Knee > Meniscus Tear > Treatments

   Arthroscopic Repair

Preparing for Surgery

The decisions you make and the actions you take before your surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include a knee brace, crutches, ice packs or coolers, or a continuous passive motion (CPM) machine. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   Understand the potential risks and benefits of the surgery, and ask your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   If possible, practice walking with your crutches in case you need to use them after surgery.

   Most insurance companies require a second opinion before agreeing to reimburse a patient for a surgical procedure. Getting a second opinion from a surgeon who is as qualified as the surgeon who gave the initial diagnosis is advisable in any case.

   Make sure the orthopedist performing the surgery is board-certified, which can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your arthroscopic meniscus repair. If your surgery is going to be inpatient, there may be a separate department, so be sure to ask your doctor. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your knee area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important things to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia, which can lead to pneumonia.

   Since you will most likely be able to go home within a few hours of surgery, and because the anesthetic and pain medications may make you drowsy, arrange for someone to drive you home when you are released.

   Wear a loose pair of pants or other clothing that will fit comfortably over your knee bandage when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Arthroscopic meniscus repair typically takes about 40 minutes to perform, and usually you will be able to leave the hospital the same day. There are three main types of meniscus repairs. Your surgeon chooses a technique based on the location of the tear and his or her experience with the techniques. All of the techniques have a reported success rate of 70 to 90 percent.

   General anesthesia is typically used for this type of surgery, though in some cases a spinal or epidural anesthetic is used. The anesthesiologist will administer the anesthesia once you are in the operating room.

   Most meniscus surgery is performed with an arthroscope, which is inserted into the knee through a quarter-inch incision and is used to view the meniscus tear. One or two additional small incisions, or "portals," will be made to allow the insertion of instruments into the knee.

   Fluid is injected into the knee joint through one of these portals, which allows the surgeon to view, through the arthroscope, the extent of the tear.

   Many tears can be repaired with small (one-half inch long), dart-like devices that are inserted through one of the portals and placed across the meniscus tear to hold it together. These devices are usually absorbed by the body over time.

   Other techniques usually involve making a longer incision on the side of the knee and placing stitches across the meniscus tear to hold it together.

   Incisions are usually closed with stitches and the patient is taken to the recovery room.

After your meniscus has been surgically repaired, you will remain in the recovery room until you have recovered from the effects of anesthesia, which may include drowsiness. Many surgeons inject local anesthesia into the knee in the operating room, which helps to numb some of the tissues surrounding the knee and decreases pain for two to eight hours. If that is done, you may not need pain medicine until you go home. Your knee will be bandaged and wrapped, usually with an ace bandage wrapped over layers of gauze and cotton, and your knee will be elevated. Ice may be used to reduce swelling, and a brace may be used. Your surgeon may suggest you initially use crutches, though you probably will be able to bear some weight on the leg right after surgery. Your temperature, blood pressure, and heartbeat will be monitored by a nurse who, with the help of the doctor, will determine when you can prepare to go home. You will normally be able to leave the hospital or clinic within a few hours after surgery. Make sure to have someone available to drive you home, as you will most likely be unable to drive a car.

Arthroscopic meniscus repair is outpatient surgery, unless it is associated with other surgery at the same time, such as ACL (anterior cruciate ligament) reconstruction. In that case, your surgeon may elect to keep you in the hospital overnight. If you need to stay in the hospital, your surgeon may have you begin doing continuous passive motion exercises while in bed as soon as possible after surgery is completed. Your leg will be flexed and extended to keep the knee joint from becoming stiff. This may be done using a continuous passive motion (CPM) machine. The CPM is attached to your bed and then your leg is placed in it. When turned on, it takes your leg through a continuous range of motion. There will likely be pain, and you can expect to be given pain medication as needed. Be sure to ask for medication as soon as you feel pain coming on, because pain medication works best on pain that is building rather than on pain that is already present. The nurses will not give you more than your doctor has prescribed and what is considered to be safe. Ice also helps control pain and swelling. Typically, physicians will have patients ice their knees for one hour four to five times a day.

Most patients are able to return to work within a few days or a week after arthroscopic meniscus repair, provided work does not involve strenuous activity such as heavy lifting or climbing. You may need to use crutches during the first week, though you also may be able to bear weight on your leg. It may take a week or more before you can resume driving a car, depending on which leg was operated on. The wrap usually can be removed from the knee within 12 to 72 hours after surgery. Some bruising or swelling is normal, and you will notice two or three small incisions held together by tiny stitches and, in some cases, an additional one- to one-and-a-half-inch incision. Icing your knee two or three times a day for 15 to 20 minutes at a time, and elevating it above heart level, can decrease pain and swelling. Taking non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen also can reduce pain and inflammation. The first follow-up visit is usually scheduled for a week to three weeks after surgery, at which time the stitches will be removed.

At one time, it was thought that severely limiting weight-bearing activities would aid in recovery from meniscus repair surgery. But restricting these activities has been found to actually hamper the process. Surgeons now usually recommend that patients try to walk without crutches, bend their legs, and begin stretching and strengthening exercises as soon as possible after surgery, to keep the knee joint and surrounding muscles flexible. The goal is to strengthen the muscles of the lower limbs without putting too much strain on the meniscus. For at least eight weeks after surgery, you will probably not be able to return to sports activities, until you have regained equal strength in both legs. Full recovery usually takes two to four months. Following are some signs to watch for in determining if you are ready to return to action. You should be able to:

   Flex and extend your knee without pain

   Experience no swelling

   Feel as if your injured knee is as strong as your other knee

   Jog and sprint without limping

   When running, stop and cut without pain at 45- and 90-degree angles

   Jump off both legs and off your injured leg without pain.

Though many meniscus injuries occur during sports and are difficult to avoid, there are several steps you can take to improve the overall strength and flexibility of your knee:

   Manage your weight. Every pound in excess of your normal weight puts three or four additional pounds of pressure on your knee every time you take a step.

   The hamstrings, in the back of the thigh, and quadriceps, the muscles in the front of the thigh, are crucial shock and impact absorbers. These muscles must be kept strong and flexible to protect the joint surfaces in your knee.

   Stretching before exercising should be a regular part of your warmup; however, it is important not to over-stretch. Never push or pull on your leg with your hands while you are stretching, and avoid squatting during your warmup, which can put stress on your knee joint.

   Well-cushioned, well-fitting athletic shoes can reduce the impact of the load exerted on the knee.

   If you are engaging in activities that require a lot of twisting and turning such as racket sports, skiing, soccer, and basketball, do not assume you can play yourself into shape; make sure you are in good physical shape before you play.