Meniscus Removal (Meniscectomy): Procedure, Recovery, and Risks

How is Meniscus Removed?

Meniscus removal, known as meniscectomy, is a surgical procedure, most commonly performed arthroscopically, to excise damaged or torn portions of the meniscal cartilage within the knee joint that are causing pain, locking, or instability, and are not amenable to repair or conservative treatment.

Understanding the Meniscus

The menisci are two C-shaped pieces of fibrocartilage located between the femur (thigh bone) and the tibia (shin bone) in each knee joint. There are two menisci per knee: the medial meniscus (on the inside) and the lateral meniscus (on the outside). Their primary functions include:

• Shock absorption: Distributing load across the knee joint.
• Joint stability: Enhancing congruence between the bones.
• Lubrication and nutrition: Aiding in the distribution of synovial fluid.
• Proprioception: Contributing to the sense of joint position.

When a meniscus is torn, often due to twisting injuries, squatting, or degenerative changes, it can lead to symptoms such as pain, swelling, tenderness, clicking, catching, or locking of the knee joint.

When is Meniscus Removal Considered?

Surgical removal of a meniscus is typically considered when:

• Conservative treatments fail: Rest, ice, compression, elevation (RICE), physical therapy, anti-inflammatory medications, and activity modification have not alleviated symptoms.
• The tear type is not repairable: Some tears, particularly complex or degenerative tears, are not suitable for surgical repair due to their location (poor blood supply) or extent.
• Symptoms are significant: The tear causes persistent pain, mechanical symptoms (locking, catching), or instability that significantly impacts daily activities or athletic performance.
• Partial meniscectomy is preferred: Surgeons aim to remove only the damaged portion, preserving as much healthy meniscus as possible to maintain its functional benefits. Total meniscectomy is rare and reserved for cases where the entire meniscus is irreparably damaged.

The Surgical Procedure: Meniscectomy

Meniscectomy is overwhelmingly performed using arthroscopic surgery, a minimally invasive technique.

1. Anesthesia: The patient will receive anesthesia, which may be general (patient is asleep), spinal (numb from the waist down), or regional (numbing the leg).
2. Preparation: The knee area is thoroughly cleaned and sterilized. Surgical drapes are applied to maintain a sterile field.
3. Incisions: The surgeon makes two or three small incisions, typically less than half an inch long, around the knee joint. These are known as "portals."
4. Arthroscope Insertion: A thin, pencil-sized instrument called an arthroscope is inserted through one of the incisions. The arthroscope contains a camera and a light source, transmitting real-time images of the inside of the knee joint to a video monitor in the operating room.
5. Fluid Infusion: Sterile saline solution is continuously pumped into the joint through another portal. This inflates the joint, providing a clear view and washing away debris.
6. Visualization and Assessment: The surgeon meticulously examines the entire knee joint, including the menisci, articular cartilage, ligaments, and synovium, to confirm the diagnosis and assess the extent of the damage.
7. Surgical Tools and Removal: Through other small incisions, specialized miniature surgical instruments (e.g., shavers, graspers, punches, motorized burrs) are inserted. The surgeon carefully trims and removes only the damaged or torn portion of the meniscus, smoothing any rough edges to prevent further irritation. The goal is to remove as little healthy tissue as possible.
8. Closure: Once the damaged meniscal tissue is removed and the joint is irrigated, the instruments are withdrawn. The small incisions are typically closed with one or two stitches or sterile adhesive strips and covered with a dressing.

The entire procedure usually takes less than an hour, and it is typically performed as an outpatient procedure, meaning the patient can go home the same day.

Post-Operative Care and Rehabilitation

Recovery from meniscectomy is generally quicker than from meniscus repair.

• Immediate Post-Op: Patients usually experience some pain and swelling. Pain medication is prescribed. Crutches may be used for a few days to a week to reduce weight-bearing, though full weight-bearing is often allowed immediately.
• Rehabilitation: Physical therapy (PT) is crucial for a successful recovery.
  • Early Phase: Focuses on reducing swelling, managing pain, restoring full knee range of motion (ROM), and gentle muscle activation (e.g., quadriceps sets).
  • Intermediate Phase: Progresses to strengthening exercises for the quadriceps, hamstrings, and glutes, balance training, and proprioceptive exercises.
  • Advanced Phase: Involves more functional movements, agility drills, and sport-specific training, gradually preparing the patient for a return to desired activities.
• Return to Activity: Most individuals can return to light activities within a few weeks and more strenuous activities or sports within 4-6 weeks, depending on their progress in physical therapy and the extent of the surgery.

Potential Risks and Complications

While arthroscopic meniscectomy is generally safe, potential complications can include:

• Infection
• Bleeding or excessive swelling (hemarthrosis)
• Blood clots (deep vein thrombosis - DVT)
• Nerve or blood vessel damage
• Persistent pain or stiffness
• Failure to relieve symptoms
• Development or progression of osteoarthritis over time.

Long-Term Outlook After Meniscectomy

Removing even a portion of the meniscus can alter the biomechanics of the knee joint. The removed tissue no longer contributes to shock absorption and load distribution, which can lead to increased stress on the articular cartilage. This increased stress is why meniscectomy, particularly total meniscectomy, is associated with a higher risk of developing or accelerating the progression of osteoarthritis in the affected knee over many years.

Therefore, the emphasis in modern orthopedic surgery is always to preserve as much meniscal tissue as possible, favoring meniscus repair over removal whenever clinically appropriate. Adherence to a structured rehabilitation program and careful management of activity levels are critical for optimizing long-term outcomes and minimizing the risk of future joint degeneration.

Meniscus Repair vs. Removal (Meniscectomy)

It's important to distinguish between meniscectomy (removal) and meniscus repair.

• Meniscectomy: Involves excising the damaged portion of the meniscus. It's often chosen for tears in the avascular (poor blood supply) inner two-thirds of the meniscus or for complex, degenerative tears. Recovery is generally faster.
• Meniscus Repair: Involves suturing the torn edges of the meniscus back together, aiming to heal the tissue. This is typically performed for tears in the vascular (good blood supply) outer third of the meniscus, especially in younger, active individuals. Repair aims to preserve the meniscus's native function, potentially reducing the long-term risk of osteoarthritis, but it involves a longer and more conservative rehabilitation period to allow for healing.

The decision between repair and removal is made by the orthopedic surgeon based on the tear's location, size, pattern, the patient's age, activity level, and overall knee health.