Meniscal Tear/Repair

What is it?

A meniscal tear is a common injury of the knee. The meniscus is a wedge-like, shock-absorbing piece of cartilage found within your knee joint. It is shaped like a C and curves inside and outside the joint to stabilize your knee. It also allows your thigh (the femur) and your shin (the tibia) bones to glide and twist over each other with movement, as well as provide cushioning support for the weight-bearing job of your legs.

Meniscus tears are fairly common. Turning or twisting of the knee may cause tearing of the meniscus. A meniscal tear can also occur simultaneously with injury to other ligaments of the knee (in particular, the anterior cruciate ligament which helps to connect the upper and lower leg bones).

You may hear a popping sound at the time of injury to the meniscus, and you may still be able to bear weight and walk on the injured knee. Pain, swelling, and redness of the joint then develop over the next 12 to 24 hours. In some cases, a piece of cartilage can interfere with knee movement, and you may notice that your knee will “lock” or “pop” with attempted movement. Medial meniscal tears are more often symptomatic than lateral meniscal tears.

Accurate diagnosis starts with the history of injury and physical examination. During your visit, your physician will ask a series of questions to get an idea of how your injury occurred and what symptoms you are experiencing. Special tests, including an MRI, may be ordered to help with the diagnosis.

What are the treatment options?

Initial treatment of a meniscal tear follows basic home care management — “RICE,” which stands for Rest, Ice, Compression, and Elevation. Nonsteroidal anti-inflammatory medications (NSAIDs) are helpful to relieve pain and inflammation. This may be all that is needed for minor tears that have occurred in the outer edges of the meniscus.

The majority of the times, tears in the meniscus need to be taken care of surgically. This is due to the fact that the meniscus has a limited blood supply. Only the outside one-third of the meniscus is supplied with blood. This is considered the red zone. Tears in this area can heal if repaired. The inner one-third of the meniscus (white zone) is not supplied with blood and a tear to this area will not heal.

If you have a meniscal tear which is causing you mechanical problems, such as clicking, popping or catching, careful arthroscopic partial meniscectomy is often the quickest way to solve the problem and restore knee function. Losing a small, already torn part of the meniscus is not a mjor problem in the long run, provided the knee is stable and that articulating surfaces are not worn out. However, complex meniscal tears are often associated with unstable ligaments and damaged articular surfaces; surgical removal of most of the meniscal tissue, therefore, is associated with accelerated wear and tear.

Removing the menisci increases the contact pressure between the femur and the tibial articular surface and may predispose one to early arthritis.

Surgery may involve using a small, pen-sized camera (called an arthroscope) to trim torn flaps in the cartilage and repair any other damaged ligaments. Often, a brace or cast is needed after surgery, and physical therapy is an important part of recovery to relieve pain and strengthen and stabilize the muscles around your knee.

Procedure Goals

The goal of meniscal surgery is to repair the tear and leave as much of the healthy meniscal tissue as possible.

Risks of the Procedure

Before Procedure

It is likely that you will go through physical therapy for a few weeks before surgery. The goals of attending physical therapy pre-operative include reducing pain and swelling, restoring the knee’s full range of motion and strengthening the muscles. Meeting these goals will assist with a better healing process post-operative including restoration of full range of motion.

Day of Surgery

The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.

Wear shorts or loose pants.

Do not eat or drink anything after midnight for arrivals before noon. Otherwise, do not eat or drink anything seven hours prior to your arrival at the surgery center.

If crutches or a walker are needed, please rent or borrow them prior to your surgery.

You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.

After Procedure

You will discharge the same day of your surgery. Before you go home you will practice walking with crutches and you may have to wear a knee brace or splint to help protect the knee.

For meniscectomy, begin your post-operative exercises the day after surgery. You will be weight bearing as tolerated unless otherwise instructed and can advance range of motion as pain allows.

For meniscal repair, begin exercises the day after surgery. You will partial or no weight bearing. Wear immobilizer at all times except when doing exercises. Advance range of motion as directed by your physician.

Discharge Instructions

Diet

• You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.

Knee Care & Bathing

• Use your crutches as needed and maintain your weight bearing precautions. 
• Keep your knee elevated above heart level as much as possible for the first 48 hours, then as needed when symptomatic for up to two weeks. This will prevent painful swelling and promote healing. 
• Keep your incisions clean and dry all the time. 
• It is ok to shower or sponge bathe 2 days after surgery but you must keep your incision clean and dry at all cost! This usually entails wrapping your knee in a plastic garbage bag to keep it dry.

Cold Therapy

• To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48 hours and then as needed to help control pain and swelling.
• To avoid frostbite, place a towel or t-shirt between the ice pack and your skin. 
• It is not necessary to use ice while sleeping. 
• We recommend the use of a cold therapy unit, which is often an out of pocket expense. The advantage of this unit is that the temperature can be regulated, allowing for continuous use for several hours at a time.

Pain Medication

• Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol. 
• While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off. • No driving while taking any narcotic pain medication! 
• The pain medication may cause some nausea so take it with food. 
• The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.

Follow-up Care

• Watch for temperature > 101.5F, persistent numbness and tingling in the knee, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, blue toes, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room. 
• Please make sure to follow instructions given to you by your physician, they may have specific instructions to your care.
• If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.

Rehabilitation Plan- Exercises

Following your surgery and prior to your first post-op visit, the following exercises are very important in order to restore your knee motion and maintain muscle function. Your rehab program will be advanced at your first post-op visit with your surgeon and physical therapist. Use the ice machine as instructed or as often as possible, especially before moving the knee. Crutches and immobilizer or brace (locked straight) should be used at all times while walking. Your weight bearing status will depend on the procedure performed.

Exercises:

1. Seated Extension Stretch: Open the immobilizer or brace and place a rolled towel under your heel to allow your knee to stretch into full extension. Restoring normal extension is very important and needs to be addressed now. Perform this 2-3 times a day. 10-15 minutes each session. You may and should use ice during this session.

2. Seated Quad Set: With the leg straight and immobilizer open, place a rolled towel under your knee and tighten the quad muscles in the front of the thigh, pushing the knee down into the towel. Perform this 2-3 times a day. 25-30 reps each session.

3. Ankle Pumps: Move your ankle up and down frequently during the day. This will help the circulation in the calf and decrease lower leg swelling.

4. Heel Slides (for meniscectomy only): To bend your knee, begin with sliding your heel towards your buttocks as far as you can into your pain tolerable range, then slide back down straight. When you can put your feet up on the wall, you can begin wall slides. Rest the operative leg on the non-operative leg, then lower the feet down the wall, allowing gravity to bend your knee. Use your non-operative leg to push your feet back up the wall. Repeat several times during a 10-15 minute session. Do this 2-3 sessions a day.