Knee surgery for a meniscus tear

Our consultants at Parkside Orthopaedics and Sports Medicine Centre are experts at treating knee injuries. One of the most common knee injuries is a meniscus tear. This is when you damage a cushioning pad of cartilage in your knee joint. In some cases, you may need a day procedure called a meniscectomy or meniscal repair to remove or repair the torn knee cartilage.

What is the meniscus?

On each side of your knee, you have a small C-shaped pad of cartilage (strong tissue) called the meniscus. The two pads in each knee are like a cushion or shock absorber between your thighbone and shinbone. Their main purpose is to:

• absorb the impact in your knee when you walk, run or bend
• help to keep your knee joint stable
• allow your knee to move smoothly
• distribute your body weight evenly over the knee joint

What causes a meniscus tear?

Although the meniscus is a tough and flexible layer, it can be damaged through an injury or age-related wear and tear. The most common cause of a meniscus tear is twisting or rotating your knee. This may happen if you play contacts sports, such as football or rugby, or sports that involve sudden turns, such as tennis or basketball. Sometimes everyday activities, such as kneeling, squatting or lifting something heavy, can cause a meniscus tear.

If your injury is serious, you may damage other parts of your knee at the same time. For example, you may sprain or tear a band of tissue called the anterior cruciate ligament.

As you get older, the risk of tearing the meniscus increases. Wear and tear can weaken the cartilage in your knee. Minor injuries are then more likely to result in a torn meniscus.

What are the signs and symptoms of a meniscus tear?

If you tear the meniscus, you may get a popping sensation in your knee. This is usually a sign that a piece of cartilage has become loose. Other symptoms of a meniscus tear are:

• pain in the knee, especially when twisting or turning
• swelling or stiffness
• tenderness
• difficulty in straightening or extending your knee fully
• a feeling that your knee is locking in place or catching (this is called a locked knee and is caused by a piece of torn cartilage getting trapped in the knee)
• a feeling that your knee is unstable and may ‘give way’

If you have any of these symptoms or cannot move your knee in the normal way, it is important to see a healthcare professional. An untreated meniscus tear can make it hard to carry out daily activities and increase the risk of arthritis in the affected knee.

How is a meniscus tear diagnosed?

If you have injured your knee, you can have a full assessment at Parkside Orthopaedics and Sports Medicine Centre. A specialist orthopaedic consultant asks about your symptoms, medical history and any activities that could have torn the meniscus. They examine your knee, test its range of movement and watch how you walk or squat.

Your consultant may also arrange for you to have imaging tests:

X-rays: As the meniscus is made of cartilage rather than bone, X-rays cannot show a meniscus tear. However, they can help to diagnose any other possible causes of your knee pain, such as arthritis.

MRI scan: An MRI scan is the best imaging test to detect a torn meniscus. It produces detailed pictures of the soft and hard tissues in your knee.

Our Diagnostic Imaging Suite has advanced equipment. We perform high quality X-rays and scans in a comfortable environment.

Your consultant may also examine the inside of your knee joint with an arthroscope. This is a thin metal tube with a light and camera at one end (please see below for more details).

Can a meniscus tear be treated without surgery?

Your individual treatment plan depends on:

• the exact area where you have torn the meniscus
• the size of the meniscus tear
• whether you have any other knee injuries
• your age, general health and level of activity

There is a good blood supply to the outer part of the meniscus. The blood cells can help a tear in this area to heal by itself. However, there is a limited blood supply to the inner part of the meniscus. If you have a tear in this area, you are more likely to need surgery.

At first, your consultant usually recommends non-surgical treatment. This may include resting your knee, taking anti-inflammatory medicines, using an ice pack and elevating (raising) your leg. A steroid injection is often advised to help settle the inflamed and painful meniscus. Our Physiotherapy Department can teach you exercises to strengthen your knee muscles and offer gentle massage to reduce swelling and stiffness.

How is a meniscus tear treated with surgery?

If a meniscus tear does not heal with rest and treatments like physiotherapy, you may need surgery. Your consultant often recommends surgery if your knee feels locked in place when you try to move it. The aim is to remove or repair the torn pieces of cartilage, which affect your joint movement and cause your knee to lock.

We usually carry out a minimally invasive procedure called a knee arthroscopy to treat a meniscus tear. This is a type of keyhole surgery and you do not normally need to stay in hospital overnight. We have a £2.7 million refurbished Day Unit with 12 private pods specially designed for patients having day surgery. In most cases, you have a general anaesthetic. This means that you are asleep during the procedure and do not feel any pain.

Your surgeon makes two or three small cuts around your knee. They fill your knee joint with a sterile liquid to make it bigger and easier to see. Your surgeon then inserts the long, thin tube with a light and camera called an arthroscope and other fine surgical instruments.

The camera sends pictures of the inside of your knee joint to a computer screen. Your surgeon can then examine the meniscus tear in detail. If the tear is in the outer part of the meniscus, it may be possible to stitch together the torn cartilage. This is called meniscal repair.

Most tears are to the inner part of the meniscus, where there is no blood supply to help them heal. In that case, your surgeon removes the torn cartilage with small instruments. This is called a meniscectomy and there are two possible procedures:

• Partial meniscectomy: This is the most common procedure, where your surgeon removes the torn part of the meniscus only. They leave the rest of the meniscus in place and make the edges smooth. The cartilage can then continue to cushion your knee bones.

• Total meniscectomy: In rare cases, your surgeon may remove the whole damaged meniscus. This is only done when necessary because the cartilage reduces the stress on your knee. Removing all the cartilage may increase the long-term risk of arthritis.

If you have torn your anterior cruciate ligament, this is usually replaced with a piece of suitable tissue during the same procedure. We often use one of four hamstring tendons (strong bands of tissue) at the back of your knee.

Your surgeon rinses any loose particles from your knee joint. They close the small cuts with special tape or stitches and put a bandage on your knee.

What happens after a meniscectomy procedure to remove torn knee cartilage?

After the procedure, you recover in our modern and comfortable Day Unit. Our expert team look after you and give you any pain relief that you need.

When you have recovered from the anaesthetic, a physiotherapist helps you to start moving. You may need crutches or a walking frame for a few days. Your physiotherapist explains how to use them and teaches you gentle exercises. These exercises help you to regain strength, stability and a full range of movement in your knee.

You can usually go home on the same day. Before your leave the hospital, we give you practical advice on taking care of your knee. You need to keep your wounds clean and dry until they have healed. It is also important to elevate (raise) your leg as much as possible. Our pharmacy gives you any painkillers or other medicines that your consultant has prescribed.

If you have a partial or total meniscectomy, it normally takes between two and six weeks to make a full recovery. The recovery process is different if your meniscus is repaired and can take about three months. We explain when it is safe to return to work or other activities and arrange a follow-up appointment with your consultant. Our nurses are available 24 hours a day to deal with any concerns or questions.

Book now

If you injure your knee and tear the meniscus, Parkside Orthopaedic and Sports Medicine Centre provides first-class independent healthcare.

We offer an all-inclusive price package for keyhole surgery to remove torn knee cartilage (an arthroscopic meniscectomy). This package starts from £2,705. Terms and conditions apply. For more information about prices, please call 020 3925 1062.

To make an appointment at Parkside Orthopaedics and Sports Medicine Centre, please call 020 3944 0568 or complete this form online. Appointments are available six days a week.