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Complete Removal Of Damaged Meniscus

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HOME   1 - THE BASICS   2 - CRUCIATES   3 - COLLATERALS     4 MENISCI     - terminology     - anatomy     - injury     - tear types      - menisectomy     - repair     - replacement   5 - PATELLAE   6 - ARTHRITIS   7 - REHAB   8 - PATIENT STORIES   9 - SPORT 10 - FINDING HELP                       MENISCECTOMY Meniscectomy means 'cutting out the meniscus'. Really it is too broad a term to describe what usually happens during knee surgery, so surgeons resort to using descriptive terms, such as: Meniscal trimming Partial meniscectomy Excision of bucket-handle Excision of parrot beak Complete meniscectomy . If you have read the section on types of tear, then you will understand the procedures above. There is one big issue about 'complete' meniscectomy that you must understand - "complete meniscectomy is a one-way ticket to arthritis!" Compete menisectomy is removal of the entire meniscus and its rim. It takes away the meniscal rim and has the following almost certain consequences: shock absorption is lost forever the lack of the 'spacer' of the meniscus means more forces are applied through that side of the joint the joint surfaces of the femur (thighbone) and tibia (shinbone) are going to become stressed, softened, and eventually break down ('arthritis') and there will be arthritic pain the leg may demonstrate 'bow leggedness' or 'knock-knees', due to the collapse of the joint on the one side (one 'compartment') the knee may be seen to thrust outwards with each step, further stressing the joint ('lateral thrust') the bone may attempt to try to heal the problem - but with totally unhelpful bony outgrowths called 'osteophytes' ('bone mushrooms'). These may form at the joint line or in the notch where the cruciate ligaments reside eventually the cruciate ligaments may become incompetent and rupture Knee surgeons will generally try to preserve this external rim at all costs, although part of the meniscus may have to be removed in a partial meniscectomy.   Meniscectomy - Overview:  Below

Source Guidelines Update 3rd Edition Meniscectomy and Meniscus Repair 80.6, 81.47 Other names/synonyms: Débridement, Partial Meniscectomy, Meniscus Shaving What is it? Meniscectomy is the surgical removal or repair of the knee meniscus (semi-lunar cartilage). Meniscectomy depends on the location and type of tear encountered. Rarely is the entire meniscus removed since the advent of arthroscopic surgery, which allows removal of only the damaged tissue or repair of the tear. Tears along the inner curve of the meniscus, especially those that are of the ragged degenerative type, are most commonly treated by removing the portion of damaged meniscus. The terms débridement, partial meniscectomy, or meniscus shaving are often used to describe this procedure. Tears in the thick substance of the meniscus, near the outer rim where the blood supply is located, can often be repaired with stitches (sutures). This procedure (meniscus repair) is technically challenging but often very successful in promoting healing. Meniscus repair has a greater risk of complication and a longer recovery time but is the preferred procedure when possible. Individuals undergoing meniscus repair wear a protective brace, which limits knee motion and requires a period of limited weight bearing on crutches. Both meniscectomy and meniscus repair are now most commonly arthroscopic procedures, and may be combined with other procedures about the knee. The procedures may be done under local, regional or general anesthesia and are outpatient procedures. What is the reason for this procedure? Meniscus repair or meniscectomy is performed when conservative treatment fails. It is also performed to relieve symptoms and to slow the degenerative process. Meniscus repair also provides protection of the knee ligaments. The goal is to protect the articular surface from degenerative damage and to increase stability of the knee. What might complicate it? Meniscus repair may be complicated by nerve or blood vessel damage, bleeding, infection, stiffening of the knee joint (arthrofibrosis) and failure of the repair. Complete meniscectomy may increase the rate of degenerative changes to the articular surface and increase instability of the knee. Surgical complications include infection, changes in sensation around the incision, as well as the usual surgical complication risks. The procedures may be complicated by osteoarthritis, knee ligament injury, loose bodies, synovitis and arthrofibrosis. Some individuals develop a post surgical inflammation aggravated by physical therapy, which slows recovery. It is important to note that having the procedure done arthroscopically does not automatically mean that recovery will be short and/or easy. What are possible work restrictions and accommodations? Strenuous activities should be restricted for several weeks. Other restrictions include no kneeling, squatting, crawling, climbing or prolonged standing during the early phase of recovery. Use of crutches and knee brace will affect agility. Frequent rest periods with facilities that allow the individual to elevate the lower extremity may enable earlier return to work. Some individuals may have permanent restrictions on kneeling, jumping and squatting based on findings during surgery. Use of medications for pain and swelling may require review of any drug policies. What type of rehabilitation might be appropriate for recovery from this procedure? At what frequency and for how long? Physical therapy, three times a week for a period of six to twelve weeks. Who are the appropriate specialists for treatment, referral, or independent examination? Orthopedic surgeon and physiatrist (after surgery). Karl Note:  I very strongly advise to never include any psychiatrist as part of the treatment, and to avoid any orthopedic surgeon who even is ready to recommend psychiatric treatment.  Such a referral indicates an orthopedic surgeon who is far too drug-oriented to allow him to work on your knees in any way! What are the factors that might influence length of disability? Type of procedure, occurrence of complications, individual's job requirements, ability to modify work activities and compliance with rehabilitation would all affect the disability period. What is the expected length of disability? - Updated Table Arthroscopic. Meniscectomy. Job Classification Minimum Expectancy Optimum Maximum Expectancy Sedentary Work 7 Days 14 Days 28 Days Light Work 14 Days 21 Days 42 Days Medium Work 14 Days 21 Days 56 Days Heavy Work 21 Days 42 Days 70 Days Very Heavy Work 28 Days 42 Days 84 Days What is the expected length of disability? - Updated Table Surgical treatment, open. Meniscectomy. Job Classification Minimum Expectancy Optimum Maximum Expectancy Sedentary Work 14 Days 21 Days 42 Days Light Work 21 Days 35 Days 49 Days Medium Work 28 Days 42 Days 56 Days Heavy Work 35 Days 42 Days 56 Days Very Heavy Work 35 Days 56 Days 84 Days What is the expected length of disability? Meniscus repair. Job Classification Minimum Expectancy Optimum Maximum Expectancy Sedentary Work 7 Days 10 Days 42 Days Light Work 7 Days 14 Days 91 Days Medium Work 35 Days 42 Days 119 Days Heavy Work 42 Days 84 Days 140 Days Very Heavy Work 91 Days 119 Days 182 Days What is the duration trend from the normative data? Meniscectomy ICD-9-CM = 80.6, 81.47 Number of Cases = 1,454 Mean LOD= 48 Days Median LOD= 40 Days Cases > 6 months= 2% (REED/CORE DATA)

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