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 recovery.
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
total meniscectomy. 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 nurse
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 steps 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.
total meniscectomy normally takes about 40 minutes to
perform, and usually you will be able to leave the hospital
the same day.
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 one-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
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.
the tear cannot be repaired or removed through partial
meniscectomy, the surgeon will use the arthroscope in
combination with other instruments to remove the meniscus.
are usually closed with stitches and the patient is
taken to the recovery room.
After your arthroscopic
total meniscectomy, 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 this 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 to keep the knee stabilized.
Your surgeon may suggest you use crutches or a cane
initially, 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.
Most patients are able to return to
work within a few days or a week or two after arthroscopic
total meniscectomy, 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 a few small incisions held together
by tiny stitches. Icing your knee three or more 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 and 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.
Surgeons 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 with putting too much strain on the
meniscus. Many patients are able to begin a muscle-strengthening
program, using weights, within a week of surgery. For
the first few weeks after surgery, you will probably
not be able to run or jog until you have regained equal
strength in both legs. Full recovery and return to sports
activities can take from three to six weeks, if no arthritis
is present in your knee. If you have arthritis, then
you may not see the full benefits of the arthroscopy
for up to six months. Every patient over the age of
40 will have at least some chondromalacia, or loss of
articular cartilage, which is synonymous with arthritis.
Following are some signs to watch for in determining
if you are ready to return to action. You should be
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 overstretch. 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 running 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.
| Treatment Introduction
Occasionally, a large tear of the
lateral (outside) meniscus can best be treated by arthroscopic
total meniscectomy, a procedure in which the entire
meniscus is removed.