Meniscal Repair

Arthroscopic partial lateral meniscectomy knee cartilage removal

Description

An arthroscopic meniscectomy is a surgical procedure to cut out part or all of the knee meniscus via keyhole surgery.  A complete meniscectomy is where all of the meniscs right up to and including the meniscal rim is removed.  Partial meniscectomy describes the procedure where not all of the meniscus is removed which may vary from minor trimming of a frayed edge to anything short of removing the rim.  This is a minimally invasive procedure often undergone as an outpatient.

Indication

Meniscal tears that are not suitable for meniscal repair.

Clinical Presentation

• joint line tenderness and effusion
• symptoms are frequently worsened by flexing and loading the knee, activities such as squatting and kneeling are poorly tolerated.
• complaints of 'clicking', 'locking' and 'giving way' are common
  

Diagnostic Tests

• Joint line tenderness has been reported to be the best common test for meniscal injury.
• McMurray's test positive if a pop or a snap at the joint line occurs while flexing and rotating the patient's knee.
• Appley's test performed with the patient prone, and with the examiner hyperflexing the knee and rotating the tibial plateau on the condyles.
  
• Steinman's test performed on a supine patient by bringing the knee into flexion and rotating.
• Ege's Test is performed with the patient squatting, an audible and palpable click is heard/felt over the area of the meniscus tear. The patient's feet are turned outwards to detect a medial meniscus tear, and turned inwards to detect a lateral meniscus tear.
  
• Imaging
  

Pre-Op

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Post-Op

The goal of rehabilitation is to restore patient function based on individual needs.  It is important to consider the type of surgical procedure, which meniscus was repaired, the presence of coexisting knee pathology (particularly ligamentous laxity or articular cartilage degeneration), the type of meniscal tear, the patient's age, preoperative knee status (including time between injury and surgery), decreased range of motion or strength, and the patient's athletic expectations and motivations.

• control the pain and inflammation - cryotherapy, analgaesics, NSAIDs,
  
• restore ROM - ROM exercises within any limts in range that the consultant has requested
  
• restore muscle function - specific strengthening exercises including qudriceps, hamstrings, calf, hip
  
• optimize neuromuscular coordination - propriocetive re-education
  
• progress weight bearing - weight bearing and joint stress are necessary to enhance the functionality of the meniscal repair so should be progressed as indicated by the consultant.  Excessive shear forces may be disruptive and should be avoided initially.

Key Evidence

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Resources

Timothy Brindle,John Nyland and Darren L. Johnson (2001) The Meniscus: Review of Basic Principles With Application to Surgery and Rehabilitation. Journal of Athletic Training, 36(2), 160–169.

Case Studies

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