1. Do You Take Out the Whole Mensicus (Meniscectomy)?
Total meniscectomies through large, open incisions are no longer done. Numerous studies have documented the rapid onset of accelerated arthritic changes in the joint following a total meniscectomy. Nowadays, only the torn part is removed (partial meniscectomy) with arthroscopic techniques. Think of it like a sofa cushion. If there's a tear on one corner and you sit on that corner, there's not going to be much of a cushion effect. If you sit on the rest of the cushion, it's probably still fine. Also, the structural integrity of that portion of the meniscus has been compromised, so it's not functioning like it's supposed to anyways.
2. Won't I Get Arthritis if You Take Out My Meniscus?
Taking out part of the meniscus decreases the contact area, thereby raising contact pressures. You probably will have a higher chance of getting arthritis in that knee at some point, but I can't tell you when. Remember, though, that there are many factors determining the progression of knee arthritis. A meniscus tear can cause pain and swelling which can cause muscles to weaken. Remember, one treatment for arthritis is exercise and muscle strengthening. If the meniscus tear limits your ability to do physical therapy or other activities, you may want to have it taken out.
3. What Can I Expect During and After the Surgery?
The procedure is usually completed in less than two hours of actual surgical time. Of course, there is additional time for the anesthesiologist to put you to sleep, time for positioning, and time to wake up afterwards. You go home the same day with some sort of assistive device (crutches or walker) that is used for the first few days. Generally, most people have a fairly good recovery by four to six weeks, although each patient is different and recovers at a different rate.
4. What Are the Outcomes of Meniscus Surgery?
People with partial meniscectomies have a high percentage of good-to-excellent results in the short-to-medium range follow-up of around four to five years. That percentage tends to drop with longer followup, but one study showed 78% good-to-excellent results at twelve years. Another important factor is the amount of articular cartilage injury seen at the time of surgery. Patients with more cartilage damage had worse outcomes. Similarly, those with degenerative tears (who are older and likely have early arthrits) tended to fare worse than traumatic tears. However, even those with degenerative tears had better outcomes with partial, rather than total, meniscectomies.
5. Can't You Repair It?
Only rarely is a meniscus going to be repairable, because of its poor circulation. Some factors to consider are the location, tear configuration, age of the patient, activity level and timetable to return to a particular activity. The blood supply only reaches roughly the outer one-third of the meniscus. If the surgeon puts in stitches but there is no blood supply to bring new cartilage cells, then the tear is never going to heal. In these cases, it is better to take out the torn portion so that you can get into rehabilitation faster. Also, the recovery after a meniscus repair is longer, involving protected weight-bearing and limitations to range of motion. So when you hear about athletes coming back and playing a few days or weeks after their knee surgery, they had partial meniscectomies, not meniscal repairs, as is sometimes reported.
