Knee arthroscopy or keyhole surgery of the knee joint, is a very commonly performed operation. It may be used to:
The meniscus is a special type of cartilage within the knee. It acts to distribute load and force within the joint. The meniscus also has a role in providing stability to the joint. There is a medial (inner knee) meniscus and a lateral (outer knee) meniscus. The medial meniscus is a more fixed structure and is more commonly injured than the lateral meniscus.
Very broadly speaking meniscal tears can be traumatic or degenerative.
Degenerate meniscal tears are common and are a normal part of the ageing process. The same type of collagen that is in our skin is in the meniscus and just as we look older as the years progress our meniscus undergoes degenerative changes over time.
Degenerative tears in those over the age of 60 should be thought of as normal. These tears may not be associated with a specific event, are not particularly painful and do not cause the catching or locking that occurs with traumatic tears. For these types of tears there is a body of evidence suggesting that the results of an arthroscopic debridement or removal of the tear are no better, and in fact may be worse, than no surgery. This position is supported by the Australian Orthopaedic Association and was the subject of a recent expose on the television. For these types of tears we would recommend a prolonged period of non-surgical management and potentially an injection into the knee combined with physiotherapy.
Traumatic meniscal tears are associated with a specific event that you will remember. Typically these types of injury are associated with a twisting event with a flexed knee. They will be painful for a period of days to weeks and will be associated with swelling in the knee. You may feel a click or catch in the knee. Occasionally the knee may lock where it gets stuck in one position and is painful, or you cannot fully straighten the knee. You may have a sense of instability in the knee.
For traumatic tears the surgical options are removal of the torn portion of the meniscus or repair of the torn meniscus. The decision to repair is based on:
If a tear is removed you are able to walk on the knee immediately after the procedure and return to work and sports within a timeframe measured in weeks.
If a tear is repaired you will need to be on crutches for 6 weeks and will be wearing a brace for this period. You will not be able to return to manual work with repetitive bending or squatting for a period of 3 months and will not be able to return to pivoting sports for 4-6 months.
The recovery from a standard knee arthroscopy (such as removal of a meniscus tear or a loose fragment) takes approximately 4-6 weeks. The first 7-10 days will be the most painful. During this period, while the wounds are still healing, we prefer you take things quietly and allow the knee to settle. If you try and pursue your regular activities too quickly, the knee may remain swollen and sore for a longer period. You should slowly build up your walking distance as the pain settles. We do not encourage running or returning to pivoting sports for 6 weeks after the surgery.
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Sunshine Coast University Private Hospital
Suite 12, 3 Doherty Street, Birtinya, QLD, 4575