Meniscectomy Surgery: Everything You Need to Know

Your doctor may suggest a meniscectomy, or meniscus removal surgery, when you have a torn meniscus—a tough, rubbery piece of cartilage that sits above the shinbone and provides cushioning and stability. Meniscus removal can decrease pain and restore mobility in severe cases where the cartilage can’t heal on its own or be repaired.

What Is a Meniscectomy?

A meniscectomy is an outpatient, scheduled surgery to remove a torn meniscus in your knee. It’s typically performed as arthroscopic surgery. This involves making small incisions, about a centimeter long, that allow the surgeon to insert a camera called an arthroscope as well as small instruments that can remove part or all of the meniscus.

There are two types of meniscectomy surgeries.

• Partial meniscectomy: Removes a small piece of the torn meniscus
• Total meniscectomy: Removes the entire meniscus

In most cases, a partial meniscectomy is done to try to preserve as much of the cartilage as possible. Removing an entire meniscus may be more likely to cause arthritis about 10 years later. That’s because the meniscus helps decrease stress on the knee and provides shock absorption, stability, and joint lubrication. Without the meniscus, the impact on the knee is three times higher.

Contraindications

A meniscectomy is not recommended if at-home treatment can help your meniscus heal on its own or if it can be repaired via meniscus repair surgery. This can depend on the severity of the tear as well as its location.

The outcomes of meniscal repair surgery tend to be more effective for people under 30 years of age who have the procedure within two months after the injury. Those over 30 may be less likely to have a successful surgical repair since meniscal tissue begins to weaken with age.

Your doctor will make a determination about surgery based on your condition as well as your age, activity level, and general health. Some health conditions may increase the risk of a procedure, including infections or an uncontrolled medical condition.

Potential Risks

Potential complications from a meniscectomy include:

• Injury to nerves and blood vessels
• Fracture of the joint
• Instability or weakness of the joint
• Blood clot (deep vein thrombosis)
• Long-term risk of arthritis in the knee

Purpose of Meniscectomy

A meniscal tear can develop suddenly due to injury (such as when you twist your knee) or slowly due to a degenerative condition like osteoarthritis. As you age, the cartilage becomes less resilient. Because of this, injuries can happen more frequently, whether from playing sports or stepping on an uneven surface.

Damage to the meniscus can cause significant pain and mobility issues. A meniscectomy can help resolve these issues when other, more modest treatment options can't.

The location of the tear may determine whether the meniscus can be repaired. The outer one-fourth of the meniscus has a rich blood supply. Tears in this “red zone” of the meniscus can heal on their own or be repaired through surgery.

If the tear in this area is small, it may be more likely to heal through non-surgical treatments, such as:

• The RICE protocol: Rest, ice (20 minutes at a time), compression (bandage), and elevation
• Use of a brace
• Activity modification
• Non-steroidal anti-inflammatory medications
• Steroid injections
• Physical therapy

The inner two-thirds of the meniscus, on the other hand, doesn’t have a rich blood supply. If a tear happens in this location, the meniscus may not have the ability to heal because of the lack of nutrients from the blood. A tear in this non-vascular part, or “white zone,” may require meniscectomy.

Symptoms from a degenerative tear will occasionally ease without surgery. Your doctor may consider surgery if your knee is “locked,” persistently swollen, or keeping you from participating in normal activities for three to six months.

Before going in for surgery, you’ll have an appointment with your orthopedic surgeon for a physical examination. The surgeon will do a physical exam to look for joint-line tenderness where the meniscus sits, pain when rotating the knee, clicking in the joint, and range of motion.

You may need bloodwork or an electrocardiogram (ECG or EKG) to make sure that you’re healthy enough for surgery.

How to Prepare

You’ll have an appointment to meet with the surgeon and ask any questions before the procedure. This will give you a chance to find out more about the risks and benefits specific to your condition.

Your surgeon will talk to you about the type of anesthesia that they’ll use, whether it’s general, regional, or local anesthesia. They’ll also let you know what to expect on the day of surgery and how you can prepare for the recovery phase.

Your doctor may give you a prescription for pain medicine in advance of your procedure so that you can have it filled and on-hand to use after you are discharged. You may be referred to a physical therapist before the surgery to get fitted for crutches and instructed on how to use them.

Location

A meniscectomy is performed in a hospital or outpatient surgical center. As part of your preparation, make arrangements for someone to bring you home after surgery.

What to Wear

You’ll be asked to change into a hospital gown before the procedure. Bring or wear loose shorts or pants that will be easy to fit over your bandage and dressing after surgery.

Food and Drink

Follow your surgeon’s instructions for when to stop eating and drinking before surgery. They may tell you to stop eating after midnight the night before the surgery so you are able to receive anesthesia on an empty stomach.

Medications

Two weeks before surgery, your doctor may tell you to stop taking medications that can increase the risk of bleeding. These may include aspirin, Advil (ibuprofen), Aleve (naproxen), and Coumadin (warfarin).

What to Bring

If you received crutches from your physical therapist, remember to bring them on the day of surgery. If you don’t have crutches, they should be given to you at the hospital after surgery.

Also bring any paperwork, your insurance card, and a form of identification like a driver’s license.

Pre-Op Lifestyle Changes

If you currently smoke, let your surgeon know before the surgery. Smoking can sometimes lead to complications because it slows the flow of blood, increasing the chance of a blood clot. It can also slow the healing of your bone and wounds.

What to Expect on the Day of Surgery

Your pre-surgical nurse or physician’s assistant will meet with you to go over the details of the surgery with you. The nurse will perform a physical exam and check your vitals. You may be asked to sign consent forms before the surgery.

During the Surgery

The surgery should last about one hour. Once you are in the operating room, the planned form of anesthesia will be administered:

• If you have local anesthesia, your knee will be injected with medicine to numb the area. You may be given medications to relax you, but you’ll be awake throughout the procedure.
• With regional anesthesia, pain medicine is injected in a space in your spine. You’ll be numb below the waist but awake during the surgery.
• With general anesthesia, you’ll receive medication to put you to sleep through an intravenous (IV) line in your arm or through a breathing mask. The anesthesiologist will monitor your vitals throughout the procedure. When you’re asleep, the anesthesiologist may put a breathing tube in your windpipe to protect your airway.

The surgeon then makes three small holes, or portals, in the knee. An arthroscope, which includes a light and camera, is inserted into one of the incisions. Another incision is used as a portal for the insertion of saline solution to help the surgeon see and make it easier to move the instruments. The third incision is used for the surgical instruments to remove the meniscus.

The surgeon will inspect the inside of the knee and look at the meniscus tear. The surgeon will then cut and remove the torn piece with small instruments called punches. The edges of the meniscus are made smooth with a motorized instrument with suction called a shaver.

Saline is once again flushed through the knee to help rinse out any loose particles. Then the incisions are closed with stitches or tape strips.

After the Surgery

You’ll stay in the recovery room until your anesthesia wears off. While discharge requirements may vary, you’ll probably be able to go home when your medical team has determined that your vitals are stable and you’re able to urinate, drink fluids, and walk with your crutches.

You can usually go home the same day as the surgery.

Your knee will be wrapped with dressing and an elastic bandage, and you will be given an ice pack to help with pain and swelling. Leave the bandage in place until you start physical therapy.

Recovery

Your recovery time may vary depending on your age and overall health. You may want to arrange for someone to stay with you the first two days after the surgery to help around the house while you’re recovering.

Some people are able to go back to work and drive after one week. You may be able to resume normal activity and exercise after one month or once your strength and range of motion are restored. Check with your doctor to find out when you can resume different activities and whether you need to make any modifications to protect your knee.

Your doctor may suggest exercises that you can do to help you get back to normal quickly. These can help you improve control of your leg muscles and range of motion in the knee. You may be able to do them at home, or your doctor may suggest that you make an appointment with a physical therapist.

You’ll likely need a follow-up appointment with your doctor between nine days and two weeks after the surgery.

Healing

You’ll have some pain and swelling for up to a week after surgery. For the first two days after surgery, your surgeon may suggest putting ice on your knee for 20 minutes at a time several times a day to help reduce pain and swelling. You can help decrease swelling while resting by putting two or three pillows under your knee while laying flat on your back.

Your surgeon will let you know when it’s safe to bathe or shower. They may advise covering your knee with plastic to keep the bandage from getting wet in order to decrease the risk of infection.

Use crutches to help keep stress off your knee while it’s healing. Your physical therapist will work with you to determine when you can stop using them. Usually, this can happen when you are able to comfortably put your full weight on the operated leg.

Pain medications, including opioids such as hydrocodone or oxycodone, may be prescribed for the first 48 hours. These medications can be safe if used properly and for a short amount of time. Follow your surgeon’s instructions to avoid misuse of opioids, which can lead to overdose, addiction, or death.

Your surgeon may recommend using over-the-counter pain medication thereafter. Most patients are able to stop taking pain relief drugs after the first week.

Possible Future Surgeries

Patients with osteoarthritis who have a meniscectomy may be more likely to need knee replacement surgery down the road.

A 2016 study found that osteoarthritis patients who had an arthroscopic meniscectomy were three times more likely to need knee replacement surgery than osteoarthritis patients who didn’t have a meniscectomy.

Talk to your doctor if you have any questions about the effectiveness of meniscectomy for your condition and whether it might lead to future surgeries.

A Word From Verywell

A meniscectomy may be an option if you have a meniscus tear causing severe symptoms that aren’t responding to conservative treatment. Your surgeon will consider the location and cause of the tear before recommending surgery. They’ll be able to tell you if a partial or complete meniscectomy can help relieve your pain and mobility issues and allow you to get back to normal activities.