Meniscal_Surgery - uszkodzenia i leczenie łąkotek.pdf - ● ortopedia i traumatologia - Jacek-Paulina

A Patient’s Guide to

Meniscal Surgery

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the advice of your health care provider because of any information you read in this booklet.

A Patient's Guide to Meniscal Surgery

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A Patient's Guide to Meniscal Surgery

Introduction

The menisci (plural for meniscus) protect

the articular cartilage on the surfaces of the

thighbone ( femur

The meniscus is very important to the

long-term health of the knee. In the past,

surgeons would simply take out part or

all of an injured meniscus. But today’s

surgeons know that removing the meniscus

can lead to early knee arthritis. Whenever

possible, they try to repair the tear. If

the damaged area must be removed, care

is taken during surgery to protect the

surrounding healthy tissue.

femur tibia ).

Articular cartilage is the smooth, slippery

material that covers the ends of the bones that

make up the knee joint. The articular cartilage

allows the joint surfaces to slide against one

another without damage to either surface.

femur ) and the shinbone (

This guide will help you understand

• what parts of the knee are treated

during meniscal surgery

• what operations are used to treat a

damaged meniscus

• what to expect before and after

meniscal surgery

Anatomy

Most of the meniscus is avascular , meaning

no blood vessels go to it. Only its outer rim

gets a small supply of blood. Doctors call this

area the red zone . The ends of a few vessels

in the red zone may actually travel inward to

the middle section, the red-white zone . The

inner portion of the meniscus, closest to the

center of the knee, is called the white zone . It

has no blood vessels at all. Although a tear in

the outer rim has a good chance of healing,

damage further in toward the center of the

meniscus will not heal on its own.

What parts of the knee are involved?

There is one meniscus on each side of the knee

joint. The C-shaped medial meniscus is on the

inside part of the knee, closest to your other

knee. ( Medial means closer to the middle of

the body.) The U-shaped lateral meniscus is on

the outer half of the knee joint. ( Lateral means

further out from the center of the body.)

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thighbone ( femur

thighbone ( ) and the shinbone (

A Patient's Guide to Meniscal Surgery

Surgeons aim to save the meniscus. If an

injured part must be removed, only the

smallest amount of the meniscus is taken out.

Preserving the nearby areas of the meniscus is

vital for keeping the knee healthy. If a tear can

possibly be repaired, surgeons will recommend

a meniscal repair.

©MMG 2003

A torn meniscus may cause symptoms of pain

and swelling and sometimes catching and

locking. The goal of surgery is to take these

symptoms away. When the knee locks and you

have to tug on it to get it moving, a small flap

from a meniscal tear may have developed. The

flap may be getting caught in the knee joint as

Rationale

What does my surgeon hope to accomplish?

The meniscus is a pad of cartilage that acts

like a shock absorber to protect the knee.

The meniscus is also vital for knee stability.

When the meniscus is damaged or is surgically

removed, the knee joint can become loose, or

unstable. Without the protection and stability

of a healthy meniscus, the surfaces of the knee

can suffer wear and tear, leading to a condition

called osteoarthritis .

you bend it. Or a small piece of the meniscus

could actually be floating around inside the

joint. This fragment, called a loose body , can

get lodged between the moving parts of the

knee, causing the knee to lock. In these cases,

surgery may be needed, sometimes right away,

to fix the flap or to remove the loose body.

Most tears of the meniscus do not heal on their

own. A small tear in the outer rim (the red

zone) has a good chance of healing. However,

tears in the inner part of the meniscus often

require surgery. When tears in this area are

causing symptoms, they tend to get bigger.

This puts the articular cartilage on the surfaces

of the knee joint at risk of injury.

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A Patient's Guide to Meniscal Surgery

Only when the majority of the meniscus is

damaged beyond repair is the entire meniscus

removed. Surgeons are experimenting with

solutions to replace the meniscus.

Before surgery you will be placed under either

general anesthesia or a type of spinal anes-

thesia. The surgeon begins the operation by

making two or three small openings into the

knee, called portals . These portals are where

the arthroscope and surgical instruments are

placed inside the knee. Care is taken to protect

the nearby nerves and blood vessels.

Preparations

What do I need to know before surgery?

You and your surgeon should make the

decision to proceed with surgery together.

You need to understand as much about the

procedure as possible. If you have concerns or

questions, be sure and talk to your surgeon.

Partial Meniscectomy

The procedure to carefully remove a damaged

portion of the meniscus is called partial menis-

cectomy. The surgeon starts by inserting the

arthroscope into one of the portals. A probe

is placed into another portal. The surgeon

watches on a screen while probing the

meniscus. All parts of the inside of the knee

joint are examined. When a meniscal tear is

found, the surgeon determines the type and

location of the tear.

Once you decide on surgery, you need to take

several steps. Your surgeon may suggest a

complete physical examination by your regular

doctor. This exam helps ensure that you are

in the best possible condition to undergo the

operation.

You may also need to spend time with the

physical therapist who will be managing your

rehabilitation after surgery. This allows you to

get a head start on your recovery. One purpose

of this preoperative visit is to record a baseline

of information. The therapist will check your

current pain levels, ability to do your activities,

and the movement and strength of each knee.

Surgical instruments are placed into another

portal and are used to remove the torn portion

of meniscus.

A second purpose of the preoperative visit is

to prepare you for surgery. The therapist will

teach you how to walk safely using crutches or

a walker. And you’ll begin learning some of

the exercises you’ll use during your recovery.

On the day of your surgery, you will probably

be admitted for surgery early in the morning.

You shouldn’t eat or drink anything after

midnight the night before.

When the problem part of the meniscus has

been removed, the surgeon checks the knee

again with the probe to be sure no other tears

are present. A small motorized cutter is used

to trim and shape the cut edge of the meniscus.

The joint is flushed with sterile saline to

wash away debris from the injury or from the

surgery. The portals are closed with sutures.

Surgical Procedure

What happens during meniscal surgery?

Meniscal surgery is done using an arthroscope ,

a small fiber-optic TV camera that is used to

see and operate inside the joint. Only small

incisions are needed during arthroscopy. The

surgeon does not need to open the knee joint.

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