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A meniscectomy is an orthopedic surgery that involves the surgical excision of all or a portion of a torn meniscus in the knee. If a meniscus is torn, it can sometimes be replaced but it may, in certain circumstances, need to be removed instead. It all depends on where the tear is located, how big the tear is, and the pattern of the tear. The person’s age and overall health and activity level will play into whether or not the meniscus is removed or repaired. Sometimes the decision isn’t made until after the surgeon takes a good look at the meniscus in arthroscopic surgery.
There are several different types of meniscus tears. They can have different patterns of injury. For example, horizontal and flap tears usually result in surgical removal of at least a portion of the meniscus.
Meniscus surgery is usually done arthroscopically in which a small camera is inserted into the joint space. Other incisions are made so that tiny tools can be used to manipulate and possibly excise a portion or all of the meniscus. Arthroscopic surgery is preferred because it does less damage to the knee joint in the process of doing surgery. Some tears are severe enough, however, that they require open knee surgery. Recovery is easier after an arthroscopic surgery.
When you have a total meniscectomy, the entire meniscus is removed. In a partial meniscectomy, the smallest portion of the disc is removed that will relieve the pain. The remaining edges of the meniscus are smoothed out so there aren’t any frayed edges. The meniscectomy can be done under regional or general anesthesia. Usually they are done on an outpatient basis and you get to go home shortly after the procedure.
Following the procedure, you may have rehabilitation, depending on your age, the type of surgery you had, your health status and your normal activity levels. You rest for a period of time after the surgery, begin walking on the knee and you undergo rehabilitation exercises after that. You can usually bear weight on the leg within one to two days after the surgery. Full activity can happen within 2-4 weeks post-surgery. Full range of motion is possible without pain after a period of time and you can return to your normal activity level after that.
If the tear in the meniscus is causing pain or swelling, it usually means that the pieces of the meniscus that are torn need to be removed; the remaining meniscus is smoothed out. The idea is to remove as little of the meniscus as possible so the joint has its natural lubrication. If you remove too much of the meniscus, there can be degeneration of the knee. People recover faster if the meniscus is left intact as much as is able. Only the orthopaedic surgeon can decide how much or how little of the meniscus is to be removed.
If you have the whole meniscus removed, your symptoms will generally improve but you lose the cushioning and stability features of the joint. Young or active people will be unhappy with a total meniscectomy. There have been studies showing that 78-88 percent of patients who have had a partial meniscectomy will report that they have good results and are able to return to normal activity following the procedure.
There are risks and complications to having a meniscectomy; however, it is usually well tolerated and does not cause complications often. The major risk is that of damage to the nerves during the procedure. This damage can be permanent.
Doctors have confirmed a direct relationship between the amount of meniscus taken out and the way the load is distributed across the knee. The knee becomes unable to sustain the load during walking, running or doing other weight-bearing things. Degeneration of the knee tends to occur in situations where a total or large partial meniscectomy is performed and this leads to degenerative arthritis.
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