twoto 31ve years at a retear rate typically around 15 percent Whe - PDF document

twoto ve years at a re-tear rate typically around 15 percent. When a patient undergoes repair of a torn meniscus, the rehab time is substantial because activities have to be limited signicantly for about three months while the tissue heals. Ideally, a patient who has undergone meniscal repair would do limited activities beyond 90 degrees of knee exion after the repair. Who can have a meniscus repair? Patients who are typical candidates for meniscal repair are younger — ideally less than 20 years old. Younger patients tend to do better because they have a better blood supply to the meniscus, which is necessary for repair. In addition to concerns for age, the size of the tear is also signicant. Patients who have a 1- to 3-cm tear tend to be the best candidates for meniscus repair. Dierent kinds of tears can occur, and only a small percentage of them occur in areas with blood supply within the meniscus. Patients who have a tear outside the blood supply experience no benet from meniscus repair. Patients who have reconstruction of an ACL tear also seem to do very well with meniscus repair, assuming that the tear is in the area of the meniscus that has a good blood supply.Which tears can avoid surgery and be observed? Patients with small tears of less than 1 cm are good candidates to be observed, as many of these can be asymptomatic or heal spontaneously. Also, tears with minimal displacement of less than 3 to 5 mm when visualized on the MRI have a high likelihood of being minimally or completely asymptomatic for many patients. Patients with degenerative tears who also have signicant arthritis in the joint most often should be observed, as the arthritis seems to produce symptoms in many of those patients. Patients who only have a partial tear that does not

extend to the surface also tend to do very well with observation and avoidance of surgery. How are meniscus tears treated with surgery? e standard of treatment at this time for a torn meniscus is arthroscopic surgery. is involves the use of a small camera passed into the joint to allow direct visualization of the entire working apparatus of the knee. is surgery typically is done using two or three small incisions to allow passage of the camera and working instruments into the knee. rough these small incisions we can pass in tools to remove the torn parts of the meniscus with minimal morbidity to the patient. For patients with previous repair of the meniscus, depending on the method of repair, an additional small incision may also be required. What are the most common risks of surgery for a torn meniscus? e most common problem with surgery for a torn meniscus is that the patient’s symptoms return. e return can result from a re-tear or because arthritic symptoms develop.e return of these symptoms may occur over several months or may take severaldecades to develop. e two most problematic complications seen with any frequency are deep vein thrombus (DVT) and pulmonary embolism and infection. Patients are rapidly mobilized after surgery and allowed to progress in activity as soon as possible, which is the best treatment and prophylaxis for DVT and pulmonary embolus. To prevent infection, patients frequently receive antibiotics before surgery. As a result of mobilization and antibiotics, the risk for DVT and infection remains quite low for arthroscopic meniscal surgery. Another group of complications typically arises from underlying cardiovascular or pulmonary problems. Lastly, although infrequent, are complications due to the anesthetic used for the sur

gery. What happens after meniscal removal? Patients typically go home within a few hours after the surgery. ey are allowed to progress in weight bearing and usually do not require crutches for activities. Patients typically receive a set of exercises to start working through the day after surgery and can proceed with a desk job several days after surgery. ey can progress to light labor and physical therapy within one to two weeks. Typically patients can do unrestricted activity by eight weeks after surgery. Occasionally we use bracing to help patients in their postoperative period. What happens after repair? Similar to removal of a meniscus, patients usually go home several hours after surgery. Patients are typically on crutches with protected weight bearing for six weeks after their meniscus repair. Physical therapy usually begins within three to seven days. Weight bearing progresses over the period of six to 12 weeks postoperatively. Braces may used during this period. Finally, patients are typically allowed to return to full activity three to six months after surgery. Michael R. Meisterling, MD, com-pleted his residency at the University of Minnesota Department of Orthopaedic Surgery, followed by a Sports Medicine Fellowship at the Adidas Sports Medicine Clinic. Dr. Meisterling is Board Certied in orthopaedic surgery and is a candidate member of the American Academy of Orthopaedic Surgeons. “e meniscus is important because it dissipates forceacross the knee joint. In a normal patient, the force acrossthe knee joint during walking can be two to four timesthat of the normal body weight.”– Michael R. Meisterling, MD ORTHOPAEDIC EXCELLENCEAlmost all patients with meniscus tears ndsquatting very difcult or at least aggravating.Treating Meniscus Tear