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The meniscus is a cartilaginous structure located in the knee joint. Its main functions are cushioning and additional strengthening of the joint. In total, there are two menisci in each knee joint, lateral and internal. Damage to these cartilages is fraught with serious impairment of the motor function of the joint.
The situation is complicated by the fact that the blood supply to the menisci is very poor. The arteries penetrating the cartilage extend only a few millimeters in it. As a result, meniscal injuries are a fairly common situation. They can be the result of an injury or occur as a result of arthrosis, specific inflammation in the joint, for example, provoked by syphilis or tuberculosis, as well as a purulent inflammatory process.
The nature and symptoms of meniscus injury
The meniscus is characterized by several types of damage: longitudinal or transverse rupture; separation; compression and loss of stability. The outer meniscus, due to its greater mobility, often suffers from compression. The inner cartilage plate is prone to tearing.
The meniscus can fail if it is subjected to regular and prolonged stress. The cartilage is deformed and eventually replaced by scar tissue, which, of course, can no longer perform the functions that the meniscus performs in a normal situation. Due to the ongoing loads, the integrity of the cartilage that has undergone pathological changes is violated.
The evidence that a meniscus injury has occurred is the loss of the ability to move quickly and actively. When moving in the knee joint, distinct “clicks” are heard, pain is felt. Particularly difficult in case of damage to the meniscus is to overcome the steps – moreover, both ascent and descent. In addition, the diseased joint may swell, the skin over it reddens and becomes hot.
In the event that a partial or complete destruction of the meniscus has occurred, a procedure for removing this cartilage, a meniscectomy, may be prescribed.
When is a meniscectomy performed?
The choice of a repair method for a meniscus that has been damaged depends on how serious the destruction is and in what zone the damaged area is located.
So, for example, surgical intervention can be dispensed with if the ruptures are insignificant and are located in the so-called “red zone” – in other words, in that part of the cartilage where a few vessels are located. The operation is carried out only under the condition that the damage is very significant, and healing does not occur for a long time.
If the injured area is in the “white zone”, where there are practically no blood vessels, then it makes no sense to stitch the meniscus, and you should not count on its healing “naturally”. In this case, doctors recommend a meniscectomy.
In addition, it is necessary to remove the meniscus if there is a separation of the cartilage from the body of the joint, as well as when a piece of the meniscus is completely torn off. In the event that surgical intervention is not carried out, the so-called “joint blockade” develops. The patient experiences acute pain, and the knee completely loses the ability to move.
In most cases, specialists try to remove only part of the meniscus. However, if the cartilage is completely shattered or the lesions are multiple, a complete meniscectomy must be resorted to.
In addition, complete removal is recommended for elderly patients, even if the damage is minor. Finally, the meniscus is completely removed before transplantation.
Types of meniscectomy
Removal of the meniscus can take place in two ways: open and closed.
An open meniscectomy involves opening the joint during surgery. It is more traumatic, and patients after it recover longer. In addition, the likelihood of complications is much higher.
As a rule, now they try not to do an open operation. Use it only to remove significant parts of the meniscus.
Surgical intervention involves the implementation of oblique incisions. The surgeon gradually dissects the skin, subcutaneous tissue, and ligaments of the patella, after which he opens the joint in layers, using special tweezers, lifting and opening the synovial membrane. The incision is stretched and fixed with special hooks to provide a good view of the meniscus.
At the initial stage, the anterior horn of the cartilage is cut off with a scalpel, after which it is cut off in the region of the posterior attachment of the meniscus. In the event that the meniscus is partially removed, after excision of the fragments, the edges are aligned, and then all the tissues of the joint are sutured in layers.
As noted above, this procedure is considered severe, extremely painful for the patient and requires a long period of rehabilitation. Therefore, the arthroscopic method of meniscectomy is much more widely used today. This procedure is carried out using a special device – an arthroscope.
Benefits of Arthroscopic Meniscectomy
Closed or arthroscopic meniscectomy has a number of undeniable advantages:
- This method is less traumatic.
- The patient does not need to stay in the hospital for a long time.
- With a closed operation, the risk of complications is significantly reduced.
- The patient needs much less time to recover.
- After the operation, there is no unaesthetic scar, which is important in cosmetic terms.
- The price is more affordable than the cost of open surgery.
Due to all these factors, this method is used more often, especially if it is necessary to carry out a partial rather than complete removal of the meniscus.
Contraindications to the procedure
Like any other surgical intervention, arthroscopic meniscectomy has a list of contraindications. In some cases, this operation should be postponed, and in some situations it is not allowed at all.
Thus, meniscectomy is excluded if the patient’s health condition does not allow the use of anesthesia and anesthesia, as well as in case of individual intolerance to drugs that will be used before, immediately during or after the intervention.
Contraindication is a number of acute and chronic diseases. So, intervention is excluded for heart failure and coronary disease, if the patient suffers from arrhythmia or high blood pressure. Meniscectomy is not recommended for patients with varicose veins and thrombosis.
Relative obstacles to intervention are problems of the respiratory system: bronchial asthma, chronic bronchitis. It is not necessary to operate on patients with emphysema, as well as with diagnosed respiratory failure.
Surgery is not recommended for patients with chronic renal failure, chronic pyelonephritis. Care should be taken to intervene in patients with cirrhosis of the liver, liver failure.
Anemia, leukemia, and reduced blood clotting are considered contraindications for arthroscopic meniscectomy. The operation is not performed on patients with severe obesity, diabetes mellitus and a history of cancer.
There are also a number of joint diseases in which arthroscopic meniscectomy is not performed, in particular, with fibrous and bone ankylosis, adhesions and joint contracture.
Pain relief methods
The method of anesthesia that will be used during the operation is selected by the anesthetist purely individually, based on the results of the examination that is performed before the intervention.
It should be noted that one of four methods of pain relief can be used for arthroscopic meniscectomy.
Local anesthesia
The indisputable advantage of this method is the fact that such anesthesia is quite simple and relatively safe. Moreover, when using it, the presence of an anesthesiologist during the operation is not required. At the same time, local anesthesia has its drawbacks. First of all, it is not suitable for surgery that requires a long time. In addition, when performing intra-articular manipulations, the process is more difficult due to the presence of a large amount of anesthetic in the joint. Finally, the patient may experience some inconvenience due to the fact that a tourniquet will be applied to the thigh. In connection with all of the above, physicians use local anesthesia for arthroscopic removal of the meniscus only in some cases.
Conduction anesthesia
Sometimes blockade with lidocaine solution is used. The substance effectively blocks the sciatic, femoral and external nerves. The action of such anesthesia lasts about an hour and a half.
Epidural anesthesia
An effective method is epidural anesthesia, which involves the introduction of drugs into the spinal canals. At the same time, the doctor maintains visual and verbal contact with the patient.
General anesthesia
The main advantage of this method is that it makes it possible to completely eliminate discomfort for the patient and regulate the duration of manipulations. However, an anesthesiologist must be present during surgery. In addition, general anesthesia is associated with a certain risk for the patient.
Preparation and conduct of the operation
Before the operation, the patient must undergo all the necessary examinations, including a consultation with a general practitioner and an anesthesiologist who chooses the type of anesthesia. About a week before surgery, you should definitely stop taking blood thinners.
The operation is performed in the supine position. The patient is placed on his back on the operating table, his leg is placed on a special stand. A tourniquet is applied to the thigh to temporarily restrict blood flow.
Arthroscopic meniscectomy is performed using an arthroscope. This is a special device with three tubes, each of which has its own purpose. First of all, the doctor makes a microscopic incision, not exceeding half a centimeter in length, and inserts a tube with a mini-camera equipped with a backlight into the joint. This device allows you to fully visualize the course of the surgical intervention, transmitting an enlarged image to the monitor.
The doctor then makes two more incisions and inserts the remaining two tubes. The second tube is used to supply saline. It is used to flush the joint cavity, and in addition, it helps to improve visibility so that the surgeon can control his every move.
The third tube is used to introduce specific instruments into the joint, with the help of which the meniscus fragments are removed. After all the manipulations are completed, the doctor removes the equipment from the joint, and treats the puncture sites with an antiseptic and applies a sterile bandage. The tourniquet is removed from the patient’s thigh.
As a rule, the duration of arthroscopic meniscectomy does not exceed one hour.
In the event that the meniscus has been removed by more than fifty percent, it can be replaced with an artificial or biological (from a donor) implant, which is implanted in place of the missing part.
Postoperative period and complications
As a rule, after a meniscectomy, the patient spends two to three days in the clinic. The next day after the operation, the doctor makes a puncture in the joint area to remove blood and accumulated joint fluid. Painkillers are prescribed as needed.
Ice compresses and an elastic bandage should be used for 48-72 hours after surgery. While in bed, the injured limb should be moved and periodically raised.
The patient is allowed to walk with incomplete support on the injured limb one day after the operation.
On the second day after surgery, the patient should begin to perform special gentle exercises that are designed to help restore the functionality of the knee joint. It is also mandatory to take medications that help relieve pain, improve blood circulation and remove inflammation and swelling.
Full recovery after a meniscectomy will take several months. It will speed up the process of performing the gymnastic exercises recommended by the doctor.
If we talk about the complications that the removal of the meniscus is fraught with, then we should mention the possibility of a protracted pain syndrome and the formation of blood clots. It is also impossible to exclude the possibility of hemorrhage into the joint and serious swelling. To avoid this, you should follow all the doctor’s instructions.
The cause for alarm is pain that does not go away even when taking painkillers, swelling of the joint, bleeding from surgical wounds, fever.