Partial Meniscectomy

• What is a Partial Meniscectomy?
• Why is a Partial Meniscectomy Procedure Performed?
• How to Prepare for an Arthroscopic Partial Meniscectomy
• What Happens During a Partial Meniscectomy Procedure?
• Are There Risks Associated with Partial Meniscectomy Procedure?
• Post-Arthroscopic Partial Meniscectomy Procedure and Recovery
  

A partial meniscectomy is an outpatient procedure that removes the damaged part of the meniscus cartilage, which provides cushion and support for the knee. The meniscus gives essential protection and stability for the knee and may become damaged due to injury or wear and tear.

A partial meniscectomy helps to relieve pain and restore function by trimming the torn portion of the meniscus. If a full repair is unnecessary or not possible, a partial meniscectomy is often the best solution to treat a compromised meniscus.

Depending on the location of the meniscus tear, a physician may recommend either a partial medial or partial lateral meniscectomy. A partial medial meniscectomy involves removing or trimming the damaged portion of the meniscus on the knee's inner side (medial). This is typically performed when there is a tear in the medial meniscus. On the other hand, a partial lateral meniscectomy involves the removal or trimming of the torn portion of the meniscus on the outer side (lateral) of the knee. This procedure is carried out when there is a tear in the lateral meniscus.

The procedure involves the use of an arthroscope and arthroscopic instruments to meticulously resect only the symptomatic and unstable torn sections of the meniscus. Whether it's a partial medial meniscectomy for the inside of the knee or a partial lateral meniscectomy for the outside, the goal is to stabilize and improve the function of the knee while avoiding the need for a total meniscectomy.

When the cartilage that cushions the knee is damaged, a doctor may recommend non-surgical treatment, including physical therapy, anti-inflammatory medication, knee braces, and injections to aid a torn meniscus. However, if the treatment options cannot successfully alleviate symptoms caused by the damaged meniscus, a partial meniscectomy is the best option to remove damaged areas.

Only about 25% of meniscus tears are suitable for repair and require trimming of the meniscus to fix the impaired knee. A partial meniscectomy will provide immediate relief by removing the unstable flap of tissue that causes pain, locking, or catching in the knee.

The main goal of the procedure is to eliminate the problematic fragments in the knee that protrude into the joint. These fragments can impede joint movement, leading to knee locking. By carefully trimming the torn sections, physicians aim to enhance joint function, reduce discomfort, and prevent further tearing.

To prepare for an arthroscopic partial meniscectomy, adhere to the following guidelines to ensure a smooth and comfortable experience. On the day of the procedure, you will check in at the "patient admissions" section of the medical center. After check-in, you'll proceed to a holding area for final preparations, which may include completing paperwork and, in some cases, shaving hair from the knee area.

It's crucial to follow the exact protocol your physician outlines for the day of the surgery. You'll most likely be instructed not to eat or drink anything after midnight the night before to reduce the risk of complications during anesthesia. On the day of the procedure, wear loose clothing, especially over the knee area, so the doctor can smoothly perform the knee arthroscopy. Additionally, alleviate any nerves or anxiety by reading, watching television, or chatting with visitors.

Preparations may also involve avoiding certain medications or dietary supplements that could increase the risk of bleeding. Lastly, ensure someone is available to pick you up after the surgery, as you won't be allowed to drive yourself home due to drowsiness from the anesthesia and pain medications. If you live alone, have someone check on you or stay with you to ensure you are comfortable during recovery.

During a partial meniscectomy procedure, the physician will likely adhere to the following steps:

1. Numbing the knee: The physician administers local or general anesthesia to numb the knee, ensuring patient comfort throughout the procedure.
2. Creating Incisions: Two small incisions are carefully made, providing access for the surgical instruments and arthroscope.
3. Arthroscopic Inspection: The arthroscope, acting as a camera, is inserted into the knee joint, allowing the physician to see and navigate the interior of the knee joint.
4. Meniscus Examination: Once inside, the physician thoroughly inspects the meniscus, identifying areas that require attention.
5. Trimming with Surgical Instruments: Surgical instruments, such as meniscal biters or baskets, are employed to cut small, damaged portions of the meniscus.
6. Arthroscopic Shaving: An arthroscopic shaver, equipped with a reciprocating blade and suction, facilitates precise trimming of the torn meniscus.
7. Finishing Procedure: Once the physician has finished the procedure, the openings in the skin are closed, the knee is bandaged, and the patient is monitored briefly before being provided with postoperative care instructions for optimal recovery.

The minimally invasive procedure typically takes less than an hour. A partial meniscectomy aims to resect the torn portion of the meniscus while preserving as much of the remaining meniscus as possible. This preservation effort is vital to maintain the shock-absorbing capacity of the meniscus and minimize the risk of a re-tear. The meniscus tear is meticulously trimmed and "saucerized" to remove any edges that could catch in the joint, reducing the likelihood of further discomfort while preserving as much meniscus tissue as possible.

What is the Difference Between Secondary and Tertiary Approaches for Partial Meniscectomy Procedures?

The common approach for a partial meniscectomy involves the use of arthroscopy and specialized instruments to visualize and trim the damaged part of the meniscus. However, your physician may decide to take either secondary or tertiary approaches depending on your specific condition:

• Secondary Approach (Open Meniscectomy): This approach requires a larger incision if the meniscus tear is extensive or located in an area that makes it challenging to access with arthroscopic instruments. An open meniscectomy gives the physician a broader view of the knee joint.
• Tertiary Approach (Meniscal Repair): In cases where the meniscus tear is repairable, a meniscal repair may be performed. This involves suturing the torn edges of the meniscus together, allowing for natural healing. This approach is more complex than a standard meniscectomy but aims to preserve the meniscus.

Meniscectomies are relatively simple, safe procedures, but some complications may occur. Possible risks associated with a partial meniscectomy include the following:

• Damage to Cartilage, Meniscus, or Ligaments: The procedure may risk unintentional damage to the surrounding cartilage, meniscus, or ligaments in the knee.
• Blood Clot Formation: Prolonged immobility after the procedure may increase the risk of blood clot formation in the leg, a condition known as deep venous thrombosis. Patients need to keep their leg elevated to encourage blood circulation.
• Injury to Blood Vessel or Nerve: There is a possibility of damage to blood vessels or nerves during the procedure, which can lead to complications.
• Infection in the Knee Joint: If the incision is not kept clean, bacteria can enter the knee, causing infection. Signs of infection include increased pain, swelling, warmth, and drainage from the incision.
• Bleeding into the Knee Joint: During the procedure, there is a risk of bleeding into the knee joint, leading to increased pain and swelling. Knee Stiffness Following the Procedure: Some individuals may experience knee stiffness after the procedure, affecting mobility and flexibility. Physical therapy is often recommended to address this concern.
• Compartment Syndrome: Although rare, compartment syndrome is a potential complication that arises when increased pressure within the muscles can lead to reduced blood flow. This can result in pain and swelling.

Typically, arthroscopic partial meniscectomy is performed as an outpatient procedure, and you won't need to stay in the hospital overnight. Weight-bearing is usually allowed immediately after the procedure. Crutches may be provided initially, but you should try walking without them as soon as possible. Your physician will help you coordinate with a physical therapist to expedite recovery and help you restore mobility, range of motion, and muscle function.

It's important to avoid scrubbing the incision while showering, and avoid hot tubs or pools to prevent infection. Also, do not apply lotions or creams not prescribed by your physician. Patients typically can resume playing sports after 3-4 weeks, return to driving after 1-2 weeks, and go back to work within 3-5 days. However, if you have a heavy-duty occupation, it's best to wait 4-6 weeks before returning to work.

Call your physician immediately if you experience unusual symptoms, such as severe pain, excessive swelling, or signs of infection. You'll also need to schedule a follow-up visit 7-10 days after the procedure to have your stitches removed.