Tear > Treatments
Preparing for Surgery
The decisions you make and the
actions you take before your surgery can be every bit
as important as the procedure itself in ensuring a healthy
sure you have received any equipment you will need when
you get home from the hospital. This may include a knee
brace, crutches, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor when your surgery
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
possible, practice walking with your crutches in case
you need to use them after surgery.
insurance companies require a second opinion before
agreeing to reimburse a patient for a surgical procedure.
Getting a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
At most medical centers, you will
go to "patient admissions" to check in for
meniscus repair. If your surgery is going to be inpatient,
there may be a separate department, so be sure to ask
your doctor. After you have checked in to the hospital
or clinic, you will go to a holding area where the final
preparations are made. The paperwork is completed and
your knee area may be shaved (this is not always necessary).
You will wear a hospital gown and remove all of your
jewelry. You will meet the anesthesiologist or anesthetist
(a nurse who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important things to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
anesthesia, which can lead to pneumonia.
you will most likely be able to go home within a few
hours of surgery, and because the anesthetic and pain
medications may make you drowsy, arrange for someone
to drive you home when you are released.
a loose pair of pants or other clothing that will fit
comfortably over your knee bandage when you leave the
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
meniscus repair typically takes about 40 minutes to
perform, and usually you will be able to leave the hospital
the same day. There are three main types of meniscus
repairs. Your surgeon chooses a technique based on the
location of the tear and his or her experience with
the techniques. All of the techniques have a reported
success rate of 70 to 90 percent.
anesthesia is typically used for this type of surgery,
though in some cases a spinal or epidural anesthetic
is used. The anesthesiologist will administer the anesthesia
once you are in the operating room.
meniscus surgery is performed with an arthroscope, which
is inserted into the knee through a quarter-inch incision
and is used to view the meniscus tear. One or two additional
small incisions, or "portals," will be made
to allow the insertion of instruments into the knee.
is injected into the knee joint through one of these
portals, which allows the surgeon to view, through the
arthroscope, the extent of the tear.
tears can be repaired with small (one-half inch long),
dart-like devices that are inserted through one of the
portals and placed across the meniscus tear to hold
it together. These devices are usually absorbed by the
body over time.
techniques usually involve making a longer incision
on the side of the knee and placing stitches across
the meniscus tear to hold it together.
are usually closed with stitches and the patient is
taken to the recovery room.
After your meniscus has been surgically
repaired, you will remain in the recovery room until
you have recovered from the effects of anesthesia, which
may include drowsiness. Many surgeons inject local anesthesia
into the knee in the operating room, which helps to
numb some of the tissues surrounding the knee and decreases
pain for two to eight hours. If that is done, you may
not need pain medicine until you go home. Your knee
will be bandaged and wrapped, usually with an ace bandage
wrapped over layers of gauze and cotton, and your knee
will be elevated. Ice may be used to reduce swelling,
and a brace may be used. Your surgeon may suggest you
initially use crutches, though you probably will be
able to bear some weight on the leg right after surgery.
Your temperature, blood pressure, and heartbeat will
be monitored by a nurse who, with the help of the doctor,
will determine when you can prepare to go home. You
will normally be able to leave the hospital or clinic
within a few hours after surgery. Make sure to have
someone available to drive you home, as you will most
likely be unable to drive a car.
meniscus repair is outpatient surgery, unless it is
associated with other surgery at the same time, such
as ACL (anterior cruciate ligament) reconstruction.
In that case, your surgeon may elect to keep you in
the hospital overnight. If you need to stay in the hospital,
your surgeon may have you begin doing continuous passive
motion exercises while in bed as soon as possible after
surgery is completed. Your leg will be flexed and extended
to keep the knee joint from becoming stiff. This may
be done using a continuous passive motion (CPM) machine.
The CPM is attached to your bed and then your leg is
placed in it. When turned on, it takes your leg through
a continuous range of motion. There will likely be pain,
and you can expect to be given pain medication as needed.
Be sure to ask for medication as soon as you feel pain
coming on, because pain medication works best on pain
that is building rather than on pain that is already
present. The nurses will not give you more than your
doctor has prescribed and what is considered to be safe.
Ice also helps control pain and swelling. Typically,
physicians will have patients ice their knees for one
hour four to five times a day.
Most patients are able to return
to work within a few days or a week after arthroscopic
meniscus repair, provided work does not involve strenuous
activity such as heavy lifting or climbing. You may
need to use crutches during the first week, though you
also may be able to bear weight on your leg. It may
take a week or more before you can resume driving a
car, depending on which leg was operated on. The wrap
usually can be removed from the knee within 12 to 72
hours after surgery. Some bruising or swelling is normal,
and you will notice two or three small incisions held
together by tiny stitches and, in some cases, an additional
one- to one-and-a-half-inch incision. Icing your knee
two or three times a day for 15 to 20 minutes at a time,
and elevating it above heart level, can decrease pain
and swelling. Taking non-steroidal anti-inflammatory
drugs such as aspirin or ibuprofen also can reduce pain
and inflammation. The first follow-up visit is usually
scheduled for a week to three weeks after surgery, at
which time the stitches will be removed.
At one time, it was thought that severely
limiting weight-bearing activities would aid in recovery
from meniscus repair surgery. But restricting these
activities has been found to actually hamper the process.
Surgeons now usually recommend that patients try to
walk without crutches, bend their legs, and begin stretching
and strengthening exercises as soon as possible after
surgery, to keep the knee joint and surrounding muscles
flexible. The goal is to strengthen the muscles of the
lower limbs without putting too much strain on the meniscus.
For at least eight weeks after surgery, you will probably
not be able to return to sports activities, until you
have regained equal strength in both legs. Full recovery
usually takes two to four months. Following are some
signs to watch for in determining if you are ready to
return to action. You should be able to:
and extend your knee without pain
as if your injured knee is as strong as your other knee
and sprint without limping
running, stop and cut without pain at 45- and 90-degree
off both legs and off your injured leg without pain.
Though many meniscus injuries occur
during sports and are difficult to avoid, there are
several steps you can take to improve the overall strength
and flexibility of your knee:
your weight. Every pound in excess of your normal weight
puts three or four additional pounds of pressure on
your knee every time you take a step.
hamstrings, in the back of the thigh, and quadriceps,
the muscles in the front of the thigh, are crucial shock
and impact absorbers. These muscles must be kept strong
and flexible to protect the joint surfaces in your knee.
before exercising should be a regular part of your warmup;
however, it is important not to over-stretch. Never
push or pull on your leg with your hands while you are
stretching, and avoid squatting during your warmup,
which can put stress on your knee joint.
well-fitting athletic shoes can reduce the impact of
the load exerted on the knee.
you are engaging in activities that require a lot of
twisting and turning such as racket sports, skiing,
soccer, and basketball, do not assume you can play yourself
into shape; make sure you are in good physical shape
before you play.