Meniscectomy: indications, procedure, outcomes, and rehabilitation

Abstract

Meniscal injuries are among the most frequent reasons for knee problems. The goal of this manuscript is to review the biomechanical relevance of the human knee's menisci in relation to surgical indications, surgical techniques, rehabilitation, and outcomes. In order to identify the relevant literature, we performed a PubMed search for the years ranging from 1980-2013 using the following search terms: meniscus; biomechanical function; meniscectomy; meniscal repair; and clinical outcome. The meniscus helps to distribute the forces between the tibial and femoral articular cartilage layers in a load-sharing capacity. Meniscus damage or meniscectomy intuitively leads to an overloading of the cartilage and, hence, to the development of osteoarthrosis. Precise knowledge of meniscal shape and function, of the type of injury, of surgical techniques, as well as of postsurgical rehabilitative care are of decisive importance for an individually-adjusted treatment strategy. Other underlying coexisting knee pathologies also need to be considered. The diagnosis of a meniscal injury is based upon clinical history, physical examination, and imaging studies. The treatment of a meniscal lesion includes conservative, as well as operative, procedures. The goals of surgery are to reduce pain and disability, as well as to preserve meniscal function without causing additional cartilage damage. The resection of meniscal tissue should be restricted to as much as is necessary, and as little as is reasonably possible. Postoperative rehabilitation serves the purpose of improving functional deficits and pain, as well as of restoring a good range of motion and preventing secondary damage. It is the surgical therapy that dictates the aftercare, and with regards to the latter, there are clear differences between meniscectomy and meniscal repair.

Home-Based vs Supervised Inpatient and/or Outpatient Rehabilitation Following Knee Meniscectomy

“…Numerous studies have investigated post-AM treatments during the previous decades. 21 Nevertheless, the optimal postoperative approach is debated. 22 Some authors investigated home-based rehabilitation programs (HBP) instead of standard inpatient and/or outpatient supervised physical therapy (IOP).…”

“…This entails a surgical trauma to the knee requiring postoperative management to facilitate the restoration of normal joint function. Numerous studies have investigated post-AM treatments during the previous decades . Nevertheless, the optimal postoperative approach is debated .…”

Region- and layer-specific investigations of the human menisci using SHG imaging and biaxial testing

“…Moreover, the slightest variation in tissue behavior during different probing tasks, such as push and continuous run on the superior meniscal surface and pull on the inferior meniscal surface ( Tuijthof et al, 2011 ), could be easily analyzed, as such detailing is essential to ascertain the tissue stiffness. This procedure helps the orthopedic surgeons make decisions regarding whether the meniscus should be repaired or resected ( Anetzberger et al, 2014 ).…”

“…This study is a part of developing a digital twin for human knee joint for practicing arthroscopic surgery ( Bjelland et al, 2022 ). Probing meniscus is a common task in meniscectomy to ascertain the tissue characteristic as being hard or soft ( Hu and Desai, 2004 ), which usually serves as the initial guide for surgeons to diagnose degenerative meniscus ( Anetzberger et al, 2014 ). Hence, the quasi-static deformation must be modeled accurately for providing accurate haptic feedback to the surgeon in surgical training and simulation ( Tuijthof et al, 2011 ).…”

All-inside suture device is superior to meniscal arrows in meniscal repair: a prospective randomized multicenter clinical trial with 2-year follow-up

“…These seven patients, however, were equally distributed in the two treatment groups. In the literature, there is no consensus concerning rehabilitation regimes following meniscal repair [ 3 ], but during the last decades, the trend is towards less restrictive regimes. The patients in this study were instructed to use crutches with partial weight bearing the first 6 weeks post-operatively but had no restrictions in range of motion without weight bearing.…”