Our Summary

Meniscectomy, a surgical procedure to remove part or all of a damaged meniscus in the knee, is still a common orthopedic procedure despite calls for preserving the meniscus where possible. The meniscus is a piece of cartilage that provides a cushion between your thighbone and shinbone. This paper argues that the procedure is being done too frequently, given strong evidence that non-surgical treatment or meniscal repair can be just as effective for certain types of meniscus tears.

For example, in cases of traumatic tears, especially longitudinal vertical tears in areas with good blood supply, repair has shown high success rates in terms of recovery time, functional outcome, and cartilage protection. In some cases, simply leaving the meniscus alone can be an option.

Even with degenerative meniscus lesions, which are commonly found in middle-aged and elderly people and are often associated with aging tissue and osteoarthritic processes, non-surgical treatment is usually just as effective as surgery. Surgery should only be the first choice when non-surgical treatments have failed, or in cases with severe mechanical symptoms.

The paper emphasizes that meniscal preservation should be the priority, particularly in young athletes who have a horizontal cleavage, as meniscectomy could be extensive and result in long-term issues. The main takeaway is that we should try to “save the meniscus” wherever possible.

FAQs

  1. What is a meniscectomy and why is it considered a common orthopedic procedure?
  2. What are some alternatives to meniscectomy for treating meniscus tears?
  3. Why does the paper argue that meniscal preservation should be a priority, especially in young athletes?

Doctor’s Tip

One helpful tip a doctor might tell a patient about meniscectomy is to make sure to follow post-operative rehabilitation and physical therapy guidelines carefully. This will help ensure proper healing, strengthen the muscles around the knee, and improve range of motion and function. It is important to follow the specific recommendations provided by the healthcare team to optimize recovery and reduce the risk of complications.

Suitable For

Patients who are typically recommended meniscectomy include:

  1. Patients with traumatic tears, especially longitudinal vertical tears in areas with poor blood supply.
  2. Patients with degenerative meniscus lesions that have not responded to non-surgical treatment.
  3. Patients with severe mechanical symptoms, such as locking or catching in the knee joint.
  4. Patients with horizontal cleavage tears in young athletes, where meniscal preservation is a priority to prevent long-term issues.

Ultimately, the decision to recommend meniscectomy should be based on a thorough evaluation of the patient’s specific condition and needs, taking into consideration both non-surgical and surgical treatment options.

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 non-surgical treatments like rest, ice, physical therapy, and corticosteroid injections.
  3. If non-surgical treatments are unsuccessful, the patient may be recommended for meniscectomy surgery.

After meniscectomy:

  1. Patient undergoes the surgical procedure to remove part or all of the damaged meniscus.
  2. Recovery period involves physical therapy, pain management, and gradually increasing activity levels.
  3. Patient may experience temporary pain, swelling, and stiffness post-surgery.
  4. Over time, patient gradually regains strength, range of motion, and function in the knee.
  5. Long-term effects may include increased risk of osteoarthritis due to reduced cushioning in the knee joint.

What to Ask Your Doctor

  1. Can my meniscus tear be repaired instead of removed through meniscectomy?
  2. What are the risks and benefits of a meniscectomy compared to other treatment options?
  3. How long is the recovery time after a meniscectomy, and what kind of physical therapy will I need?
  4. Are there any long-term consequences or risks associated with having part or all of my meniscus removed?
  5. Will a meniscectomy increase my risk of developing osteoarthritis in the future?
  6. Are there any alternative treatments or therapies that could be effective for my meniscus tear?
  7. How will a meniscectomy affect my ability to participate in sports or physical activities in the future?
  8. What criteria do you use to determine if a meniscectomy is necessary in my case?
  9. Are there any specific factors about my meniscus tear or overall health that make me a better candidate for meniscectomy or another treatment option?
  10. How often do you perform meniscectomies, and what is your success rate with this procedure?

Reference

Authors: Beaufils P, Pujol N. Journal: Orthop Traumatol Surg Res. 2017 Dec;103(8S):S237-S244. doi: 10.1016/j.otsr.2017.08.003. Epub 2017 Sep 2. PMID: 28873348