear and tear in the joint).

Needling (vascularization by attaching vascular cannulas)

This method is mainly used for so-called Grade II lesions,but especially with partial tears in the area of the meniscus base. Diseased parts of the meniscus are surgically "pricked" with a hollow needle. This is intended to cause new blood vessels to sprout and thus promote healing in a targeted manner.

Meniscus trimming (freshening the meniscus surface)

As already described in the context of the meniscus suturing, the wound edges are "refreshed". This is usually done by motorized milling. The aim is to regenerate the meniscus tissue or to achieve scarred healing. This technique is also often used in combination with a resection.

Aftercare

The type of follow-up treatment can be designed differently; there are different expert opinions in this regard.
1. Immobilization with plaster of paris with unloading or partial loading
2. Early functional follow-up treatment
Whereas in the past people preferred immobilization using plaster of paris, today people tend to opt for what is known as "early functional aftercare".
This implies:

Partial exposure to a splint over a period of around 14 days.
Strengthening the muscles through tension exercises and physiotherapy.
As a rule, from the 9th week onwards, flexion of up to 120 ° can be achieved with free extension.
Sport can be considered after about 6 months.

Duration of meniscus surgery

The duration of a meniscus operation also depends on various factors.
Both the type and extent of the injury and the surgical procedure performed play a decisive role in this context.

In addition, the preparation of the patient and induction of anesthesia are added to the scheduled duration of the meniscus operation. The actual meniscus operation takes up only a fraction of the time in the estimated duration.
In addition, the duration of meniscus surgery can vary greatly from patient to patient. Even with the same clinical picture and extent and the same surgical procedure, the anatomical conditions of the individual patient play an important role.

Before the induction of anesthesia, the patient must cover a period of six to eight hours to be sober. This means that he is not allowed to consume any food or fluids.
The induction of general anesthesia and the preparation of the patient can take 15 to 20 minutes be expected. However, this time can be significantly longer due to problems with intubation or the laying of the venous access.
The actual meniscus operation then lasts approximately 30 to 60 minutes. However, the operating time can also be exceeded quickly due to difficult anatomical conditions or intraoperative complications.

Aftercare

Both after a Partial meniscus removal, as well as after the introduction of threads, a conscientious follow-up treatment should be initiated quickly.
Immediately after the meniscus operation, partial weight bearing on the affected knee using forearm crutches is recommended. However, the load on the knee joint should be for a period of four to seven days at maximum 15 to 20 kilograms lie. Afterwards, the follow-up treatment can be continued with a dosed increase in load.
In this context, it is important to note that pain that occurs during the stress phase should lead to a reduction in stress. This also applies if pronounced swellings develop in the area of the affected knee after the meniscus operation. Since the venous system is heavily stressed by the temporary immobilization and therefore blood clots can develop, a regular one is necessary Thrombosis prophylaxis for normal aftercare after meniscus surgery.

In addition, decongestant measures should be taken immediately after the meniscus operation. Above all, cooling the affected knee (four to five times a day for 10 minutes), taking decongestant drugs and targeted Lymphatic drainage can optimally complement the follow-up treatment.
After meniscus surgery with meniscus refixation, follow-up treatment is generally carried out by a Splint therapy (Orthosis).
Over a period of about a week, the operated knee joint must be immobilized with a so-called positioning splint.

After this, the follow-up treatment is continued with a functional splint that limits the range of motion of the knee joint. With this method of meniscus surgery, the maximum load should not exceed 15 to 20 kilograms for at least 3 weeks.
The functional splint is usually worn for a total of 6 weeks.

In addition, the follow-up treatment must be supplemented by special physiotherapy without stress. Training can begin in the 7th week after the actual meniscus operation. Even with this surgical procedure, however, the stress must be reduced again if severe pain or swelling occurs.

forecast

If the meniscus is only removed, the patient usually regains his former ability to work and do sports quickly (after 3 - 6 weeks). After meniscus sutures, the ability to play sports does not begin 12-16 weeks postoperatively, better 6 months. The ability to work depends on the demands of the job.

cure

Healing after meniscus surgery also depends on many factors.
In this context, these are the most important things Extent of injury and the chosen Surgical procedure a crucial role.

In general, however, it can be assumed that healing will proceed without problems after a successful meniscus operation. Affected patients should expect to be severely restricted over a period of several weeks.
If the meniscus is only removed, the healing is usually complete after three to six weeks. After about three weeks, the affected knee can be moderately loaded again.
Six weeks after the meniscus operation with partial removal of the meniscus, the patient should be fully fit for work and sport.

If so-called meniscus sutures have to be placed during meniscus surgery, healing takes a significantly longer period of time. In these cases, it can be assumed that the load-bearing capacity of the knee joint is restored after 12 weeks at the earliest. Healing can take up to 16 weeks after the meniscus sutures have been placed.
In general, the healing process after meniscus surgery is usually problem-free and consequential damage is not to be expected.

Appointment with a knee specialist?

I would be happy to advise you!

The knee joint is one of the joints with the greatest stress.

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:

Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main

How long are you on sick leave after meniscus surgery?

Knee injuries that make meniscus surgery necessary can take a long time to heal.
For this reason, many of the affected patients ask themselves how long they are on sick leave after meniscus surgery and after what period of time they can return to their professional activity without restriction.
How long people who work in a job with high knee strain will be on sick leave must be decided by the treating doctor on a case-by-case basis.

How long an affected person is on sick leave after meniscus surgery depends on various factors:
Both the Type and severity of the knee injury, as well as the Occupation of the person concerned play a crucial role in this context.
If only a small part of the meniscus was removed during the meniscus operation, an office worker, for example, can go back to work one to two weeks after the operation.

In general, however, it can be assumed that such professions will be on sick leave for at least two to three weeks.
If parts of the meniscus were refixed during meniscus surgery, the affected knee must be protected for a longer period of time. In this case it should be assumed that an office worker (or members of other professional groups with low knee strain) is on sick leave for at least two to three weeks.
Patients who put more strain on their knee due to work should at least six to eight weeks wait until work can be resumed.

Although the healing phase takes a long time, the knee should not be excessively stressed too early. Failure to do so can lead to serious complications, which can lead to the person concerned having to be on sick leave for even longer.

Cost of meniscus surgery

The Cost of meniscus surgery depend both on the extent of the injury and the extent of the surgical intervention. In addition, additional costs for diagnostics, general anesthesia, renting the operating room and follow-up treatment must be covered.
Depending on the disease of the meniscus, additional costs for rehabilitation measures and aids may arise even after a successful meniscus operation.

However, since meniscus surgery is not a cosmetic procedure without medical indication, these costs do not have to be borne by the patient himself. Both statutory and private health insurances have to cover the entire cost of meniscus surgery including diagnostics, the operating room, general anesthesia and follow-up treatment.
The costs of subsequent rehabilitation treatment are usually not borne by the insured person.

Risks of meniscus surgery

Meniscus surgery, like any other surgical procedure, involves certain risks. (please refer: Complications of surgery)
The hazards typical of an operation are generally divided into two classes: general and specific Risks.

General Risks

The usual general risks also apply to meniscus surgery. During an operation under general anesthesia, complications in the area of the cardiovascular system can occur. In addition, breathing can be restricted during meniscus surgery. The statistically greatest risk of an operation is the development of a so-called thrombosis. However, the occlusion of a vein by a blood clot is normally prevented by various measures. Especially after meniscus surgery with subsequent immobilization of the knee joint, injections with a blood-thinning drug must be administered over a period of several days. Nevertheless, with all possible precautionary measures, a thrombosis can develop. People who have swelling or pain in the lower leg or calf after meniscus surgery

notice, should therefore immediately consult the treating specialist. In addition, infections can occur after an operation. In the case of meniscus surgery, inflammation of the knee joint is one of the most feared risks. Small cuts during surgery can reduce the risk of infection, but not completely eliminate it. In addition, bleeding and nerve damage are among the most common risks of knee surgery.

Special risks

In meniscus surgery, wound infections are both general and special risks. Especially with the open surgical method, germs can penetrate the wound during meniscus surgery. These pathogens can then lead to pronounced inflammatory processes in the knee joint area. An infection of the knee joint after meniscus surgery is considered a particularly unfavorable complication, as the knee joint cartilage can be severely damaged by the inflammatory processes. However, since meniscus surgery is performed under strict sterile conditions regardless of the surgical procedure chosen, wound infections are rather rare. In addition, persistent pain after meniscus surgery is one of the relevant risks. If the injured meniscus is replaced by a meniscus replacement during the surgical procedure, there is also the risk that the implant will tear under load. Furthermore, a joint effusion can occur even after a successful meniscus operation due to the tissue trauma. This complication then makes it necessary to puncture the newly operated knee joint. The puncture can also lead to wound infections and bleeding. Other special risks of meniscus surgery include injuries to the cartilaginous joint surfaces and long-term impairment of joint function. In addition, surgical refixation of a torn meniscus can lead to renewed tearing. As a result, the affected patient needs another operation.

Sport after menisukus surgery

The question of how long after one Meniscal surgery No sport is allowed to be done cannot be answered in a general way.
The duration of the sports leave depends on the illness being treated as well as the healing process. In rare cases, even after a successful meniscus operation, you may not be allowed to do any sport that stresses the knee joint for a lifetime.

However, if the knee joint injury was detected early, the chances are very good that normal sport can be resumed once it has healed completely. This is especially the case if the meniscus has not been damaged Damage to the cartilage surfaces have arisen.
If, on the other hand, signs of wear and tear associated with the meniscus injury can be detected in the area of the cartilage surfaces, no sport may be practiced for a longer period of time.
The duration of the sports leave then depends less on the success of the meniscus operation or the recovery of the meniscus. Rather, the damaged cartilage surface should have completely regenerated before you can start exercising again.

The regeneration can take several months, depending on the condition of the cartilage tissue. Small injuries to the meniscus can usually be two to three weeks return to exercise after meniscus surgery. However, the affected knee should initially only be put under moderate strain.
If pain or other discomfort occurs during exercise, training must be stopped immediately.

Patients who start exercising again without consulting a doctor risk serious damage to the knee joint. If the injured knee is excessively stressed before the menisci and cartilage have completely healed, this can very likely lead to lifelong problems.
Strength Knee painSignificant restrictions on movement and poor resilience of the affected knee are often the result of too short a sports leave. If the knee joint was already severely damaged before the meniscus operation, it may no longer be possible to resume sport to its full extent. For this reason, any injury to the meniscus should be diagnosed and treated by a specialist doctor as soon as possible.

If meniscus surgery is necessary due to the extent of the injury, the surgical procedure should be carried out as soon as possible. In addition, there are a few aids that can reduce the duration of sports leave after meniscus surgery.
Immediately after the end of complete immobilization of the knee joint, affected persons should attend a special Rehab program take part. Be in such a program physiotherapy exercises which help to stabilize the knee again after meniscus surgery and to prepare it for normal loads.