Arthroscopic Meniscus Repairin Azamgarh, Procedure & Recovery

Aging or an injury to the meniscus can cause a tear with symptoms like severe knee pain and joint instability. Meniscus is a cartilaginous structure present in the knee between the shinbone (tibia) and femur (thigh bone) that acts as a cushion to provide shock absorption. Arthroscopic meniscus repair is a surgical procedure to repair a torn meniscus using a special tube-like device called an "Arthroscope" inserted through keyhole-sized incisions (cuts). Specialized surgical instruments with strong sutures (threads) sew (stitch) the torn pieces of the meniscus together, which heal over time. 

Arthroscopic meniscus repair is a minimally invasive (does not involve extensive incisions or bleeding) procedure that aids in repairing a torn meniscus. In arthroscopic meniscus repair, your surgeon will use a special device known as an arthroscope that consists of a light source and a tiny lens camera at the end. This scope is inserted through keyhole-sized incisions, and the surgeon can view the interior of the surgical site through the images captured by the camera. The images are projected on the screen to guide the surgeon to locate the tear and insert the surgical instruments. Special instruments consisting of sutures or threads are inserted, which help stitch the meniscus torn parts and re-attach them. These sewed pieces gradually heal by themselves over a period of time. 

There are three techniques to perform an arthroscopic meniscus repair:

• The inside-out technique: The sutures are inserted from the inside of the joint, engaging both tear fragments.
• The outside-in technique: The sutures are introduced outside the meniscus capsule through the joint.

The all-inside technique: The first suture is introduced from inside the joint through the capsular fragment of the tear, and the second suture is inserted through the central fragment of the tear and the capsule.

Meniscus is a thin, fibrocartilaginous structure in your knee between the tibia and the femur. This acts as a shock absorber that helps to distribute the load evenly on the knee and maintains joint stability. It also provides lubrication and nutrition to the knee joint. 

The meniscus can degenerate due to aging or tear due to any high-impact injury or trauma. This causes severe joint pain, swelling, instability, difficulty bending and straightening the knee, and a feeling of your knee giving away. Several grades and types of meniscal tears are present that help determine the type of treatment required to treat the meniscal tear. 

 According to the MRI (Magnetic Resonance Imaging) scan classification:

• Grade 1- Incomplete tear
• Grade 2- Moderate or partial tear
• Grade 3- Severe or complete tear

According to the location of the tear within the meniscus:

• Radial tear- A tear is seen within the avascular (lack of blood supply) part of the meniscus. 
• Incomplete tear- A tear that occurs due to frictional forces causing cartilage wear and tear.
• Horizontal tear- A tear seen within the vascular part of the cartilage.
• Flap tear- A tear in which a part of the cartilage is peeled back that gets locked within the joint. 
• Complex tear- A tear that is a combination of radial and horizontal tears.
• Bucket-handle tear- A tear in the center of the meniscus. 

An arthroscopic meniscus repair is recommended for the following:

• Grade 2 meniscal tear
• Horizontal meniscus tear
• Incomplete meniscal tear 

An orthopedic surgeon (a doctor specializing in the diseases of bones, cartilage, muscles, tendons, and ligaments) will first discuss the symptoms you have been experiencing during your first consultation. Your surgeon will rule out the presence of other debilitating diseases like diabetes (increased blood sugar levels), hypertension (high blood pressure), blood disorders, and other conditions that may affect the course of your treatment. 

Inform your surgeon about the type of medications that you have been taking (blood thinners, anti-inflammatory drugs, and other herbal supplements). Discuss with your surgeon any allergy to medications, latex, or anesthesia. 

A physical exam will be conducted to evaluate your knee joint to check for the following:

• Swelling and tenderness in the joint
• Clicking or popping sound when the knee is bent or straightened
• The range of motion of your knee

Medical tests will be conducted to assess your overall health and to confirm the presence of a meniscal tear.

• Blood tests to check the levels of the blood components like red blood cells, etc., and the presence of any infection.
• Urine tests to check for the presence of any infection.
• Chest X-ray to rule out pathologies of the lungs.
• ECG (Electrocardiogram) to check the general condition of your heart.
• X-ray of the knee to check the location and type of the meniscal tear.
• MRI (Magnetic Resonance Imaging) scan to evaluate the grade of meniscus tear to determine the type of treatment required.

Preparing yourself before the surgery is important to reduce stress and anxiety and to facilitate optimal healing and recovery. This includes:

• Strengthening your knee muscles before surgery for optimal recovery post-meniscectomy through brisk walking, bending, and straightening your knee.
• Using an antiseptic or antimicrobial skin cleanser or soap a week before the surgery to thoroughly wash your leg(s). This decreases your risk of post-op infection.
• Discontinuing medications like blood thinners, anti-inflammatory drugs, antidepressants, and other herbal supplements 2 weeks before the surgery to reduce your risk of bleeding.
• Quitting social habits like smoking and alcohol at least 2 to 3 weeks before the procedure since they delay wound healing. 
• Fasting for at least 6 to 8 hours before the surgery since it is performed under general anesthesia (a numbing agent) may lead to aspiration of food particles into the lungs. 

It is also important to prepare your home in such a way as to avoid any injury or fall during your recovery period. 

• Your surgeon may advise you to avoid climbing stairs; hence you must arrange a room on the same floor as your living area. 
• Getting in and out of your bed should not be tedious, so keep in mind to adjust your bed height accordingly. 
• Your bathroom and toilet area should be accident-proof, which is possible with the help of rails or support bars near your toilet and shower area. 
• You must adjust your toilet seat to a comfortable height that makes it easy for you to sit and get up easily. This helps to prevent excess strain or pressure on your operated knee. 
• Leg elevation is beneficial to control your post-op swelling, which is possible through sturdy chairs with a footrest. 

Arthroscopic meniscus repair is a minimally invasive and outpatient procedure that does not require hospitalization. The procedure is usually performed under general anesthesia (a numbing solution). 

• On the scheduled day of your surgery, you will be made to sign a consent form giving your surgeon permission to perform the procedure. 
• Your nurse will check your vitals (blood pressure, blood sugar levels, pulse, heart rate, and oxygen level) and then clean the surgical site with an antiseptic solution to remove surface contaminants. 
• Your anesthesiologist will administer general anesthesia through an IV (intravenous) line that puts you to sleep. 
• Using a surgical knife (scalpel), the surgeon will make 2 to 3 keyhole-sized incisions in your knee.
• An arthroscope will be inserted into one of the incisions that capture images of the surgical site and project them on the screen.
• Your surgeon will view the surgical site and locate the meniscus tear to insert special surgical instruments through other keyhole incisions. 
• These instruments consist of threads or sutures that will be guided by the surgeon to stitch the torn pieces of the meniscus and secure them together.
• The sutures are introduced through the inside-out, outside-in or all-inside technique, depending on the extent of the meniscus tear. 
• Your surgeon will finally close the skin incisions with resorbable sutures or stitches. 
• The procedure usually takes 60 to 90 minutes, depending on the severity of the meniscal tear. 
• Your surgeon may place a protective knee brace to help control your knee and provide protection. 

Immediately after the surgery, you will be observed in a recovery room for 1 to 2 hours until you regain consciousness. Once your vitals (blood pressure, sugar level, pulse, heart rate, and oxygen level) are stable, you will be sent home. 

• Post-op pain, swelling, and soreness around your operated knee are normal and can be treated through painkillers prescribed by your surgeon. Swelling can be controlled through ice packs, massage, or electric stimulation with the help of physical therapy. 
• There are preferably no bathing restrictions, and you can shower the following day. However, avoid swimming, saunas, and tub baths for at least 4 weeks. 
• You will be instructed to use crutches to walk to take the stress off the knee as it heals.
• Avoid lifting heavy objects and strenuous exercises for 3 to 4 weeks, as this can put an unwanted load on your operated knee. Light activities and exercises can begin 3 weeks post-surgery, including bending and extending your operated knee.
• The knee brace will be removed after 4 weeks, and you can resume your work and driving by this time once your knee is stabilized. 
• Complete recovery may take around 3 to 4 weeks, depending on the severity of the meniscal tear and the repair technique.

You will learn a few low-impact exercises from your physical therapist before leaving the hospital, which can be continued at home. 

• Heel slides- Lie on your back. Bend your surgical knee by sliding your heel toward your buttocks.
• Quad sets- Lie on your back with your legs straight. Tighten your thigh muscles pushing your knee down into the bed.
• Hamstring curls- Lie on your belly on the floor and gently bend your injured knee backward. Bring it closer to your buttocks. Hold for 5 seconds, and then straighten it.

Arthroscopic meniscus repair helps to reattach the torn pieces of the meniscus using strong sutures or threads. It has the following benefits and risks associated with it:

Benefits

• Improves your mobility
• Relieves the symptoms that negatively impact your quality of life
• Prevents or slows the development of arthritis (inflammation of the joint)
• Improves your knee stability
• Involves small incisions with less bleeding and minimal scarring
• Shorter operating time with quick recovery

Risks 

Though arthroscopic meniscus repair is a safe procedure, there could be a few possible risks involved:

• Persistent stiffness of the operated knee joint
• Abnormal pooling of blood near the knee area
• Allergic reactions to anesthesia cause skin rash, hives, itching, nausea and vomiting, dizziness, and breathing difficulties. 
• Risk of infection with related symptoms like high-grade fever (>103), chills, and body pains
• Blood clots that may dislodge and travel through the bloodstream, like deep vein thrombosis (DVT) in legs or pulmonary embolism in the lungs 

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