Our Summary

This research paper looks at how removing part or all of a specific section in the knee (known as the lateral meniscus) can affect the movement (kinematics) and pressure (forces) in the knee. The researchers used a robotic system to apply different loads to 10 preserved human knees. They then measured the movement and pressure in the lateral meniscus for four different conditions: when the knee was untouched, when one-third and two-thirds of the lateral meniscus was removed, and when all of it was removed.

The results showed that removing just a third of the lateral meniscus caused a significant decrease in the side-to-side movement of the tibia (one of the bones in the lower leg), and also reduced the pressure in the lateral meniscus. Removing two-thirds of the meniscus produced similar results. When all of the lateral meniscus was removed, the side-to-side movement of the tibia reduced even further.

The study concludes that even a small removal of the lateral meniscus could make the knee more prone to injury. Therefore, doctors should aim to repair and remove as little of the lateral meniscus as possible when treating tears, to avoid the potential harmful effects of partial removal observed in this study.

FAQs

  1. How does the removal of the lateral meniscus affect the movement and pressure in the knee?
  2. What are the observed effects of removing one-third, two-thirds, and all of the lateral meniscus on the knee’s kinematics?
  3. Based on the study, what should doctors aim for when treating lateral meniscus tears to avoid potential harmful effects?

Doctor’s Tip

A helpful tip a doctor might tell a patient about meniscectomy is to try to preserve as much of the meniscus as possible during the surgery to maintain the stability and function of the knee joint. Removing only the damaged portion of the meniscus, rather than the entire meniscus, can help prevent long-term issues with knee movement and pressure. It is important to follow post-operative rehabilitation and physical therapy programs to optimize recovery and prevent further injury.

Suitable For

Patients who are typically recommended for meniscectomy are those who have a torn meniscus that is causing significant pain, swelling, and limited range of motion in the knee. Meniscectomy is often recommended for patients who have not responded to conservative treatments such as rest, physical therapy, and anti-inflammatory medications.

Specifically, patients who may be recommended for meniscectomy include those with:

  1. Acute tears: Patients who have recently injured their meniscus through activities such as sports or trauma may benefit from a meniscectomy to relieve pain and restore function.

  2. Degenerative tears: Older patients with degenerative tears in the meniscus, often due to wear and tear over time, may require a meniscectomy if conservative treatments are not effective.

  3. Complex tears: Patients with complex tears that cannot be repaired through other methods may be recommended for meniscectomy to alleviate symptoms and prevent further damage.

  4. Recurrent tears: Patients who have undergone previous meniscus surgeries and are experiencing recurrent tears may require a meniscectomy to address the ongoing issue.

It is important for patients to discuss the risks and benefits of meniscectomy with their healthcare provider to determine if this surgical procedure is the best course of action for their specific condition.

Timeline

  • Before meniscectomy:
  1. Patient experiences knee pain, swelling, and limited range of motion.
  2. Patient undergoes physical examination, imaging tests (such as MRI), and possibly a diagnostic arthroscopy to confirm the diagnosis of a meniscus tear.
  3. Doctor recommends meniscectomy as a treatment option if conservative measures (such as rest, physical therapy, and medications) have not been successful in relieving symptoms.
  • After meniscectomy:
  1. Patient undergoes arthroscopic surgery to remove part or all of the damaged meniscus.
  2. Patient may experience pain, swelling, and stiffness in the knee immediately after surgery.
  3. Patient undergoes physical therapy to regain strength and range of motion in the knee.
  4. Patient gradually returns to normal activities, with full recovery typically taking several weeks to months depending on the extent of the meniscectomy and individual healing process.
  5. Patient may experience long-term consequences of meniscectomy, such as increased risk of osteoarthritis due to altered knee biomechanics.

What to Ask Your Doctor

Some questions a patient should ask their doctor about meniscectomy include:

  1. What are the risks and potential complications associated with a meniscectomy procedure?
  2. How much of the meniscus will need to be removed during the surgery?
  3. Will the removal of the meniscus affect the movement and pressure in my knee?
  4. What is the expected recovery time and rehabilitation process following the surgery?
  5. Are there any alternative treatments or procedures that could be considered instead of a meniscectomy?
  6. How long will it take for me to return to normal activities and sports after the surgery?
  7. What steps can I take to prevent further injury to my knee following a meniscectomy?
  8. Will I need any additional treatments or therapies after the surgery, such as physical therapy?
  9. What are the long-term implications of having part of my meniscus removed?
  10. How frequently will I need follow-up appointments to monitor my recovery and knee health after the surgery?

Reference

Authors: Novaretti JV, Lian J, Patel NK, Chan CK, Cohen M, Musahl V, Debski RE. Journal: J Bone Joint Surg Am. 2020 Apr 1;102(7):567-573. doi: 10.2106/JBJS.19.00712. PMID: 31985506