Arthroscopy of the knee is the most common procedure performed by orthopedic surgeons and the most frequent reason for arthroscopic knee surgery is to investigate and repair meniscal tears. Although there are two menisci in the knee: one medial and one lateral. The medial meniscus, located on the inside of the knee, is the one torn most often. There are two types of meniscal tears that occur: sudden/acute tears and degenerative tears. Sudden meniscal tears can happen during activities, like sports, through direct contact, like a football tackle, or by a movement that torques or rotates the knee. In this type of tear, some people report hearing a "pop". Conversely, degenerative tears tend to happen over time, typically without an acute injury or traumatic event. Medial meniscal tears are more likely to occur in older people, particularly from the fourth to sixth decades of life, simply because the aging tissue within the knee cannot withstand as much stress. During a flare-up, these tears can cause noticeable pain on the inside or outside part of the knee.
Common symptoms of a torn menisci are: stiffness, swelling, buckling or locking of the knee and a limited range of motion. Most patients are able to continue walking on their injured knee. The patient who has a degenerative meniscal tear tends to have good days and bad days, depending upon how irritated the meniscus is and how inflamed the knee becomes. If the patient has minimal symptoms that they can tolerate, then continued observation is appropriate. However, if the patient has disabling symptoms, arthroscopic surgery would be performed to alleviate the pain and restore motion and function.
If the symptoms become problematic for a period of six weeks or more, an MRI scan can help diagnosis the source of the problem. X-rays are not helpful in the diagnosis of a meniscal tear as they only provide imaging of the bone, but they may help your specialist rule out another problem, such as arthritis. If a meniscal tear is confirmed, your orthpaedic specialist will probably prescribe a regimen designed to reduce inflammation and to rest the injured knee.
The RICE protocol ( Rest, Ice, Compression and Elevation) along with Ibuprofen or Naproxen may provide enough relief so that the patient can tolerate the meniscal tear without considering surgery. However, if the painful symptoms do not resolve, further treatment is generally surgical in nature. The meniscus does not have a good blood supply on the inner two-thirds of its anatomy. Because of this, once a tear occurs, the likelihood of it healing is minimal.
Arthroscopic knee surgery is performed on an outpatient basis. The procedure is done through two small incisions in the front of the patient's knee, allowing access to the entire inside/outside part of the knee for treatment. The surgeon inserts a miniature camera into the knee so that the structures of the knee can be clearly visualized. Once the meniscal tear is visualized, the surgeon will insert very small surgical instruments into the knee and will trim or repair the menisci as necessary. The patient is able to go home the day of the surgery.
When recovering, the patient can put full weight on the knee and begin range of motion activities immediately. When comfortable, the patient may return to all activities. If there are no arthritic changes in the knee, recovery usually happens quickly. Your orthopaedic specialist may recommend special strengthening and Range of Motion exercises to help you achieve maximum recovery. Usually patients can rehabilitate at home, although Physical Therapy may be prescribed. Most patients recover well and without incident from Meniscal Surgery.
If you suspect you may have a Meniscal tear, you should consult with a skilled orthopaedic surgeon to get a definitive diagnosis and effective treatment plan.
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