Knee Problems-Meniscus Repair
Anterior
Cruciate Ligament
Posterior Cruciate Ligament
ACL
/ PCL Revision Operations
Meniscus Repair
Meniscus Transplant
Total Knee Replacement
Osteotomy
Cartilage Regeneration and Arthritis
Orthopaedic Updates
Meniscus Repair
Dr. Frank Noyes of Cincinnati Sportsmedicine and Orthopaedic Center has spent many years developing highly specialized arthroscopic techniques to repair tears in the meniscus. Initiated in 1983, this program has involved more than 1000 patients. The results of over 200 of these meniscus repairs have been published, along with the surgical techniques required for a successful outcome. Over 15 years of experience have enabled us to repair not only small "simple" tears, but also complex multi-component tears, which most physicians elect to remove.
"The difference between our philosophy and that of others is to repair not only small "simple" meniscus tears, but also complex tears that extend into the portion of the meniscus that has a limited blood supply. Although the success rate is lower for complex tears (80%) compared to simple tears (98%), we feel it is worth the time and effort to try to save this vital structure. Otherwise, most of the meniscus would have to be removed, which often leads to arthritis and serious future problems."
Sue Barber-Westin
Director of Clinical Research Studies
Cincinnati Sportsmedicine Research and Education Foundation
"The preservation of meniscal tissue is now understood to be extremely important, and we make every attempt to use advanced surgical techniques and a carefully constructed rehabilitation program to gain successful results. Our extensive experience with this procedure enables us to be very aggressive in our efforts to save the mensicus, especially in young patients and highly competitive athletes."
Frank Noyes, M.D.
President
Cincinnati Sportsmedicine Research and Education Foundation
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Patients
Life After a Meniscus Repair Nine Years Later
What began as just a minor discomfort felt every once and awhile turned into pain so great that some nights 40 year-old Ed Miller couldn't sleep. "If I played sports or had a
very active day in my construction business, my knee would
swell and hurt all of the time."
Ed came to see Dr. Frank Noyes who diagnosed a lateral meniscus cyst and tear. Surgery was inevitable. In knees such as Ed's, most physicians remove the cyst and the portion of the meniscus that is torn. However, Dr. Noyes took a more aggressive approach at trying to save the vital meniscus tissue. After removing the cyst, he carefully repaired the tear, using the assistance of the arthroscope and multiple sutures.
That was nearly nine years ago. Today, as owner and founder of Edwards Construction, Ed gratefully acknowledges that his knee is "just like a normal knee" and that the surgery "allowed me to do all of the things I did before the problems started". He had "no side effects what-so-ever" and maintains a hectic lifestyle managing a successful company. "My operated knee is actually better than my other knee that has some problems, it's just like new."
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Questions and Answers
What is the meniscus?
The menisci, two c-shaped wafers made of cartilage, act as shock absorbers within the knee and add to joint stability.
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Why do I need my meniscus?
With activity such as walking, climbing stairs, or running, forces as great as 3 to 6 times your body weight cross the knee joint. In other words, if you weigh 150 pounds, your knee joint feels 450 to 900 pounds of force when you run or stoop. The menisci normally diffuse these forces over a wide area. But if the meniscus is torn or badly damaged, the forces are concentrated onto a small area of the joint. Eventually, they cause the joint lining to crack and fragment, the joint begins to deteriorate and pain and swelling result. This process is called "arthritis".
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How do I know if Iāve torn my meniscus?
Most people have the following symptoms:
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When should I see a physician?
If your symptoms last more than two days, you should seek the proper medical care; a sports medicine trained physician. If your pain and swelling are severe, seek attention immediately.
Fortunately, approximately 50% of meniscus tears heal without surgery. Even so, it is important to see a sports medicine physician who will tell you exactly what you are dealing with and initiate the proper conservative treatment. It is important to learn safe and effective exercises to perform daily to keep your muscles strong, even if surgery is not required.
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Why should I see a sports medicine trained orthopaedic surgeon?
The training of an orthopaedic surgeon involves many years of undergraduate, medical school, and residency education. The specialization of sports medicine involves additional training, usually at an educational center where a fellowship year is completed. This involves advanced training in arthroscopic surgery, required in the treatment of most knee, shoulder, ankle, elbow and sports medicine-related injuries. The sports medicine-trained surgeon also has knowledge of specific rehabilitation and muscle performance issues to safely regain function and return patients to athletics. A sports medicine center combines the disciplines of physicians, physical therapists, athletic trainers, and more to totally heal all aspects of an injury.
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Will I need surgery?
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There are four factors that determine the answer to that question.
The answer is "no" if: |
Multiple suture placement for a complex meniscus tear extending into the central one-third avascular region.
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Your symptoms go away within a few weeks. A meniscus may heal on its own. A small tear in the outer portion or periphery of the meniscus that has a rich blood supply may heal. If your symptoms do go away that does not mean you should not seek medical care. Conservative treatment does not mean no treatment. You must still be under an orthopaedic surgeon's care and go through rehabilitation to strengthen your knee and maintain its proper range of motion.
The answer is definitely "yes" if:
You can't bend or extend your knee. If you have a meniscus tear your knee may catch or lock, indicating that the meniscus is "flipped up into the joint" preventing knee motion. This occurrence may show up as a feeling of your knee is locked in position.
The answer is definitely "yes" if:
You are young, active and your symptoms last several weeks.
The answer is possibly "yes" if:
A physician has confirmed you have a meniscus tear and you've undergone a one to two month rehabilitation program with little symptom relief. Some large tears should be repaired early to save the meniscus. If not repaired, the meniscus may become dislodged in the knee and incur further damage making it unrepairable. An MRI may be useful to determine the extent of a meniscus tear and if early operative treatment is required.
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What are my surgical options? |
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There are three types of arthroscopic meniscus procedures. The type of procedure used depends on where the tear is located.
1. Simple tear. Tears in the outer one-third, or periphery, of the meniscus (which contains a rich blood supply) can be repaired with a 95% chance of successful healing. There are no restrictions, such as age, other injuries, or activity level for this procedure. |
2. Complex tear. Tears extending into the central one-third protion of the meniscus, which has a limited blood supply, can also be repaired in many cases. In the past, surgeons elected to remove these types of tears due to the difficulty in achieving a repair which would heal. With techniques developed at our Center, our philosophy is to now aggressively attempt to save the meniscus if possible. Our success rate for these types of repairs is 80% - and depends on the healing ability of the patient after the repair has been performed. We have found no restrictions to repairing these types of tears - even in patients up to 55 years of age have successfully had this operation. It is important to check with your surgeon before surgery if advanced suturing and repair techniques would be used to repair complex tears.
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3. Total menisectomy. If the meniscus has multiple tears located in different regions, is shredded or severely deteriorated due to multiple injuries, then it cannot be repaired. It may be possible to save some of the meniscus, but if it must be removed it can be later replaced with a transplant.
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What can I expect after the surgery and how can I avoid complications? |
| Rehabilitation is an essential element or your recovery. The success of your meniscus repair surgery is not only determined by an expert surgeon, but also by following a rigorous rehabilitation program. YOUR SURGERY MAY FAIL IF YOU DO NOT FOLLOW THE RIGHT REHABILITATION PROGRAM. |
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Your rehabilitation program will depend on whether your tear was simple or complex.
1. Simple tear. Rehabilitation following surgery for this type of tear is typically:
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Immediate motion and exercises following surgery
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Crutches for four weeks
- Resumption of running, if desired, after four months
- Full activity at six months
- NO SQUATTING, KNEELING OR DEEP KNEE FLEXING FOR SIX MONTHS
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Cincinnati Sportsmedicine has one of the lowest meniscus repair complication rates reported in the medical literature because our patients follow these rehabilitation guidelines.
2.Complex tear. Rehabilitation following surgery for this type of tear is typically:
- Immediate motion and exercises following surgery
- Crutches for six to eight weeks
- Resumption of running, if desired, at 6 months
- Full activity at seven to nine months
- NO SQUATTING, KNEELING OR DEEP KNEE FLEXING FOR SIX MONTHS
Click here to see our detailed rehabilitation
protocol
Many meniscus repairs that fail do so because the patient was allowed to return to full activity at three months or was allowed to kneel or squat early in their recovery. A meniscus repair takes time to heal. We insist that our patients, be patient. It is worth the wait.
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What if after my surgery, I'm still having problems with my knee? |
If you are still having problems with pain, swelling, locking or catching there is the chance the meniscus has torn again. With proper examination, a physician can tell if this has happened. Should this occur, the meniscus can be repaired again or the portion of the meniscus that did not heal can be removed.
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If you'd like more information regarding meniscus injuries and repair,
please contact our Director of Clinical Studies, Sue Barber-Westin, at
sbwestin@csmref.org.
