Meniscus

Torn Meniscus Surgery in Indianapolis, IN and Mooresville, IN

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Meniscus Injury

Meniscus Surgery

Meniscus Injury

The meniscus is a strong tissue in the knee that provides both cushioning and support. The two menisci (plural of meniscus) of each knee are crescent-shaped wedges that fill the gap between the tibia (shin bone) and femur (thigh bone). The menisci provide joint stability by creating a cup for the femur to sit in. The outer edges are fairly thick while the inner surfaces are thin to accommodate the rounded surface of the femur. If the menisci were missing, the curved femur would be in direct contact with the flat tibia, causing significant pressure, abrasions and wear on the joint.

The meniscus acts as a shock absorber for the knee. The medial (inside) meniscus bears up to 50% of the load on the medial aspect of the knee. The lateral (outside) meniscus absorbs up to 80% of the load on the lateral aspect of the knee. During walking, forces on the knee can increase 2 – 4 times body weight. While running, these forces increase up to 6 – 8 times body weight. There are even higher forces when landing from a jump. If the menisci are removed, the forces are no longer distributed over the entire area of the tibia. This can eventually damage the cartilage on the ends of the bones and can lead to arthritis.

There are two categories of meniscal injuries:

Acute tears usually occur suddenly when the knee is bent and forcefully twisted.
Degenerative tears of the meniscus are more common in older people. As the meniscus ages, it weakens and becomes less elastic. Sixty percent of people over the age of 65 probably have a degenerative tear of the meniscus. Degenerative tears may result from minor events and there may or may not be any symptoms. In some circumstances, the arthritic joint (bone spurs / narrowing between the bones) can cause the meniscus to tear.

The location and type of the meniscus tear is very important in determining the best course of treatment. There are many different shapes and types of tears. Acute injuries tend to tear the meniscus with sharper edges. Degenerative tears are usually “complex”, meaning that the meniscus has several different patterns, often with frayed or worn down edges.

Non-operative treatment: in some cases, the treatments listed below can improve knee pain and function. These are often recommended for more degenerative tears.

Rest/Activity modification—your doctor may suggest rest and activity modification, such as avoiding strenuous, high-impact activities like running and jumping. They may also recommend avoiding hyperflexion (knee bent past 90 degrees) activities, such as squatting, lunging and kneeling.
Non-steroidal anti-inflammatory medicines—drugs like ibuprofen and naproxen reduce pain and swelling. Make sure to take the medication with food to prevent stomach problems. Also take medications with a full glass of water to prevent damage to the kidneys.
Physical therapy— usually there is an initial focus on restoring normal motion to your knee. Stretching exercises to improve range of motion are very helpful. Once your pain is improving, your therapist can start you on a strengthening program for the supporting muscles that surround the knee.
Steroid injection—if rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and cortisone may be helpful. Cortisone is a very effective anti-inflammatory medicine. The goal is to reduce the pain and swelling of the knee. This treatment is helpful in patients who want to avoid surgery and/or whose arthritis is too severe for an arthroscopic (minimally-invasive) surgical procedure.

Operative treatment: in many cases, especially acute tears, surgery for a torn meniscus can help restore function and reduce pain of the knee. There are several options when it comes to surgery for a torn meniscus, which are detailed in another information sheet.

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Meniscus Surgery

If surgery is recommended, the procedure chosen is usually dependent on the location and type of meniscal tear. All of the surgeries listed below are outpatient surgeries (go home the same day). They are performed using arthroscopic (minimally-invasive) techniques. A general anesthetic is given. Depending on the specific surgery, a nerve block may be used to help with pain after surgery.

Partial meniscectomy
This procedure involves removing only the torn piece of meniscus, but leaving the majority intact. Usually meniscectomy is used for tears located in the inner 2/3 of the meniscus where there is no blood supply. An analogy I like to use is that of a hang-nail. The torn meniscus can be thought of as the piece of nail that is torn away. The goal of surgery is to remove the torn part of the nail and leave the rest of the nail to function normally. If the meniscus remains mostly intact with only the inner portion removed, the patient usually does well and does not develop early arthritis.

Meniscal repair
Repairs are performed on tears near the outer 1/3 of the meniscus where a good blood supply exists, or on large tears that would require a near-total resection (removal). The torn portion of the meniscus is repaired by using either sutures or absorbable fixation devices. Most of the time this can be done arthroscopically without any added incisions. On rare occasions, a small incision may be made. Meniscal repairs are also often done with ACL reconstructions. If a meniscal repair is performed, you will be placed in a brace that prevents any unwanted bending of the knee.

Meniscal transplant
There are rare cases in which the meniscus is completely torn and unable to be repaired. Another scenario is if the patient has had previous surgery where the meniscus was almost completely removed. In younger patients with one of the above scenarios, surgery to “replace” the meniscus can be done. This uses an allograft (cadaver) meniscus and bone to restore the shock absorption of the knee. It is a complex procedure with about a 1 year recovery back to impact activity.

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Helpful, kind and made it as easy as possible!

“Dr. Calloway did my surgery. He's personable, up front about what your problem is and how to solve it, and open to any questions with a great bedside manner. The surgery went perfectly to the point where I was basically a little weirded out about how well it went. I had a similar surgery on my left shoulder as I did in my right shoulder, a few differences, and this particular shoulder surgery with Dr. Calloway went smooth as butter. His office staff is very nice and personable as well. No one there makes you feel like a dollar sign. When the surgery time came Dr. Calloway came to my room and pre-op to explain what was going to happen and try to call my nerves, as I have an extreme fear of going under anesthesia. He and the surgery staff were helpful and kind and made a difficult experience is easiest possible.”

Excellent Surgeon!

“Excellent surgeon! He's friendly, personable, knowledgeable and does a great job of explaining what he's going to do and what he did do after surgery.”

I have no pain, no popping, my mobility is great!

“Dr. Calloway was great to work with. After dislocating my shoulder multiple times he suggested latarjet procedure. I am now 9 months post surgery and my shoulder feels great, my incision healed very well. I have no pain, no popping, my mobility is great and my shoulder feels secure again witch I am very thankful as I do tree work and need to use my shoulders a lot. Dr. Calloway patiently answered every question I had thoroughly and I believe he set me up for the best recovery possible.”

The surgery results were great!

“I had no problems getting scheduled for appointments or for surgery. He was very friendly and courteous and gave realistic expectations about my rotator cuff surgery. He took the time to explain exactly what procedures were to be used. He answered all my questions. The surgery results were great. He was very much engaged in getting me back on the golf course with his recommendations for physical therapy and encouragement. I would definitely recommend him to others and if I need surgery on my other shoulder he will be my first choice.”

This is the first I've been painfree!

“I was referred to Dr. Calloway as a last resort. He was honest up front and told me he couldn't guarantee that he could be any help. I underwent arthroscopic surgery to have scar tissue cleaned up and he performed a tendon release on my hip. One week after surgery I am having no pain and much more mobility. This is the first I've been painfree in more than 6 years.”