Meniscus Replacement

What is Meniscus Replacement?

Meniscus replacement is a surgical procedure performed to replace a torn or damaged meniscus in the knee. 

The meniscus is a soft, fibrous disk of cartilage in your knee joint that sits between the femur (thighbone) and the tibia (shinbone). Also called fibrocartilage, it cushions and stabilizes the joint, acting as a smooth surface for the joint to move on to prevent wear and tear. There are two menisci - one on each side of your knee joint. 

Significance of Meniscus Replacement

A meniscus can be torn or damaged during activities that rotate or put pressure on the knee joint. Most of the meniscus typically has no blood supply, so when it is injured or damaged, it cannot undergo the normal healing process and recuperate on its own. Therefore, meniscus replacement is necessary to ensure your knee is pain-free and stable. 

Indications 

The meniscus in the knee joint needs to be replaced in the following situations: 

• A meniscus that is very badly damaged and cannot be repaired
• A meniscus that is missing, leading to difficult movement of the knee 
• A persistent activity-related pain in the knee or an unstable knee

Criteria for Meniscus Replacement

Though meniscal problems can occur with any person and at any age, the procedure can be performed only if you: 

• Are aged between 30 to 55 and not obese
• Have stable and well-aligned knee ligaments 
• Have minimal or no knee arthritis

Preparation

Your doctor will recommend you observe the following prior to the surgery:

• Stop taking medicines or prescription drugs if applicable
• Avoid food or drink after midnight on the day of the procedure
• Go for additional imaging tests such as X-ray or MRI as needed

The Procedure of Meniscus Replacement

Meniscus replacement surgery is performed under general anesthesia. During the procedure: 

• The surgical area is sterilized and a small incision is made in the knee.
• The surgical site is accessed using special miniature instruments and camera. 
• The tissue or any part of the damaged meniscus is removed.
• Your surgeon will correct any malalignment and/or looseness in the knee.
• The fresh meniscus from a deceased donor is inserted with the help of special instruments.
• The meniscus is then surgically sewn into the knee (implanted).
• The sutures are placed on the native meniscal rim or capsule. 
• Other repairs are surgically performed as necessary.
• The skin layers and the muscle surrounding the knee are closed.

Post-Surgery Care 

After the surgery, you may be allowed to go home the same day or instructed to stay overnight in the hospital, depending on your condition. 

The doctor will recommend the following as you recuperate from surgery:

• Pain-relieving medicines as needed
• Use a knee brace for a few weeks
• Use crutches for 4 to 6 weeks
• Undergo physical therapy for a few months
• Complete a specific rehabilitation program 
• Stick to all follow-up appointments to help monitor the progress 

Prognosis

Strictly following the doctor’s after-surgery care instructions and committing to the prescribed rehabilitation routine may significantly increase your chances of a positive result. It may take you anywhere between 3 to 4 months to return to heavy labor and about 6 to 9 months to resume sports activities.

Risks or Complications

Though rare, you may experience the following low-intensity complications, depending on your knee anatomy, age, and medical conditions: 

• Stiffness in the knee 
• Excessive bleeding or infection
• Damage to nearby nerves or blood vessels
• Incomplete healing with the possibility of repeat surgery

Meniscus Tear Information FAQ’s

What happens to a knee once part of the meniscus has been trimmed?

If a meniscus is torn and cannot be repaired, your surgeon may recommend a partial meniscectomy. This is a surgery where the torn part of the meniscus is removed. The meniscus acts as cushion to force transmission through the knee joint.  Removing some of this cushion exposes the knee to increased contact stress. In most cases, the part of the meniscus that is removed is not functional prior to removal.  Preserving as much meniscus as possible is critical during surgery to preserve knee function and prevent arthritis.

How is a meniscus tear diagnosed?

Your doctor will use a combination of the history, physical examination, xrays and often an MRI to evaluate your symptoms and determine if they are coming from a meniscus tear.  Often patients will report pain on the side of the knee where the meniscus is torn.  Patient will typically report mechanical symptoms (catching, locking, giving way…) which suggest that a flap of torn meniscus is moving within the joint. Patients will also have tenderness over the torn meniscus. An MRI (as seen above) will show fluid within the meniscus that communicates with the joint fluid.

How should I pick a surgeon for my meniscus tear?

See my blog post here.