Surgery

Description
Arthroscopy involves inserting a small, rigid tube, the arthroscope (a rigid optical instrument), into a joint. Connected to a camera and a light source, this allows the surgeon to visualize the intra-articular region on a monitor. One or two small incisions are made to insert the miniature instruments used: forceps, scissors, a miniature burr, etc.

The advantage is that pathologies can be treated surgically, with a minimal skin incision, which drastically reduces the morbidity of the procedure.

Meniscal tear
A particular feature of the meniscus is its vascularization: the blood vessels coming from the capsule only supply the peripheral part of the menisci, as seen in the image below.

Thus, in the event of a tear, well-vascularized peripheral lesions of the meniscus can be treated by suturing because they have healing potential. Conversely, more central lesions are not vascularized and must be treated by partial meniscal resection.

Partial meniscus resection should be as conservative as possible, as the remaining healthy meniscus will continue to perform its shock-absorbing and stabilizing function. Indeed, before the advent of arthroscopy, subtotal meniscectomies, which were performed by opening the knee, often led to long-term osteoarthritis.

For meniscal repairs, we use small absorbable anchors that are placed like tiny harpoons behind the meniscus and connected to each other by a thread that is tied under tension in the joint. Healing of meniscal lesions after suturing is achieved in most cases if the lesion is located in the vascularized zone of the meniscus.

Suites
After a meniscectomy, the patient walks weight-bearing with the knee fully extended. The knee can be moved, but repetitive flexion and extension should be avoided. After meniscal repair, the patient can walk with full weight-bearing and flex the knee up to 90°.

Frequently Asked Questions

What can we expect from this operation?
In cases of non-traumatic but degenerative tears of the medial meniscus, MRI aids in management: if the meniscus is extensively torn and the cartilage damage is minimal, the prognosis for arthroscopic meniscal resection is good. Conversely, if the cartilage damage is extensive with exposure of the subchondral bone and the meniscus is already subluxated at the periphery, the results of arthroscopic meniscal resection are unpredictable.

Long-term results
Numerous studies show success rates for meniscal repair ranging from 80% to 90%. However, this success rate depends on the location and type of tear, as well as its chronicity. The best results are obtained in young patients with recent peripheral tears. If the ACL is torn, it should also be repaired at the same time.

Martin Majewski Am J Sports Med July 2006 34 1072-1076; published online before print February 1, 2006
Sanjitpal S. Gill The Journal of Arthroscopic and Related Surgery, Vol 18, No 6 (July-August), 2002: pp 569–577
Martin Logan, Am J Sports Med June 2009 37 1131-1134; published online before print March 11, 2009,