I perform meniscal repair as an arthroscopic procedure, improving my ability to explore all areas of the knee joint, while allowing surgical repair in a minimally invasive fashion, decreasing post-operative pain, scarring and swelling.
Meniscal Repair: Background
Arthroscopy is a common surgical procedure in which a joint (arthro-) is viewed (-scopy) using a small camera. Arthroscopy is usually done through two small incisions around the knee, through which a camera and small instruments can be inserted into the knee to feel, repair or remove damaged tissue.
Meniscus was previously thought to be largely irreparable, although with current techniques and specific surgical training our ability to repair meniscal tears has greatly increased. I use several methods to repair the meniscus, using sutures or suture anchors depending on the type of tear at hand.
Meniscal Repair: Day of Surgery
You will be admitted on the day of surgery. My assistant will provide you with the admission time and fasting details. Knee arthroscopy is generally performed as a day case, meaning you will be able to go home the same day as your surgery. The anaesthetist will see you prior to surgery, usually on the day of surgery itself, but they might contact you prior to this to discuss your medical history with you. If you have any specific questions you would like to discuss with the anaesthetist, please ask my assistant for their contact details.
Meniscal Repair: Post-Operative Care
Recovery from arthroscopic meniscal repair is much faster than recovery from traditional open knee surgery. Still, despite the small incisions used in arthroscopic surgery, the amount of surgery done within the knee is the same as a full open procedure.
You will be discharged with medications or a prescription for pain relief, and nursing staff at the hospital will be able to give you information regarding the general care of your knee.
Most often, you will be able to leave the hospital the same day as your procedure, once you have woken and recovered. If you require an overnight stay this can be arranged (eg country patients).
Most patients undergoing meniscal repair will have a supportive knee brace placed on their knee at the completion of surgery. You will require the use of crutches after your surgery, and a physiotherapist can show you how to use them if needed. Each meniscal repair is unique, and I will explain how long and often the brace and crutches are required for.
First 2 Weeks
There will be some dressings and bandages on your knee post-operatively. The bulky crepe and wool bandages can be taken off your knee at 24-48 hours post-operatively. There will be some adhesive dressings over the portal sites on the knee, these should stay on until your follow-up appointment with me at two weeks post-op. If the dressings get wet or dirty, then simply remove them and put another one on. On discharge, you will be given some Tubigrip (elastic knee support) and you can use this for the first 4-6 weeks post-operatively, or until swelling of your knee isn’t a problem. It may be removed for showering, and for icing. This elastic bandage is helpful to reduce the swelling in your knee.
Regular icing of your knee is helpful to reduce pain and swelling post-operatively. You should aim to ice your knee for 20 minutes, every 2 hours, depending on the level of swelling you have.
Physiotherapy and Exercises
Most patients undergoing meniscal repair will require a rehabilitation program in the post-operative phase which is most efficiently delivered by a sports physiotherapist or accredited exercise physiologist. Most often formal physiotherapy will be commenced after the initial two weeks following your surgery when swelling and any discomfort have subsided.
Times to return to driving vary. If you drive an automatic and your left knee is being operated on, your return to driving might be faster. However, in general, plan to avoid driving for up to 6 weeks.
My assistant will make your follow-up appointment with you at the time of booking your surgery. In general, I will see you approximately two weeks after your surgery. If you are unsure of your follow-up appointment, please call my assistant on 08 9212 4200.
You will be given pain relief during your inpatient stay and either medication or prescriptions to go home with to keep you comfortable. In general, regular paracetamol and an anti-inflammatory (if tolerated) are the mainstays of pain relief for you. You will be given some stronger medications which can be helpful in the early post-operative phases, but these can be phased out as your comfort level increases.
Meniscal Repair: Return to Work / Sport
Return to work times vary depending on the nature of your work and what was done at surgery. In general, you should plan to have 1-2 weeks off work at a minimum to allow you to manage your swelling and pain.
Return to Sport
Meniscal repair can be complex, and recovery can be lengthy. Meniscal tears are unique and recovery timeframes are therefore difficult to generalise. However, we would expect most patients can get back to sport between 3 and 6 months depending on the severity of the tear and complexity of the repair.
Meniscal Repair: Problems
Re-tear of the meniscus
The meniscus has no blood supply to the majority of it’s structure, meaning repair of the meniscus can be difficult to achieve. However, with current techniques success rates of meniscal repair are improving rapidly, allowing for meniscal preservation and more longevity with better function of the knee joint. However, retears can happen with reinjury or failure of the meniscus to heal with time. If you have any concern with your meniscal repair, please get in touch with my secretary to arrange a clinical review.
Superficial infection is not very common but can happen. It usually presents as redness and increased pain around the wound, and generally resolves with a short course of antibiotics.
Deep knee infection is rare. However, if it does happen you will need admission to hospital, with washing out of the knee and high dose intravenous antibiotics commenced immediately. It usually presents between 5-10 days post-operatively, with increased pain (rather than the general improvement in pain levels), increased swelling and marked decrease in your range of movement.
If you are concerned about an infection, please contact me as soon as possible. During business hours the best point of contact is via my assistant on 08 9212 4292. After hours, please contact the hospital where you had your surgery, and ask them to get in touch with me. Failing this, present to your local emergency department and ask them to contact me via Hollywood Hospital or Bethesda Hospital.
Other problems such as excessive pain, numbness, bleeding or clots in your legs after meniscal repair are very rare. If however you are concerned about your progress please contact my rooms and we will be able to advise you.
If you are considering having meniscal surgery on your knee, please make an appointment to discuss your treatment options.