A meniscectomy is a type of surgery that’s used to treat a damaged meniscus.
A meniscus is a structure made of cartilage that helps your knee work properly. You have two of them in each knee:
- lateral meniscus, near the outer edge of your knee joint
- medial meniscus, near the edge on the inside of your knee
Your menisci help your knee joint function by:
- distributing your weight over a larger area, which helps your knee hold up your weight
- stabilizing the joint
- providing lubrication
- sending your brain signals so you know where your knee is in space relative to the ground, which helps with balance
- acting as a shock absorber
A total meniscectomy refers to surgical removal of the entire meniscus. Partial meniscectomy refers to removal of only the damaged part.
The goal of the surgery is to remove fragments of the meniscus that stick out into the joint. These fragments can interfere with joint movement and cause your knee to lock.
Minor tears can often heal on their own without surgery, but more severe tears often require surgical repair.
Surgery is almost always needed when:
- a tear doesn’t heal with conservative treatment, such as rest or ice
- your knee joint goes out of alignment
- your knee becomes locked
When surgery is required, whether you’ll need a partial or full meniscectomy depends on:
- your age
- tear size
- tear location
- cause of the tear
- your symptoms
- your activity level
It’s helpful to start strengthening exercises two to four weeks before surgery. The stronger your muscles around your knee are, the easier and faster your recovery will be.
Other things you can do to prepare for your surgery include:
- talking to your doctor about what to expect during and after surgery
- telling your doctor all the prescription and over-the counter medications you take
- asking your doctor which medications you should stop before surgery, such as those that might make you bleed more easily
- making sure you have someone to drive you home after surgery, especially if you go home the same day
On the day of surgery, you’ll likely be told to have nothing to eat or drink 8 to 12 hours before the procedure.
There are two main approaches used for a meniscectomy:
- arthroscopic surgery is usually done using spinal or general anesthesia as an outpatient surgery, meaning you can go home the same day as the surgery
- open surgery requires a general or spinal anesthesia and possibly a hospital stay
When possible, arthroscopic surgery is preferred because it causes less muscle and tissue damage and leads to a quicker recovery. However, sometimes the tear pattern, location, or severity makes open surgery necessary.
For this procedure:
- Usually, three small incisions are made around your knee.
- A lighted scope with a camera is inserted through one incision and tools used to perform the procedure are inserted in the others.
- All structures in your knee are examined using the camera.
- The tear is found and a small piece (partial meniscectomy) or the entire (total meniscectomy) meniscus is removed.
- The tools and scope are removed, and the incisions are closed with a suture or surgical tape strips.
For an open meniscectomy:
- A large incision is made over your knee so your entire knee joint is exposed.
- Your joint is examined, and the tear is identified.
- The damaged part or the entire meniscus is removed.
- The incision is sewn or stapled closed.
After surgery, you’ll be in the recovery room for an hour or two. As you wake up or the sedation wears off, your knee will be painful and swollen.
Swelling can be managed by elevating and icing your knee for the first few days after surgery.
You’ll usually be prescribed a pain medication, possibly an opioid, for the first two to three days. The knee may be injected with a local anesthetic or long-acting local anesthetic that may make having to take an opioid less likely. After that, nonsteroidal anti-inflammatory drugs, such as ibuprofen, should be enough to relieve your pain.
You should be able to put weight on your knee to stand and walk as soon as you’re out of the recovery room, but you’ll probably need crutches for walking for about one week. Your doctor will tell you how much weight to put on the leg.
You’ll likely be given home exercises to help your knee regain strength and mobility. Sometimes you may need physical therapy, but usually home exercises are enough.
Recovery will take about four to six weeks, depending on the surgical approach used. The recovery period following arthroscopic surgery is usually shorter than that for open surgery.
Other factors that affect recovery time include:
- type of meniscectomy (total or partial)
- severity of the injury
- your overall health
- your usual activity level
- the success of your physical therapy or home exercises
The pain and swelling will quickly get better. By about the second or third day after surgery, you should be able to perform daily activities, such as light household chores. You should also be able to return to work if your job doesn’t involve a lot of standing, walking, or heavy lifting.
One to two weeks after surgery, you should have full range of motion in your knee. You should also be able use your leg for driving after one to two weeks, as long as you’re not taking opiate pain medication.
You’ll likely regain your previous muscle strength in the leg by two or three weeks after surgery.
By four to six weeks after surgery, you should be able to start playing sports and return to work that involves a lot of standing, walking, and heavy lifting.
Meniscectomies are pretty safe, but there are two major risks to be aware of:
- Infection. If your incision isn’t kept clean, bacteria can get inside your knee and cause an infection. Signs to look for are increased pain, swelling, warmth, and drainage from the incision.
- Deep venous thrombosis. This is a blood clot that forms in your leg vein. Your risk for it goes up after knee surgery because blood stays in one place if you’re not moving your leg very often while you regain your strength. A warm, swollen, tender calf may indicate you have a thrombosis. The primary reason that you keep your knee and leg elevated after surgery is to prevent this from occurring.
If you notice any of these signs and symptoms, contact your surgeon or healthcare provider right away. It’s important to start antibiotics as soon as possible so an infection doesn’t become worse necessitating another hospital admission and possible another surgery.
Blood clots should be treated with blood thinners quickly before a piece breaks off and travels to your lung, causing a pulmonary embolism.
In addition, having a total meniscectomy may leave you more prone to developing osteoarthritis in your knee. However, leaving the tear untreated can also increase your risk. Fortunately, a total meniscectomy is rarely necessary.
A meniscectomy can leave you a little less active than usual for about a month or so, but you should be able to return to your activities after about six weeks.
Although both have good short-term outcomes, a partial meniscectomy has a better long-term outcome than a total meniscectomy. When possible, partial meniscectomy is the preferred procedure.