Meniscectomy is a surgical procedure indicated in individuals with torn meniscus where the conservative treatments are a failure to relieve the pain and other symptoms. Meniscectomy is recommended based on the ability of meniscus to heal, patient’s age, health status and activity level.
Meniscus is the C-shaped two pieces of cartilage located between thighbone and shinbone that acts as shock absorber and cushions the joints. Meniscus distributes the body weight uniformly across the joint and avoids the pressure on any one part of the joint and development of arthritis. Being the weight bearing part, meniscus is prone to wear and tear and meniscal tear is one of the common knee injuries. Meniscal tear may be developed by people of all ages and is more common in patients over the age of 45 years with early osteoarthritis.
On the pattern of tear, meniscal tear may be of different types such as longitudinal, parrot-beak, flap, bucket handle, and mixed/complex tear. Sudden twist, squat, or tackle may be the cause for meniscal tear in adults and ageing may cause the tear in elderly individuals. Meniscal tear may cause severe pain, stiffness and swelling, catching or locking of the knee, and may limit the movement. Meniscal tear is often diagnosed with the presenting symptoms and imaging techniques such as X-rays or magnetic resonance imaging scan.
Conservative treatments for meniscal tear include R.I.C.E (Rest, Ice, Compression, and Elevation) and use of non-steroidal anti-inflammatory medications. In older patients, corticosteroid injections may be helpful along with physical therapy. Surgery is recommended in almost all younger patients as well as older patients who fail conservative treatment and/or have mechanical symptoms. Surgery is performed using arthroscopic technique and typically only the torn or unstable portion is removed if the tear is deemed irreparable.
The arthroscope is a small fibre-optic viewing instrument made up of a tiny lens, light source and video camera. The surgical instruments used in arthroscopic surgery are very small (only 3 or 4 mm in diameter), but appear much larger when viewed through an arthroscope.
The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the knee at cartilage and ligaments, and under the kneecap.
Then the surgeon makes two small incisions (about 1/4 of an inch), around the knee joint area. Each incision is called a portal. In one portal, the arthroscope is inserted to view the knee joint. Along with the arthroscope, a sterile solution is pumped into the joint which expands the viewing area, giving the surgeon a clear view and room to work. The other portal is used for the insertion of tiny surgical instruments.
With the images from the arthroscope as a guide, Dr. Patel can look at the menisci and confirm the type, location, and extent of the tear. Once Dr. Patel locates the meniscal tear, surgical scissors and shavers can be inserted into the portals to remove the torn meniscus. In total meniscectomy entire meniscus is removed and in partial meniscectomy only the torn part of the tissue is removed leaving the intact tissue in place with edges smoothed.