Meniscectomy & Meniscus Repair
Knee arthroscopy is a surgical procedure that allows Dr. Sherfey and Dr. Antebi to examine, diagnose, and repair the inside of a the knee without making a large incision through the skin. A small camera is inserted in the knee joint called an arthroscope. The camera displays pictures on a video monitor, and your surgeon uses these images to guide surgical instruments. This results in less pain for patients, less joint stiffness, and often shortens the time it takes to recover and return to activities.
Knee arthroscopy will be recommend if you have a painful condition that does not respond to nonsurgical treatment. Knee arthroscopy may relieve painful symptoms of problems that damage the cartilage surfaces and other soft tissues surrounding the joint. Common arthroscopic procedures for the knee include: Removal or repair of a torn meniscus, Reconstruction of a torn anterior cruciate ligament, Removal of inflamed synovial tissue, Trimming of damaged articular cartilage, and Removal of loose fragments of bone or cartilage.
A meniscus tear is a common knee joint injury. The meniscus is a rubbery, flexible piece of cartilage that provides cushioning between the bones in the knee. Meniscectomy is the surgical removal of all or part of a torn meniscus. In many cases Dr. Antebi & Dr. Sherfey will make their final surgical decisions during surgery, when they can see how strong the meniscus is, where the tear is, the pattern of the tear, and how big the tear is. If a meniscus tear is causing pain or swelling, typically the torn part of the meniscus needs to be removed and the edges surgically shaved to make the remaining meniscus smooth. Your surgeon will try to preserve as much meniscal tissue as possible to
prevent long-term degeneration of your knee and allow you to return to full activities.
How is it Performed?
Knee Arthroscopy is an outpatient procedure that requires only small incisions,
so tissue damage is minimized and recovery time is faster.
During surgery local anesthetic is injected into the knee to reduce the amount of pain you will feel.
- Several small (about 1 cm each) incisions are made around the knee.
- A thin tube (arthroscope) containing a camera and light is inserted through small incisions near the joint. Surgical instruments are inserted through other small incisions to allow special instruments, including a fiber-optic camera, to be placed into your knee.
- Dr. Sherfey or Dr. Antebi will probe the inside of the knee. At this time he will be able to identify the area(s) of damaged meniscus and other knee problems that might not have been apparent from previous medical imaging, such as an MRI.
- Use special tools to smooth some of the edges of the damaged meniscus. Your surgeon may also smooth nearby articular cartilage and remove any damaged pieces.
- Stitch together the torn pieces of meniscal tissue.
- Suction out any pieces of free-floating cartilage or other tissues from the knee capsule.
- Once the procedure is completed, the arthroscope is removed and the incisions are sutured closed. A sterile dressing is placed over the incision and an ACE wrap may be placed around the joint.
The surgical procedure takes 20 to 30 minutes.
After surgery, you will be moved to a recovery room monitored by nurses where you will remain while you recover from the anesthesia. You will go home within a few hours after surgery.
Preparing for Surgery
FOLLOW ALL PRE-OPERATIVE INSTRUCTIONS
given to you by Dr. Antebi and Dr. Sherfey.
- Stop all Aspirin, blood thinners, and anti-inflammatory medications (Motrin, Aleve) 10 days prior to surgery as they can cause bleeding during surgery. DO NOT STOP your blood thinners without consulting your primary care physician first.
- Stop any naturopathic or herbal medication 10 days prior to surgery as these can also cause bleeding.
- Continue with all other medications unless otherwise specified.
- Bring a list of ALL medication with you on the day of surgery to give to the anesthesiologist.
- You are advised to STOP SMOKING for as long as possible prior to surgery.
REALISTIC EXPECTATIONS: An important factor in deciding whether to have surgery is understanding what the procedure can and cannot do. More than 95% of people who have surgery experience a dramatic reduction of pain and a significant improvement in the ability to perform common activities of daily living. However, surgery will not allow you to do more than you could before you developed the injury.
MEDICAL EVALUATION: Your surgeon may ask you to schedule a complete physical examination with your primary care physician before the operation especially if you preexisting medical conditions. This is needed to make sure you are healthy enough to have the surgery and complete the recovery process. Many patients with chronic medical conditions, like heart disease, may also be evaluated by a specialist, such as a cardiologist, before the surgery.
TEST: Several tests, such as blood and urine samples, and an electrocardiogram, may be needed to help Dr. Sherfey and Dr. Antebi plan your surgery.
MEDICATIONS: Tell your surgeon about the medications you are taking. He will tell you which medications you should stop taking and which you should continue to take before surgery.
SOCIAL PLANNING: Although you will be able to walk on crutches or a walker soon after surgery, you may need help for several weeks with such tasks as cooking, shopping, bathing, and doing laundry.
Patients go home the same day following surgery.
YOUR RECOVERY at HOME: The success of your surgery will depend largely on how well you follow your surgeon’s specific instructions at home during the first few weeks after surgery. You may be able to bear weight on your knee, but you may need to use crutches for the first few days for support. Elevate your leg on pillows several times a day to help reduce swelling. Do not place a heat pad on your knee. It is important to have a balanced diet (often with an iron supplement) to promote proper tissue healing and restore muscle strength. Drink plenty of Water!
PAIN: Surgery pain is a common concern for most patients. Dr. Antebi and Dr. Sherfey utilize advanced techniques in treating post operative pain. This includes medications given prior, during and after your surgery. After your surgery, you may experience a minimal amount of pain. Your surgeon will provide medication to make you feel as comfortable as possible. Ice packs should be used regularly to reduce swelling and pain
WOUND CARE: You will go home with a dressing and ace bandage around your knee. You can remove your dressing 3-5 days after surgery. Until then, keep bandage clean and dry. You can shower once your dressing is removed and wash the wound with soap and water. Be sure to dry the
area well. Your stitches will be removed at your post op appointment. You may need to wear compression/support stockings for a couple of weeks to help prevent blood clots.
ACTIVITY & EXERCISE: Mobility is key in recovering, you are encouraged to bend and straighten your knee as much as pain allows immediately after standard knee arthroscopy. Remember, however, that your knee may be swollen and full motion may be difficult for the first few days. You should be able to resume most normal activities of daily living within 2 weeks following surgery, but recovery times for meniscal repair surgery vary greatly depend on the severity of the meniscal tear and whether another procedure was done during surgery.
Dr. Sherfey or Dr. Antebi will give you your specific instructions depending on the severity of your surgery. A reduction of pain and swelling and improvement in strength, motion, and coordination will continue for three to four months after surgery. Some pain with activity and at night is common for several weeks after surgery.
You will most likely be able to resume driving when your knee bends enough that you can enter and sit comfortably in your car, and when your muscle control provides adequate reaction time for braking and acceleration. Most people resume driving approximately 1 to 3 weeks after surgery.
TIME OFF WORK: Depends on your work requirements. Office workers usually require 1 weeks off and manual laborers 4-6 weeks off depending on activity of your job.
PREVENTING PNEUMONIA: It is common for patients to have shallow breathing in the early postoperative period. This is usually due to the effects of anesthesia, pain medications, and increased time spent in bed. This shallow breathing can lead to a partial collapse of the lungs (termed “atelectasis”) which can make patients susceptible to pneumonia. To help prevent this, it is important to take frequent deep breaths.
HOME PLANNING: Avoid Falls after surgery, it may result in a need for further surgery. Stairs are a particular hazard until your knee is strong and mobile. You should use a cane, crutches, walker, hand rails, or have someone to help you until you have improved your balance, flexibility, and strength.
POSSIBLE COMPLICATIONS OF SURGERY
Your knee needs time to heal, so be patient. Do not rush the recovery process.
INFECTION: It is important to follow your surgeons instructions carefully and make sure you are not pushing yourself too fast or too soon. Monitor your knee for signs of infections. Although the risk of infection is extremely low, it may occur. Minor superficial wound infections are generally treated with wound cleansing and antibiotics.
PREVENTING INFECTION: Keeping your wound clean with antibacterial soap and water is crucial in preventing infection. A common cause of infection following surgery is from bacteria that enter the bloodstream during dental procedures, urinary tract infections, or skin infections. Your surgeon will discuss with you whether taking preventive antibiotics before dental procedures is needed in your
Warning signs of infection. Notify AVORS immediately if you develop any of the following:
- Persistent fever (higher than 101°F orally), shaking, or chills.
- Excessive blood soaking through dressing or discharge coming from your incision.
- Increasing pain or swelling in your calf.
BLOOD CLOTS: Blood clots in veins are one of the most common complications of surgery. These clots can be life-threatening if they break free and travel to your lungs.
PREVENTING BLOOD CLOTS: Follow your surgeons instructions carefully to reduce the risk of blood
clots developing during the first several weeks of your recovery. Notify your surgeon if you develop any
of the following:
Warning signs of blood clots in leg:
- Increasing pain in your calf
- Tenderness or redness above or below your knee
- New or increasing swelling in your calf, ankle, and foot
Warning Signs of PULMONARY EMBOLISM: if these occur go to the ER or call 911
Sudden Shortness of Breath or Sudden onset of Chest Pain or Localized Chest Pain & Coughing
PAIN: A small number of patients continue to have pain after surgery. However, this complication is rare and the vast majority of patients experience excellent pain relief following surgery.
PAIN MANAGEMENT: After surgery, you will feel some mild pain. This is a natural part of the healing process. Your surgeon and nurses will work to reduce your pain. Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your surgeon may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.
NEUROVASCULAR INJURY: Although rare, injury to the nerves or blood vessels can occur duringsurgery.