Knee
Meniscus Surgery
The meniscus is a C-shaped pad of cartilage between the thigh bone and shin bone, one on each side of the knee, that cushions the joint and helps it move smoothly. Some tears can be stitched back together; others can only be trimmed back to a stable rim. Both are done arthroscopically, through keyhole incisions. Which one you need depends on where the tear is and what shape it is.
By appointment only, at Kharar (Mohali) or Solan. Your confirmation says which.
When to consider it
Not every meniscus tear needs an operation, and a tear found on a scan is not always the cause of the pain. A tear from a twist or a sports injury in a younger knee behaves differently from a degenerate tear that comes on gradually in an older knee with no clear injury. The second kind often settles with physiotherapy and time, as most knee pain does.
Surgery is usually 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 coming back, tied to a specific movement or position
A degenerate tear in an older, arthritic knee is different again. Surgery there often adds little, and you should be told so plainly instead of being 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. So a tear there in a younger patient is usually repaired, because keeping the tissue matters for the knee in the long run. The inner two-thirds has almost no blood supply and will not heal even if stitched. A tear confined to that part, or one too degenerate or complex to hold stitches, is trimmed back to a stable rim instead. Only the torn, unstable fragment is removed; the rest is left alone.
An MRI does not always make the choice clear, and the final call is often made once the tear is seen through the camera. You will usually be told beforehand which is more likely, but only the operation confirms it.
What the operation involves
It is done arthroscopically under spinal or general anaesthesia, through two small incisions: one for the camera, one for the instruments. A straightforward trim normally takes twenty to forty minutes. A repair takes longer, because placing and tensioning each stitch is slower, more careful work than removing tissue.
It is almost always a day case. If an ACL is being reconstructed at the same time, the meniscus is dealt with in the same sitting.
Dr. Ishan Khanna trained in knee and shoulder arthroscopy at Golden Clinics & Hospital, Chandigarh.
Recovery, and why it depends on which was done
This is where a trim and a repair differ most. A trim takes away the torn piece, so nothing has to heal. 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.
Physiotherapy after a repair matters as much as after any tendon or ligament surgery. The tissue is vulnerable until it has properly healed, and rushing 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). It does not put cushioning back into the knee, and losing meniscus tissue does add, gradually, to the chance of arthritis developing later. A repair avoids that, and it is part of the reason repair is preferred whenever the tear allows it.
Neither operation treats arthritis that is already there. If the knee has established wear as well as the tear, the wear needs treating in its own right. A meniscus trim on its own will not deal with it.
Risks
The general risks are infection, stiffness, blood clots and numbness near the small portal incisions, and all of them are uncommon. The risk specific to a repair is the stitched tissue failing to heal or tearing again. This is more likely in a degenerate tear, and it is discussed with you before the operation.
Common questions
Will the whole meniscus be removed?
No. The aim is always to keep as much healthy meniscus as possible, because it is what cushions the joint. Only the torn, unstable part is trimmed away; the rest is left where it is.
How long will I need crutches?
After a trim, often none at all, or only for a day or two. After a repair, it is closer to four to six weeks of protected weight-bearing, because the stitched tissue needs time to knit before it can take full load.
Can a repaired meniscus tear again?
Yes, and it is more likely with older, more degenerate tissue than with a clean tear from an injury in a younger knee. That risk is part of deciding whether to repair or trim in the first place.
Does every meniscus tear seen on a scan need treating?
No. MRI scans in people over forty routinely show meniscal tears, particularly degenerate ones, that are not causing the pain. The examination decides whether a tear on your scan is the source of your symptoms; the scan alone cannot.
Not sure this is your problem?
These pages start from the symptom. They cover what else can cause it and what is usually tried first.
Not sure whether you need this?
Ask it at a consultation, and bring your imaging and any plan you have already been given. Second opinions on surgery advised elsewhere are routine. He sees patients by appointment only, in Kharar, Mohali, and on set days each month in Solan.