What happens if your meniscus is removed

Make sure you include the risks that most apply to you. Talk with your healthcare provider about how to prepare for your meniscal transplant surgery. Ask whether you should stop taking any medicines ahead of time, like blood thinners. Tell your healthcare provider about all the medicines you take, including over-the-counter medicines like aspirin.

Before your procedure, you may need additional imaging tests, like X-rays and magnetic resonance imaging MRI. You may be able to go home on the day of your surgery. Talk with your healthcare provider ahead of time so that you can make the necessary arrangements for your recovery period. Before your surgery, a healthcare provider will carefully screen the donated meniscus for any signs of infection.

One to two times per month, Virtual Advisors receive a link to short, interactive surveys. All responses are confidential. Your healthcare provider can help explain the details of your particular surgery. An orthopedic surgeon will perform the surgery. The whole operation may take a couple of hours. In general, you can expect the following:.

You may receive spinal anesthesia and a medicine to help you relax. Your vital signs, like your heart rate and blood pressure, will be monitored during the operation.

You may have a breathing tube inserted down your throat during the operation to help you breathe. After cleaning the affected area, your surgeon will make a small incision through the skin and muscle of your knee. Your healthcare provider will insert a very small camera through this incision, using this camera to guide the surgery. Using very small instruments inserted through the incision, your surgeon will remove any remaining meniscus.

Next, he or she will surgically sew the donated meniscus into the joint space. The healthcare provider might use screws or other devices to hold the meniscus in place. Talk with your healthcare provider about what you can expect after your surgery. In some cases, you may be able to go home a few hours after your surgery. If so, make sure you have someone who can drive you home. In other cases, you may need to stay overnight at the hospital for monitoring.

You may have some pain right after your surgery, but pain medicines may help to ease the pain. The pain should quickly begin to diminish, and you should have less pain than before your surgery. This is not a recently discovered phenomena. It can be difficult to tell a patient to have patience when their knee hurts.

Most of the time when someone comes into our clinic for the first time they will report on the characteristic symptoms of meniscus related knee problems:. It is also difficult to convince an athlete that meniscus surgery may prevent them from returning to sports altogether. At this point, we will introduce the research from surgeons as a second opinion to our statements.

One of the most vital but lessor known roles of the meniscus is to provide lubrication to the knee, which it accomplishes through diffusing spreading out synovial fluid across the joint.

Synovial fluid provides nutrition and acts as a protective measure for articular cartilages in the knee. The femoral condyle of the thigh bone in the knee is covered in a thin layer of articular cartilage, which serves to reduce motional friction and to withstand weight bearing.

This cartilage is very susceptible to injury both because of its lack of proximity to blood supply and the high level of stress placed on it by excessive motion. The meniscus, therefore, is able to provide a much-needed source of nutrition to the femoral and tibial articular cartilage by spreading fluid to that avascular area. This illustration demonstrates the reasoning often given to patients that meniscus surgery is the only way.

Menisci have two zones. A red zone tear lies within the blood-rich portion of the meniscus. Where there is a blood supply there is healing as blood brings the healing and growth factors needed for wound repair.

The white zone meniscal tear is thought to be non-healing because there is no direct blood supply. Many doctors do not believe the white zone meniscus tear can be repaired because of this. This is typically the part of the meniscus removed in meniscus surgery.

Doctors writing in The Journal of the American Academy of Orthopaedic Surgeons 5 offer a very good rationale for why people still have meniscus surgery. Here are some talking points of the research:.

Most people that contact us already have a good understanding the frequent or long-term cortisone use has its challenges and risks. In March , research lead by Rush University Medical Center and published in the journal Arthroscopy 7 found that patients who received knee injections within one month prior to knee arthroscopic surgery developed postoperative infections at twice the rate of those who did not receive an injection.

This of course relates to an injection increasing the risk for surgical infection. But what about the overall impact of corticosteroids on the meniscus? It is well understood by most medical professionals and their patients that prolonged and long-term corticosteroid injections for knee pain can break down cartilage including the meniscus. These findings do not support this treatment for patients with symptomatic knee osteoarthritis. In August of in the journal Scientific Reports 10 doctors expressed concerns about damaging the meniscus tissue with cortisone injections.

For many people, one injection would be considered safe. Here are the learning points of that research:. There is a lure to surgery. We see it every day in our offices. The long-standing belief that surgery will fix everything. A recent paper from the University of Southern Denmark 11 wrote:.

A January paper published in The archives of bone and joint surgery 12 offers this assessment of meniscus repair:. It is technically challenging and has a steep learning curve. General complications of arthroscopy such as venous thromboembolism, infection and vascular injury could occur. Specific complication including nerve injuries, ligamentous injury, iatrogenic cartilage lesions, and poor suture techniques can happen during meniscal repair.

The surgeon should depict and accept the eventual complications and address them as rapidly as possible. It is also important to form patients about potential complications. Between and — research began appearing questioning not only the value of meniscus surgery but whether or not the surgery caused more harm than good.

The summary is below. The research mentioned above and reported by the New York Times was not the first time the meniscus surgery controversy was reported in the international media. Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery.

Then a scoring system was designed to measure pain, symptom severity, and knee pain after exercise at 12 months after the procedure. Continuing forward, the lead researcher of this study Raine Sihvonen, MD published more papers on the problems of meniscus surgery.

In other words, the meniscus tear is the result of knee osteoarthritis development. If you remove the meniscus you accelerate the knee osteoarthritis. We will discuss this further below. In April , Dr. Sihvonen and colleagues wrote in the Annals of Internal Medicine 15 that removing parts of the meniscus did not appear to relieve the symptoms of knee pain and knee locking in surgical patients.

Many orthopedic surgeries in my opinion have a far worse outcome then patients anticipate primarily because they cannot return to the activities they love, such as running. When people have arthroscopy surgery I try to go over their surgical reports with them because often what they perceived what was done with the surgery was not done and other things were done that were detrimental and they had no idea they were done. I have never as far as know seen an orthopedic operative report that showed a real meniscus repair, where the meniscus was sewn together and that was it.

The typical report shows partial meniscectomy and no repair yet the patient believes it was a repair. Every arthroscopy report I have ever seen, has findings that reveal osteochondral lesions, chondromalacia, meniscus degeneration, articular cartilage lesions ligament injury and many others. Remember anyone can have decreased pain by doing less, and unfortunately, many people who receive orthopedic surgeries end up doing less.

Earlier in research published in the American Journal of Sports Medicine showed what little value meniscectomy has.

Researchers compared meniscectomy to nonoperative treatment for meniscus tears. At the two-year follow-up, there was no difference in pain relief, improved knee function, or patient satisfaction. Results also showed that meniscectomy did not provide better functional improvement than the nonoperative group.

But what was the difference between these two groups? One group of patients underwent invasive surgery, had tissue remove, and will likely experience long-term meniscus degeneration.

The most serious of the long-term consequences is an acceleration of joint degeneration. In research from May , 17 doctors warned that the role of arthroscopic partial meniscectomy in reducing pain and improving function in patients with meniscal tears continues to remain controversial and that studies show no difference between arthroscopic partial meniscectomy and non-surgical treatment.

It reports on how military surgeons dealt with meniscal injury. The report reveals findings on nearly 30, meniscus surgeries. Basically, surgeons need to repair and save the meniscus. They also need to figure out how to do it. The goal of meniscectomy was to reduce pain, restore knee function, and prevent the development of osteoarthritis. However, as medical research studied the long-term effects of this procedure, it became apparent in the medical community that meniscectomy was a primary cause of the sudden onset of knee osteoarthritis.

The meniscus was, in fact, an important component of the knee. The meniscus provides several vital functions including mechanical support, localized pressure distribution, and lubrication to the knee joint. They are made of thick fibrous cartilage that allows them to function as a shock absorber between the upper and the lower leg bones.

This research asks the same question we do, Why do we still perform meniscectomy? They, like us, agree that it is high time that the paradigm shifted, in favor of meniscal preservation.

Medical research is broken up into levels of evidence. Level 1 being base evidence which means a researcher took existing research and combined it into a review of the literature. Doctors and researchers grade this the lowest level of accredited research. The German doctors say too much level 1 evidence is being offered as a generalization of meniscus surgery. The complaint is some surgeries will help some patients and that every meniscus surgery is not a bad surgery and this research is not reflective of that.

The ESSKA guidelines also say the treatment of degenerative meniscal lesions should start with conservative management. In the case of persistent symptoms, surgery should be considered after 3 months. In the case of mechanical symptoms, arthroscopy might be indicated earlier. They do say arthroscopy in advanced osteoarthritic knees is not indicated due to inferior clinical outcomes. In March , 22 researchers announced a new study to answer this question.

They write of their study:. Although several randomized controlled trials have been published that showed no clear benefit compared with sham treatment or non-surgical treatment , the incidence numbers performed of Arthroscopic partial meniscectomy remains high.

The common perception by most orthopedic surgeons is that there are subgroups of patients that do need Arthroscopic partial meniscectomy to improve, and they argue that each study sample of the existing trials is not representative of the day-to-day patients in the clinic. Short-term follow-up of meniscectomy has generated some positive results; for example, a meniscectomy can provide temporary pain relief in early stages following operation, especially when an acute tear had caused excessive pain or popping preoperatively.

Another immediate result may be a greater feeling of stability, if the tear had previously been a source of instability or knee locking by catching between the tibia and femur. On long-term follow-up, however, these initial improvements have rarely been shown to last. Complete pain relief from meniscectomy is nearly unheard of after more than ten years and, at that point, more complex issues including limited range of motion, radiographic degeneration, crepitation, and severe functional impairment have usually begun to surface.

In many cases, a simple meniscus tear, if operated on, can become a career-ending injury. Here we present a brief review of many of the papers published in recent years suggesting that meniscus surgery causes more harm than good in many patients.

November Research in the medical journal Orthopedics: Do these findings present anything really new? No, research has been ongoing telling patients and doctors of the risks associated with arthroscopic meniscus repair.

It is remarkable that studies more than a decade and a half old have issued the same warnings. In , doctors in Canada audited the effectiveness of certain medical procedures found very poor quality evidence on the effectiveness of arthroscopic debridement of the knee with partial meniscectomy. The summary of these studies? If you have a meniscus surgery, chances are you will be disappointed in the outcome and then move onto an eventual knee replacement.

In research appearing in the medical journal Clinical Anatomy , doctors issued their report on a phenomenon of super-accelerated osteoarthritis in knees with meniscus tear damage and a history of surgical meniscus removal. Coming out of Tufts Medical Center in Boston, the researchers noted that knee osteoarthritis is typically a slow, progressive problem; however, in some patients knees progressed to osteoarthritis with dramatic rapidity.

However, clinicians cannot determine which patients may be at risk for accelerated knee osteoarthritis without knowing the incident structural damage that predisposes a knee to accelerated osteoarthritis.

The Tuft researchers found that structural damage that is associated with accelerated knee osteoarthritis destabilizes and compromises the function of the meniscus or compromises the subchondral bone. In an early study researchers from the Department of Orthopaedic Surgery at Carolinas Medical Center found that a damaged meniscus is the active participant in the development of knee osteoarthritis.

In the study above, the relationship to bone damage is discussed, in this cited study the Carolinas Medical team found a strong association between meniscus damage and cartilage loss.

Even the American Academy of Orthopedic Surgeons was unable to come up with evidence to support the use of partial meniscectomy. Doctors at the Hospital of Special Surgery found that meniscus removal, not only impacts the knee at the point of the surgery but throws the whole knee out of balance and leads to several points of cartilage deterioration.

What is really remarkable is that researchers write paper after paper saying that removal of meniscal tissue in surgery causes advanced osteoarthritis and the procedures continue. Clearly, the best way to prevent cartilage breakdown and knee osteoarthritis caused by meniscus surgery is to AVOID the surgery. A March study in the British Journal of Sports Medicine 29 questioned whether experienced orthopedic surgeons could predict who would benefit from surgery for degenerative meniscus tears and who would not.

The researchers set up an experiment. Surgeons participating in this study were given 20 cases to examine. In each case, the surgeon was asked to predict the outcome of treatment for meniscal tears by arthroscopic partial meniscectomy and exercise therapy in middle-aged patients.

The surgeons were also asked to predict the beneficial change in knee function in those patients they would recommend to surgery and those patients they would send to physical therapy or an exercise program.

Surgeons at the Glasgow Royal Infirmary, University Hospital Llandough and the University Hospital Wishaw in the United Kingdom published a February paper 30 in recommending to their fellow surgeons which patients with meniscus damage and osteoarthritis would be considered as good candidates for surgery.

Here is what they said:. This study assessed the risk of needing further surgery for osteoarthritis in the five years following partial meniscectomy in different age groups and different grades of knee osteoarthritis. Range of follow-up was 3 to 5 years.

Here is a positive study on the benefits of meniscus surgery 31 in middle-aged patients: In this study, doctors said that an arthroscopic partial meniscectomy is a good option for a medial meniscal tear in late middle-aged adults.

For the best success, you need a proper diagnosis and excellent surgical technique. Motion restrictions are probably not what a middle-aged patient is expecting as a result of their meniscus surgery. The meniscus has a very difficult time healing its own injuries because of a lack of vascularization to the entire meniscus.

That is the blood that carries healing elements do not reach the entire meniscus. They write: The meniscus is comprised of circumferentially aligned fibers basically a mesh that resist the tensile forces within the meniscus that develop during loading of the knee. How it does this, is that the radial tie fibers, the perpendicular mesh network of the meniscus are helping to redistribute the knee load back to the severed but still functioning circumferential fibers.

The study conclusion spells it out. Get the facts. Your options Have surgery to treat a meniscus tear. Don't have surgery. Use home treatment and physical therapy to treat your knee. Key points to remember Your decision about surgery for a torn meniscus will depend on where the tear is located, the pattern of the tear, and how big it is. Your surgeon's experience and preference, as well as your age, health, and activity level, can also affect your treatment options.

There are two kinds of surgery for a meniscus tear. One kind repairs the tear by sewing it back together. The other kind removes part or all of the meniscus. In general, it's better to fix the meniscus than to remove it. Some types of tears can't be fixed. For example, radial tears sometimes can be fixed, but it depends on where they are. But most horizontal, long-standing, and degenerative tears—those caused by years of wear and tear—can't be fixed. You may want to have surgery if your knee pain is too great or if you are unable to do daily activities.

Surgery may help you reduce the risk of other joint problems, such as osteoarthritis. There are no long-term studies to prove it, but many doctors believe that successful meniscus repair helps to evenly spread the stress placed on the knee joint.

If the knee is protected from uneven force, there is a lower risk of future joint problems. Some kinds of tears heal on their own.

Instead of surgery, you may try rest, ice, compression, and propping up your leg on a pillow when you sit or lie down. What is a meniscus tear? How is a meniscus injured or torn? What are the types of meniscus tears? How is a torn meniscus treated? With nonsurgical treatment , you use rest, ice, compression, and elevation, and you have physical therapy. You may wear a knee brace for a short time. With surgery , you can have one of the following: Surgical repair to sew the tear together.

Partial meniscectomy, which is surgery to remove the torn section of the meniscus. Total meniscectomy, which is surgery to remove the entire meniscus.

This surgery is not usually done, because it increases the risk of osteoarthritis in the knee. If you have a small tear at the outer edge of the meniscus in what doctors call the red zone , you may want to try home treatment.

These tears often heal with rest. If you have a moderate to large tear at the outer edge of the meniscus red zone , you may want to think about surgery. These kinds of tears tend to heal well after surgery. If you have a tear that spreads from the red zone into the inner two-thirds of the meniscus called the white zone , your decision is harder.

Surgery to repair these kinds of tears may not work. You may need a partial meniscectomy instead. If you have a tear in the white zone of the meniscus, repair surgery usually isn't done, because the meniscus may not heal. But partial meniscectomy may be done if torn pieces of meniscus are causing pain and swelling. How well does surgery work? In knees that have good stability.

In longitudinal tears or in radial tears that occur in the red zone. If the repair is done in the first few weeks after the injury. What can you do instead of surgery for a torn meniscus? Why might your doctor recommend surgery?

Your doctor may recommend surgery because: You still have pain after trying other treatment, such as rest and physical therapy. Your knee "locks up" instead of working normally. You may be able to reduce the risk of future joint problems osteoarthritis. You are an active person and your tear is in the red-to-white zone. Surgery can help return your knee to normal. Compare your options.

Compare Option 1 Have surgery for a torn meniscus Don't have surgery. Compare Option 2 Have surgery for a torn meniscus Don't have surgery. Have surgery for a torn meniscus Have surgery for a torn meniscus You have surgery to fix or remove the meniscus. In most cases, you will go home on the same day as the surgery. Either type of surgery is followed by rehabilitation that includes rest, walking, and doing exercises until you have full range of motion without pain.

After surgery to fix your meniscus, you must limit movement for up to 2 weeks. It may take weeks or months before you can go back to your daily activities after surgery. That means that of people who have this surgery, 85 have relief from pain and can use their knee normally, while 15 do not. Out of people who had surgery to remove part of the meniscus, 78 to 88 had relief from pain and knee problems. You may still have pain and joint stiffness after surgery.

Surgery has risks, such as: Infection. Damage to nerves or blood vessels around the knee. Blood clots in the leg. Damage to the joint. Risks from anesthesia. Your age and your health can also affect your risk. Don't have surgery Don't have surgery You try rest, ice, compression, and elevation. You try over-the-counter medicine such as ibuprofen or naproxen to help with pain and swelling. You may do exercises to build up your thigh muscles quadriceps and hamstrings and increase your flexibility.

You may be able to relieve pain and return your knee to normal. You avoid surgery that you may not need if the tear heals on its own. You avoid the risks of surgery. You can still have surgery later if your symptoms don't get better. Your tear may not heal on its own, so you may still need surgery.

You may still have pain, or your pain may get worse. You may not have full use of your knee. Personal stories about meniscus tear surgery These stories are based on information gathered from health professionals and consumers. What matters most to you? Reasons to have surgery Reasons not to have surgery. I want to do whatever I can to fix my knee. My pain isn't too bad.