Knee meniscus can be damaged at any age. On young patients, injuries usually occur after sports accidents (torsion traumatism), or repeated micro-traumatisms through flexion (tiler’s squatting position). The treatment of a meniscal lesion is the most frequent indication for knee arthroscopy.
There are two meniscus: medial and lateral. They are shaped like crescents around the tibia’s articular surfaces. They are attached to the tibia through the posterior and anterior horns, on the front and back of the cruciate ligaments, and are attached to the capsule through their periphery. Their triangular section gives them a corner shape, between the femur and the tibia. They are elastic fibrocartilages which can’t be seen on X-rays. They go deep into the tibial surface, increasing the tibiofemoral contact area and allowing improved stability and adjustment of the joint surfaces. This leads to a better distribution of pressure and better choc-absorption during physical exercise.
Arthroscopy is a non-invasive procedure, which allows exploring the joint through optical fibers called arthroscope, which are a few millimeters wide and connected to a camera projecting an image on a TV screen.
The arthroscope is inserted into the knee through several small incisions (from 2 to 4, usually 5mm wide). Arthroscopy isn’t just a diagnostic procedure, it also allows intraarticular surgeries. As a minimal invasive operative procedure, arthroscopic surgery is now part of the standard procedures in joint surgery. When the meniscus is damaged, it almost never heals on its own. Surgery is needed to either suture it, or remove it, according to the gravity of the lesions.
1- Suture :
Suture is only possible on young patients, and when the injury is located in the vascular portion around the meniscus. Degenerative meniscus on old patients can’t be sutured. There are two types of possible sutures, either on the outside of the joint with needled threads which are retrieved through an additional way, and tied outside the joint; or the suture is entirely done inside the joint. The latter requires specific suture equipment (usually, a thread leaning on small intra-meniscal anchors). Following a meniscal suture, you’ll be able to mobilize the knee and walk with weight bearing protected by a splint for four weeks. The flexion recovery will be limited to 90° for the first three weeks. Ice should be applied on the knee, and an anticoagulant treatment should be taken for ten days. Physical activities such as sports will not be possible for three months after the surgery. Sutures have a failure rate of 25%.
2- Resection :
Resection is made with hand pliers or motorized shavers, trying to be as thrifty as possible. After this procedure, you’ll be able to use your knee right away, you can walk witn normal weight bearing.
There are no banned activities, although resting and applying ice to the knee for three to four days is highly recommended. Rehabilitation in a physiotherapy center should start the next day after surgery. Resumption of basic sedentary activities is possible after a week, on the other hand daily normal life and running should be put off until three to four weeks. Post arthroscopy residual pains can be treated through intraarticular injections of hyaluronic acid (usually an injection per week, for three weeks), called viscosupplementation.
Vos questions sur la chirurgie arthroscopique méniscale
Allowing exception, this is an ambulatory surgery with 6 to 10 hours of hospitalization only.
Considering that it’s a short procedure with little postoperative pain, it will be performed with a very light general anesthesia. This procedure can also be done with a local anesthetic, when required by the patient.
The patient can walk, leaning on a crutch if necessary. There are no forbidden activities, but they should be limited the first days, and ice should be applied on the knee to reduce swelling. The patient can usually drive after 3 to 4 days. Rehabilitation should start as soon as possible, the day after surgery. Resumption of sports is possible three weeks after the procedure.
Like any surgery, arthroscopy can lead to: – Bleeding from the puncture points – Hematoma – Intraarticular effusion, that might need a puncture – Phlebitis – “Racket shaped” anesthesia region on one of the entry points – Infection. Although very unusual, this complication might lead to a new procedure to “clean” the joint, and the use of antibiotics. – Although it’s difficult to consider all the possible postoperative complications, arthroscopy remains a simple and low risk surgery.