Meniscectomy is a knee surgery that removes part of the meniscus when it has been damaged by trauma. In about thirty years, the technique has evolved a lot: it now takes place under arthroscopy and takes care to preserve as much as possible the healthy parts of the meniscus.

Meniscectomy, sometimes called meniscal regulation or meniscal resection, involves removing the damaged part of the meniscus. Today we only remove the injured part of the meniscus, and not the entire meniscus as was the case thirty years ago.

As a reminder, the largest joint in the body, the knee provides the junction between 3 bones: the femur (or femoral condyles), the tibia (or tibial plates) and the patella. On either side of the patella, between the femoral condyles and the tibial endplates, are the medial meniscus and the external meniscus. This crescent-shaped fibro-cartilaginous tissue plays different roles:

• a role of shock absorber;
• a role of stabilizer of the knee joint;
• a role of lubricator.

The intervention takes place under general or regional anesthesia.

The leg is immobilized and a tourniquet is placed at the top of the thigh to limit bleeding during the operation.

The operation is performed arthroscopically. This technique involves inserting an endoscope (a mini camera) into the joint through a small incision (1 cm) in order to visualize and repair it.

Once the endoscope is inserted, the joint is swollen with water. This allows the introduction of miniaturized instruments through another small incision. The surgeon opens the various compartments of the joint then proceeds to resection of the damaged part of the meniscus using forceps.

The joint is cleaned with water to remove any debris, then the incisions are sutured with non-absorbable suture.

The meniscus can be damaged:

• with aging: the fibro-cartilaginous tissue can unravel and crack over the years. These degenerative lesions of the meniscus are often indicative of early osteoarthritis of the knee (gonarthrosis);
• during a trauma (during sport in particular) or repeated micro-trauma (for example in certain professions requiring to be often kneeling or squatting) the meniscus can crack or tear. The risk increases with age, because over the years, the meniscus loses its elasticity and becomes more fragile.

The lesion can affect different areas of the meniscus: the anterior horn, the posterior horn, the middle part. It can be a vertical longitudinal crack (one speaks then of “tongue”) of one of the free edges of the meniscus, a radial crack or a horizontal crack. We speak of a bucket handle when the meniscus is cut in half and folds back on itself.

Depending on the nature and the injured area, the patient presents different clinical signs: signs of effusion, inability to fully stretch the leg, pain on hyperflexion, twisting or palpation. MRI makes it possible to accurately diagnose meniscal lesions, but also to detect lesions associated with associated lesions, in particular of the cartilage or cruciate ligaments.

Depending on the nature of the traumatic injury, the pain it causes and the age of the patient, a meniscectomy will be offered. More rarely, meniscal repair is possible (when the lesion is located on the periphery of the meniscus in particular).

On the other hand, degenerative lesions of the meniscus cannot be treated by meniscectomy.

Operative suites

The operation usually takes place on an outpatient basis: the patient can go home the same evening of the operation.

Analgesic treatment and anticoagulant treatment (to prevent the risk of phlebitis) are prescribed.

Walking is possible soon after the operation, but the use of canes can be useful during the first days. Rehabilitation sessions are prescribed to prevent edema, regain good range of motion and strengthen the quadriceps muscles.

The dressing is changed by a home nurse every 2 days and the threads are removed 15 days after the operation.

The duration of the work stoppage varies according to the nature of the professional activity. Resumption of sport is possible about 2 months after the operation.

The results

Meniscectomy removes pain and mechanical blockage in the knee joint and recovers its range of motion.

Residual pain and / or stiffness may sometimes persist after the operation, especially in cases of cartilage damage (chondropathy, osteoarthritis of the knee, injury to the cruciate ligaments). Sometimes a new meniscus fissure may occur on the remaining part, and may require a new arthroscopy.

The risk of osteoarthritis of the knee after meniscectomy is much less frequent with a partial meniscectomy than with a total meniscectomy. The total meniscectomy accelerates the wear of the cartilages of the tibia and the femur.

The risks

Meniscectomy involves some rare risks:

• the formation of a hematoma;
• an infection ;
• a sprain of the internal lateral ligament during the operation;
• algodystrophy manifested in a first phase by inflammation of the joint, then in a second step, its stiffening.
• very rarely, vasculo-nerve damage.