Meniscus Surgery

When it is worth considering

Not every meniscus tear needs an operation, and not every meniscus tear found on a scan is even the reason for the pain. A traumatic tear in a younger knee, from a twist or a sports injury, behaves differently from a degenerate tear that appears gradually in an older knee with no clear injury at all; the second kind often settles with physiotherapy and time, the way most knee pain does.

Surgery tends to be considered when:

• The knee catches, clicks painfully, or locks and will not fully straighten
• Joint line pain has not settled after a proper trial of physiotherapy
• The tear pattern on MRI is one that is unlikely to heal on its own
• It is found alongside a torn ACL, where it is usually dealt with in the same operation
• Swelling keeps recurring, tied to a specific movement or position

A degenerate tear in an older, arthritic knee is a different picture again, and surgery there often adds little; that is worth being told plainly rather than operated on by default.

Repair or trim: how that gets decided

The outer third of the meniscus has its own blood supply and can heal if it is stitched back together, which is why a tear there in a younger patient is usually repaired rather than removed: keeping the tissue matters for the knee's long-term health. The inner two-thirds has almost no blood supply of its own and will not heal even if stitched, so a tear confined there, or one too degenerate or complex to hold sutures, is trimmed back to a stable rim instead, removing only the torn, unstable fragment and leaving the rest alone.

Which of the two applies is not always obvious from an MRI, and the final call is often made once the tear is actually seen through the camera. You will usually be told beforehand which is more likely, but the operation itself is what confirms it.

What the operation involves

It is done arthroscopically, through two small incisions, one for the camera and one for the instruments, under spinal or general anaesthesia. A straightforward trim typically takes twenty to forty minutes; a repair takes longer, because placing and tensioning the sutures is a slower, more deliberate step than removing tissue.

It is almost always a day case. Where an ACL is being reconstructed at the same time, the meniscus is dealt with in that same sitting.

Dr. Khanna trained in knee and shoulder arthroscopy at Golden Clinics & Hospital, Chandigarh.

Recovery, and why it depends on which was done

This is the one place a trim and a repair genuinely diverge, because a trim removes tissue that never has to heal, while a repair depends on stitched tissue knitting back together.

After a trim:

• Days 1 to 3. Walking with full weight as pain allows, often with a stick for the first day or two.
• Week 1 to 2. Swelling settling, bending returning, usually back to desk work.
• Week 3 to 6. Return to most activity; running and sport once strength and swelling allow.

After a repair:

• Week 0 to 4 to 6. Protected weight-bearing, often on crutches, and sometimes a brace limiting how far the knee bends, to keep the repair still while it heals.
• Week 6 to 12. Weight and movement progressed as the repair is judged to have healed.
• Month 4 to 6. Return to pivoting sport, once strength and control testing allow it.

The physiotherapy after a repair matters as much as it does after any tendon or ligament surgery: the tissue is vulnerable until it has properly healed, and rushing it is the main way a repair fails.

What it will not do

Trimming a torn meniscus relieves the mechanical symptoms, the catching, locking and joint line pain, but it does not add cushioning back to the knee, and removing meniscus tissue is a real, if gradual, contributor to arthritis developing later. Repair avoids that trade-off when it is possible, which is part of why it is preferred whenever the tear allows it.

Neither operation treats arthritis that is already there. A knee with established wear alongside the tear needs that wear addressed in its own right, not a meniscus trim on its own.

Risks worth knowing about

Infection, stiffness, blood clots and numbness near the small portal incisions are the general risks, and are uncommon. The risk specific to a repair is the stitched tissue failing to heal or re-tearing, which is more likely in a degenerate tear and is discussed honestly beforehand rather than after.

Common questions