Meniscectomy Surgery: An Overview

Meniscectomy is a procedure in which the surgeon will remove all or part of the damaged meniscus in a torn knee. The meniscus is C-shaped cartilage that cushions and stabilizes the knee joint. When meniscus tears occur due to trauma or degeneration, the person experiences pain, swelling, and restricted movement. This guide is to provide you with all the information regarding meniscectomy surgery, including types, symptoms, causes, recovery, and cost in India.

Types of Meniscectomy Surgery

1. Partial Meniscectomy: The procedure involves the removal of the damaged segment of the meniscus while trying to protect as much healthy tissue as possible.

2. Total Meniscectomy: This procedure resects the entire meniscus. This procedure is less common due to the increased risk of arthritis.

3. Arthroscopic Meniscectomy: This minimally invasive surgery involves making small incisions while a camera guides the intervention.

4. Open Meniscectomy: In rare cases, doctors make a large incision to better access the joint.

Symptoms

• Pain in the knee joint, especially when twisting or rotating.

• Swelling and stiffness

• A sudden popping sensation at the moment of the injury

• Inability to fully straighten the knee

• A feeling that the knee locks or catches

• Limited movement

Diagnosis of Meniscal Tear

1. Clinical Examination: The doctor evaluates the tenderness, swelling, and limited motion in the knee.

2. McMurray Test: The test for meniscal tears uses a unique motion.

3. Magnetic Resonance Imaging (MRI): Used for obtaining detailed images of meniscal and other soft tissues.

4. X-rays: It doesn't show the meniscus, but it can exclude other sources of knee pain.

5. Arthroscopy: Using an arthroscope, one can directly visualize the knee joint for both diagnosis and treatment.

Causes of Meniscal Tear

• Traumatic Injury: Athletes frequently experience sudden twisting or rotating motions.

• Degenerative Changes: These age-related wear and tear weaken the meniscus, which may easily tear.

• Knee Osteoarthritis: Increases the risk for any meniscal damage.

• Previous Knee Injuries: A history of knee problems may predispose individuals to meniscal tears.

Risks and Complications

1. Infection: Very rare, but there is a risk of infection in the surgical area.

2. Bleeding: Minor bleeding may occur; however, major bleeding is unusual.

3. Formation of Blood Clots: DVT may occur after surgery.

4. Nerve or Blood Vessel Damage: Rare, but this certainly exists if it happens.

5. Knee Stiffness or Weakness: Permanent stiffness may require physical therapy.

6. Persistent Pain or Swelling: Some patients may have discomfort.

7. Early-Onset Arthritis: The removal of meniscal tissue may increase the risk of knee osteoarthritis.

Preparation

1. Medical Evaluation: This phase will entail examining your health and pertinent blood tests and imaging studies.

2. Review of your Medications: Before surgery, you should discuss all of your medications with your doctor, especially any blood-thinning agents.

3. Fasting: Instructions regarding fasting before surgery may be provided.

4. Pre-Arrangements for Transport: You would have to arrange for someone to drive you back home after surgery.

5. Preoperative Exercises: Doctors may prescribe special exercises to aid in recovery.

Procedure

1. Anesthesia: Depending on the patient's needs and the surgeon's recommendations, we administer local, regional, or general anesthesia.

2. Arthroscopic Method:

         o    Small openings about the knee are made.

         o    An arthroscope (small video camera) enters to illuminate the path for the surgeon.

         We use various specialized instruments to trim or excise the damaged meniscus.

3. Closure: Either sutures or Steri-Strip application will close the incisions.

4. Dressing: We apply a sterile dressing to the wound to ensure it is clean and protected.

5. Postoperative Care: Ice packs, elevation, and pain control are the most important in the immediate period after surgery.

Recovery

1. Immediate Postoperative Care: Patients typically go home the same day. Pain and swelling are managed with medications and ice packs.

2. Physiotherapy: Starts soon after surgery to restore strength and mobility.

3. Weight Bearing: Depending on the extent of surgery, patients may initially need crutches.

4. Activity Restrictions: Until your surgeon gives the all-clear, you should avoid high-impact activities.

5. Complete Recovery: Most patients will recover within 4 to 6 weeks, although the time frame will vary based on individual factors.

Clinical Trials

1. Meneiscus Regeneration Techniques: Investigations are looking into biologic treatments and scaffolding for regeneration of the meniscus.

2. Stem Cell Therapy: Researchers are evaluating stem cells for their potential to repair meniscal tissue.

3. Enhanced Surgical Instruments: The newer design of arthroscopic tools has made surgery more precise and less injurious.

4. Novel Rehabilitation: New protocols of physical therapy for rapid recovery.

Side Effects

- Short-Term Effects: Swelling, bruising, and pain in the knee.

- Long-term Effects: Persistent pain and stiffness or instability in the knee.

- Psychological Effects: Anxiety or anger due to limited mobility and slow recovery.

Success rate

Meniscectomy has a very high success rate, especially when performed soon after an injury.

1. Symptom Relief: Pain relief and knee function enhancement in most patients.

2. Return to Activity: Many get back to normal activities and sports within a few months.

3. Long-Term Outlook: Partial meniscectomy has better outcomes than total meniscectomy with a lower risk of arthritis.

Diet to follow after treatment

1. Balanced Diet: Nutrient-rich foods help with healing and general health.

2. Protein Foods: Helps in the process of tissue repair and muscle rebuilding.

3. Anti-inflammatory foods: Foods containing omega-3 fatty acids, fruits, and vegetables that reduce inflammation.

4. Hydration: Fluids should be taken in large quantities to assist with recovery.

5. Supplements: This category includes calcium and vitamin D for bone health.

6. Weight Management: Keeping one's weight down is beneficial for reducing stress on the joints.

The cost of meniscectomy surgery in India

Meniscectomy surgery costs in India may widely differ depending on factors like the hospital, surgeon's expertise, and location:

1. Partial Meniscectomy: INR 50,000 to 100,000 (≈ $625-$1,250).

2. Total Meniscectomy: INR 100,000 to 150,000 (≈ $1,250-$1,875).

3. Arthroscopic Surgery: INR 70,000 to 120,000 (≈ $875-$1,500).

4. Additional Expenses: Pre-surgical investigations, post-operative care, and physiotherapy.

Conclusion

Meniscectomy is a common procedure that relieves pain and restores knee function in people with meniscal tears. With improvements in surgical techniques and rehabilitation, recovery time is now shorter, and outcomes are better. Knowing the entire process from diagnosis to postoperative care will allow the patient to make an informed decision and obtain the best result.