Meniscus Injuries: Surgery and Rehabilitation

How does a meniscus injury manifest itself?

Clinically, the patient feels an internal tearing sensation at the time of injury, followed by sharp pain. In most cases, the knee swells, and sometimes the injured part can become lodged between the articular surfaces, causing joint locking and making full knee extension impossible.

The diagnosis of a traumatic meniscus injury is primarily clinical. An orthopedic specialist's examination is necessary. This involves checking for a minimal extension deficit, possibly accompanied by joint effusion. During the clinical examination, the doctor also assesses pain in the medial or lateral meniscus region and other specific signs of meniscal damage using appropriate maneuvers.

How to treat meniscus injuries?

Conservative treatment for meniscus injuries

Conservative treatment for meniscus injuries is the first-line approach in cases without joint locking or recurrent joint effusions. It involves functional rest, ice packs, non-steroidal anti-inflammatory drugs, and possibly physiotherapy (restoring mobility, muscle strengthening, and proprioceptive exercises). If conservative treatment fails, arthroscopic meniscectomy may be considered.

Meniscus injuries: minimally invasive surgical treatment

Treatment of traumatic meniscal lesions uses a minimally invasive arthroscopic technique that removes only the damaged portion of the meniscus without opening the joint, through small 1 cm incisions. A camera is inserted through these incisions, allowing the use of surgical instruments. Arthroscopy has eliminated painful symptoms while significantly reducing surgery, hospitalization, and recovery times. Removing the entire meniscus accelerates knee degeneration and associated pain. Therefore, the primary surgical goal is to preserve as much meniscal tissue as possible. Modern techniques allow arthroscopic removal of only the injured part, preserving healthy tissue. Meniscal suture, repairing the lesion arthroscopically, is another advancement. This is typically done for individuals (generally under 40) with lesions in the outer meniscus where good blood supply allows healing. In the central meniscus, poor blood supply makes suturing ineffective, necessitating partial meniscectomy.

Meniscal prostheses or meniscus replacement

The need for total or subtotal meniscectomies, and the understanding of the menisci's crucial role in preventing arthrosis, has led to meniscal prostheses or donor grafts. Meniscus prostheses are natural or bio-engineered substitutes for meniscal tissue (fibrocartilage). Current prostheses are made from bovine collagen or laboratory-produced polyurethane. Once implanted, they are repaired by cells from the remaining meniscal tissue. Arthroscopic implantation involves suturing the prosthesis to the remaining healthy tissue and is generally indicated when the patient has lost more than 50% of the meniscal tissue. The main limitation is the need for healthy tissue for suturing and cell migration to rehabilitate the prosthesis. This is not suitable for patients with extensive lesions or those who have undergone total meniscectomy.

Meniscus graft

Meniscus grafting is the only option to slow arthrosis degeneration after total meniscectomy. Menisci are harvested from deceased donors and preserved in musculoskeletal tissue banks. Immunosuppression is unnecessary, and infection risk is minimal (similar to blood transfusions). Once a correctly sized meniscus is found, it's arthroscopically transplanted, sutured to surrounding soft tissues, and fixed to the bone.

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Rehabilitation after meniscus surgery

Average hospital stay is 1 night, but same-day surgery is possible for simple procedures without additional procedures (like cruciate ligament reconstruction).

Arthroscopic knee rehabilitation is easier than other knee surgeries. After meniscectomy, patients can walk with crutches 24 hours post-op and regain full mobility in about 2 weeks.

Physiotherapy (electrostimulation, stretching, and proprioceptive rehabilitation) can accelerate recovery. Meniscal suture with autograft or prosthesis requires different rehabilitation using a knee brace to prevent flexion during walking for 15-20 days and weight-bearing for 30 days to allow healing and stabilization.

After arthroscopic meniscus repair, athletes can jog after 2-3 weeks, play football or contact sports after 20-30 days. Sedentary work can resume after 2-7 days, heavy work after 3-4 weeks. Sutures are removed 12-14 days post-op. Scarring is minimal, limited to 2-3 1cm incisions. Keep scars dry for 15-20 days (avoid bathing/swimming). Driving can generally resume 14 days post-op (after crutch abandonment).

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