Meniscal Injuries

Acute meniscal injuries occur when the knee is suddenly twisted and forced forward into a bent position whilst the foot is still in contact with the floor. A portion of the meniscus can be torn by this combination of twisting and compression forces on the knee. These injuries are seen commonly in sports that involve twisting and turning, for example racket sports or football. The surgical procedure performed will depend upon what the surgeon finds during the operation.

Meniscus debridement

The procedure to carefully remove a damaged portion of the meniscus is called meniscus debridement (partial meniscectomy). The surgeon starts by inserting the arthroscope into one of the portals. A probe is placed into another portal. The surgeon watches on a screen while probing the meniscus. All parts of the inside of the knee joint are examined. When a meniscal tear is found the surgeon determines the type and location of the tear. Surgical instruments are placed into another portal and are used to remove the torn portion of meniscus. When the problem part of the meniscus has been removed the surgeon checks the knee again with the probe to be sure no other tears are present. A small motorized cutter (shaver) is used to trim and shape the cut edge of the meniscus. The joint is flushed with sterile saline to wash away debris from the injury or from the surgery. The portals are closed with sutures.

Meniscus Repair

Using the arthroscope and a probe, the surgeon locates the tear. The probe is used to push the torn edges of the meniscus together. A small rasp or shaver is used to roughen the edges of the tear. Then a hollow tube called a cannula is inserted through one of the portals. The surgeon threads a suture through the cannula and into the knee joint. The suture is sewn into the two edges of the tear. The surgeon tugs on the thread to bring the torn edges close together. The suture is secured by tying two to three knots. Additional sutures are placed side by side until the entire tear is fixed.

Are you a candidate?

Here are factors to consider:

• Do you have a persistent knee pain and swelling?
• Are you unable to move your knee through its full range of motion?
• Is there the feeling of your knee locking or catching?
• Do you have the feeling that your knee is giving way or unable to support you?
• Have you had an acute trauma to the knee while playing?

If you answered YES to any of these questions, then Meniscus debridement/ Meniscus Repair is worth exploring.

Post Op Recovery

Meniscal surgery is done on an outpatient basis. Patients usually go home the same day as the surgery or the next day. The portals are covered with surgical strips and the knee may be wrapped in an elastic bandage. The time it takes to recover after meniscal surgery varies depending on whether you have had a partial meniscectomy or meniscal repair. Following a partial meniscectomy the recovery rate is usually quicker than a meniscal repair. This is because the repaired meniscus needs time to heal and so a period of protection early on after the surgery is necessary. Regardless of the type of surgery performed, one of the biggest factors that will determine the rate of recovery and long-term outcome following surgery is your motivation and adherence to rehabilitation. Full recovery following partial meniscectomy is usually within 6-8 weeks and meniscal repair 2-3 months.

After Surgery Benefits

ACL injuries

The Anterior Cruciate Ligament (ACL) is most commonly injured during a twisting injury to the knee when the foot is planted on the ground. This can occur during such sports as football, soccer, basketball, or skiing. It can also be injured during a direct blow to the knee or with hyperflexion or extension of the knee.

ACL reconstruction

Since the ACL does not heal, the ligament needs to be replaced (reconstructed). The ACL is reconstructed using arthroscopic techniques. The arthroscope is placed into the knee joint through a small incision. A camera is used and the image is viewed on a TV monitor. The arthroscope allows evaluation of the entire knee joint. Small instruments are inserted through additional incisions so that the joint structures can be evaluated for any damage, any injury can be diagnosed, and damaged tissue can be repaired, reconstructed, or removed. In ACL reconstruction a replacement ligament (graft) is placed in the joint at the site of the old ACL and then fixed to the bones. In many cases, the ligament is attached with screws. The screws can be either metal, bioabsorbable screws (screws that dissolve in the body with time), or plastic. Although the ACL reconstruction is performed primarily with arthroscopy, a small open incision is needed to place the new ligament in the knee. Overall, ACL reconstruction is a highly successful operation. The advances in surgical techniques and rehabilitation have led to a 95% success rate for achieving a stable knee following surgery.

Are you a candidate?

Here are factors to consider:

• Have you felt a sudden pain after the injury?
• Does your knee keep giving way?
• Have you heard a “pop” sound when you injured your knee?
• Have you noticed a swelling within the first 1-3 hours after the injury?
• Do you have apprehensions about knee becoming “loose” or unstable while playing/walking?

If you answered YES to any of these questions, then ACL reconstruction is worth exploring.

Post Op Recovery

Rehabilitation of the knee after ACL reconstruction requires time and hard work. Return to full function can vary from 6 weeks to 6 months depending on severity and activity levels. The rate of rehabilitation may take longer, depending on the specific requirements of the individual’s sport/activity. The overall success rate for ACL surgery is very good. Many studies have shown that more than 90 percent of patients are able to return to sports without symptoms of knee instability.

After Surgery Benefits

• Improved function
• Reduction of pain and anxiety
• Have you heard a “pop” sound when you injured your knee?
• Lesser chances of early or premature wear and tear of knee
• Return to sports (recreational or professional)

PCL injuries

The Posterior Cruciate Ligament (PCL) is the strongest ligament in the knee. It is injured less commonly than the others. Still the PCL can be injured from a direct blow to the tibia that forces the bone backward on the femur. This can occur during sports when the knee hits the ground or during a motor vehicle accident, when the knee hits the dashboard. PCL injuries can also occur from hyperextension injuries to the knee.