Meniscus Surgery

The meniscus is two crescent shaped discs on each side of the knee joint. They act as shock absorbers, provide a uniform load across the entire joint surface and make the knee stable as you walk, run and jump. A meniscus operation may need to be done if you have suffered an accident that has damaged the meniscus.

There are two types of damage to the meniscus of the knee. One is due to a more serious accident, often in connection with sports. Then the injured meniscus can get pinched and the knee locks, which needs surgery. You can often get a ligament injury at the same time.

The second type is meniscus changes that usually occur in the middle age without any previous major accident, but more because the meniscus has become fragile, just as the cartilage becomes osteoarthritis. These changes are caused by knee arthritis and rarely need surgery, but are treated as in osteoarthritis with physiotherapy.

Preparations

You can wash yourself with a special bactericidal soap both in the evening before and on the morning of the operation before going to the hospital. It reduces the risk of infection. You can buy the soap yourself at a pharmacy.

You are usually not allowed to eat, drink, smoke or sniff the night before an operation.

Good to quit smoking and not drink alcohol

The benefits of quitting smoking before surgery are many. The wounds heal faster and the blood circulation and fitness improves so you can recover faster. At the same time, the risk of complications is significantly reduced. You should stop smoking altogether, but if it is not possible, it is good if you can refrain from smoking six weeks before the operation and even the first weeks afterwards. Your doctor can tell you what support is available when you need help to quit smoking.

You should also avoid drinking alcohol six weeks before an operation to reduce the risk of complications.

Then the operation goes on

Once you get to the hospital, you will see the doctor who will do the surgery. The doctor tells you how the operation will go and answers your questions. Then a regular body examination is done which examines the joint to be treated. You also know what type of anesthesia the treatment requires. You may also talk to an anesthetist if you are going to be anesthetized and get anesthesia.

After the medical examination, you are allowed to change into hospital clothes and lie down in a bed, before being taken to the operating department. There you will receive painkillers, either in liquid form that you swallow or as suppositories.

Before the operation, you will receive local anesthesia, back anesthesia or be anesthetized. You don’t feel anything if you get anesthesia or back anesthesia, but may feel that you will be operated on if you get local anesthesia, without it hurting. You can get sedative if you find it uncomfortable.

A meniscus operation or a cruciate ligament operation is done by arthroscopy, also called peephole surgery. Arthroscopy means that a doctor operates a joint using an arthroscope, a thin metal tube that is inserted into the joint through a small hole. The arthroscope transfers images to a monitor, where the doctor can monitor the work.

First, the knee is washed with bacteria-killing alcohol solution and wrapped in sterile tissue. The doctor will then make a small incision on the front of the knee and insert the arthroscope. The same incision also flushes a special saline solution to keep the joint clean. Then a second cut is made to insert small instruments into the joint. A third incision is sometimes made for a tube that flushes out the saline solution. The entire knee joint is examined with the arthroscope to find or exclude damage to other parts of the joint.

A damaged meniscus is sewn together with various instruments, if possible. If it is not possible to sew the meniscus, the broken parts are removed so that only healthy and whole meniscus tissue remains. The removed pieces are flushed out of the joint.

The holes are finally taped or sewn together and you get a bandage on your knee. The operation takes between 20 and 45 minutes.

After the surgery

You may lie in a special ward for observation after surgery, until the anesthesia has released. This is among other things so that the doctor can check that you do not start bleeding. You are usually allowed to go home the same day, but you should not drive yourself because you may be brought in and tired after the operation.

You get to talk to the doctor who operated you before you go home. You also get to meet a physical therapist, who gives you an exercise program and advice on how to do the next few days.

You usually need to change dressings after three to six days when a wound crust is formed. Then you can shower with the dressing left. Then remove the wet dressing and wash the leg with soap and water. Then you put on a new dressing. It is good if you ask your doctor before leaving the hospital if you are unsure of what is going on.

Good to touch your knee

It can take three to six months to fully recover if you have had a meniscus emergency. You may start exercising a few days after the operation and may use crutches to relieve the knee during the first few weeks.

It is good if you move as quickly as possible after the operation if the meniscus has not been sewn, by walking and loading the knee. You may need to use crutches as support. You can usually work again after a few days if you have an office job, but may need to be on sick leave for one to two weeks if you have a mediocre job.

You may be in pain, but it usually subsides after a few days. Usually you do not need to take painkillers, but it depends a little on the type of whitening surgery done.

It is important to get back the mobility of the knee, especially the stretch, and therefore you may need to work out with the help of a physical therapist. If meniscus parts are removed during surgery, it may take three to four months before your knee is fully restored. This is especially true if there are changes in the knee due to osteoarthritis.

Consult your doctor when you can start exercising easily. Sometimes the knee is swollen and stiff a month or more after surgery.

Complications

It is rare to get complications after a meniscus operation, but as with other operations, especially on the legs, there is an increased risk of blood clots. It is important to inform your doctor if you are taking birth control pills that may increase the risk of blood clots.

You can help prevent the risk of blood clots yourself by quickly getting on your legs and moving after surgery.

You may get an infection, although it is uncommon. Signs that you have an infection are that fluid is formed in the wounds, that the knee swells, gets hot and the skin around the wound blushes. At the same time you may get fever, pain and more pain as you move. You should always contact a health care center or hospital where you were operated on if you have such symptoms.

Haemorrhage is very rare after a meniscus operation, but it can happen after a cruciate ligament operation. In major meniscus operations, the knee may swell and become stiff for a few days, even if you have not received an infection. You may need to rest your knee for a few days or a week if you have undergone a major surgery.

Almost everyone gets along well

Most people who twisted their knees severely and suffered an injury are operated with the goal of sewing the meniscus together. You will be fully restored in the short term and your knee will function as before, although some of the meniscus sometimes needs to be removed.

When arthroscopy is done after the knee is severely twisted in connection with sports, the doctor sometimes discovers that you also have a damaged cross band. Then the cross band may also need to be operated. It is often done with a tendon from another part of the leg.

It may happen that the operated meniscus breaks down again. Then you usually have to be operated on again and the piece of the meniscus that is damaged is removed, as it is rarely possible to sew the meniscus a second time.

Later in life, you may have a knee problem if the doctor removes parts of the meniscus. This is because the load in the joint is distributed on a smaller surface when part of the meniscus is removed. In the longer term, you may develop osteoarthritis.

Why is the treatment done?

When a meniscus is damaged, cracks may occur or a piece may become loose. Small meniscus injuries can heal by themselves. In case of knee injuries where the doctor suspects a meniscus injury, it is usually necessary to wait a couple of weeks to see if the problems disappear.

The purpose of the treatment is to restore the knee to its original condition in order to avoid future problems. Most often it is one of the meniscus on the inside of the knee that has been damaged and broken. Sometimes the damaged meniscus can be sewn together.

Sometimes a piece of the meniscus has come loose. If a loose meniscus gets stuck somewhere in the knee joint, the knee locks as you bend or stretch it. The damaged portion of the meniscus is removed unless the meniscus can be repaired.

Consult a doctor before

It is important that you discuss with your doctor why you need the surgery and what you have expectations for the result.

You must be prepared that it may require a lot of self-training after the surgery for the knee to function well again. How well-trained you are before the surgery also has a bearing on how quickly you get well. The better strength, balance and coordination you have before the surgery, the faster your knee can be restored.

Exercise gives better results in osteoarthritis

You are likely to have osteoarthritis of the knee joint if you are middle-aged and get pain on the inside of your knee without any major injury. Often it knocks in the knee during movement and most people feel that the knee hooks up. You will not be better off by an arthroscopy than you will by exercise, if you have osteoarthritis and at the same time a meniscus injury. Studies show that it is better to start with physical therapy to strengthen the leg muscles. This protects the joint and reduces the pain. Exercising when you have osteoarthritis is not dangerous, although it can hurt. The pain usually subsides after three months of exercise. You need to continue training for the results to become more lasting.

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