Dr. Stickney, a Kirkland orthopedic surgeon, is an expert in total knee arthroplasty, total hip arthroplasty, exercise and health, and more.
When it comes to meniscal injuries, many patients have little knowledge about the types of treatment options available and their outcomes. The meniscus, a significant cushion or shock absorber in your knee, is a c-shaped disc of soft cartilage that sits between the femur and the tibia. When the knee meniscus tears, the cushioning effect diminishes and can cause knee pain and arthritis, eventually requiring treatment. One option is a meniscectomy, a surgical removal of all or part of a torn knee meniscus. A survey conducted by Brophy et al of 253 patients evaluated for meniscal pathology found 62 percent rated their knowledge of the meniscus as “little or none,” and another 28 percent had no idea that meniscectomy procedure–and not a meniscal repair–is the most common surgical treatment for surgical repair. Did you know that?
Since many meniscal tears can require surgical intervention, there’s a clear need to educate patients on options and postoperative considerations: overall outcomes, the risk of needing a subsequent surgery, the ability to return to sport (RTS), the postoperative risk of developing osteoarthritis (OA), the risk of progression to total knee arthroscopy (TKA). Meniscus tear can also affect knee stability, particularly when combined with an anterior cruciate ligament (ACL) injury. A group of doctors at the University of Colorado School of Medicine in Aurora reviewed the current literature on postoperative considerations to help orthopedic surgeons educate their patients on post-meniscectomy expectations.
The review found:
- Successful return to sport after meniscus surgery was more likely with these circumstances: patients of a younger age, medial meniscectomy and a smaller meniscal resection. The amount of meniscus resected is a function of the size of the tear. All these factors affect the time until patients are able to return to sport.
- Failure rates after meniscectomy are low when compared to meniscal repair and discoid saucerization procedures. Meniscus repair is done rarely for a large tear, most often in conjunction with ACL reconstruction. The majority of the meniscus has no blood supply and will not heal, so the majority of meniscus surgery involves removing the torn tissue and smoothing the remaining meniscus. Failure rates are increased in patients undergoing lateral meniscectomy.
- Improved clinical outcomes for non-obese males can be expected in those undergoing medial meniscectomy with minimal meniscal resection. Conversely, if a preexisting angular deformity exists, varus or valgus, which results in an imbalanced load across the knee, the success rate is less predictable. Preexisting degenerative knee changes (damage to the articular cartilage attached to the bones), and anterior cruciate ligament (ACL) deficiency will negatively impact outcomes following a meniscectomy.
- The risk of developing post-surgical osteoarthritis over the next 10-20 years should be discussed. Meniscectomy increases the risk of developing knee osteoarthritis, particularly in obese females who undergo a large meniscal resection. The development of arthritis after meniscectomy may lead to the need for knee replacement. However, leaving a mobile large meniscus tear clicking around in the knee will more likely result in early arthritis.
- Meniscectomy is a viable and successful intervention for pain relief and functional improvement for symptomatic meniscal tears, but nonsurgical care should be used first in older patients with preexisting degenerative changes. These patients will likely end up with knee replacement, and an arthroscopic meniscectomy may be an unnecessary step along that path.
If you would like to learn more about meniscal injuries or understand post-surgical outcomes related to meniscectomy, please contact our office. We’ll help you return to your healthy, pain-free lifestyle.
