Meniscal Repair Post Op Instructions

The Medial and Lateral meniscal cartilages are gasket like cushions in the knee. Positioned between the femur and tibia, they distribute the weight transferred from the larger femur above to the smaller tibia below. The Menisci also help with the stability of the knee joint. Healthy Menisci convert the relatively flat tibial surface into a more stable shallow socket.

Why Do They Tear?

Meniscal tears can occur in any age group. In younger people, the meniscus is a fairly tough and rubbery structure. Tears in the meniscus usually occur as a result of a forceful twisting injury or with hyperflexion of the knee. In younger age groups, meniscal tears are more likely to be caused by a sports injury. In more mature individuals, it can occur with squatting down, twisting or a fall. In older individuals, the meniscus can be weaker and easier to tear. Sometimes meniscal tears can occur as a result of a minor injury, even from the up and down motion of simple squatting. Degenerative tears of the meniscus can also be seen as a part of osteoarthritis of the knee, gout and other arthritic conditions.

In many cases, there is no one associated injury that leads to a meniscal tear and knee pain is the most common complaint. The pain may be felt along the joint line where the meniscus is located. Sometimes it is more vague and occasionally involves the whole knee. If the torn portion of the meniscus is large enough, locking may occur. Locking simply refers to the inability to fully straighten the knee or loss of the ability to move the knee. Locking occurs when a piece of torn cartilage, or meniscus, is stuck between the bones. In other words, the meniscus is caught in the hinge mechanism of the knee. Once stuck, it will not let the knee straighten out or move completely. (See Dr. Reznik's video, "The Locking Knee" on You Tube.) Left alone, over time the constant rubbing of the torn meniscus on the articular cartilage will cause damage or degeneration of the knee joint. As a result, the knee may also become swollen, stiff and tight.

Treatment: Meniscal Repair

Once a meniscus is torn, it won’t heal on its own. When the tear is repaired, Dr Reznik uses the arthroscope to place tiny sutures or stitches to fix the tear. Of the tears below the ones nearest the outer edge are more often repaired, depending on the overall condition of the cartilage.  That is where the blood supply is best and the cartilage has the best chance of healing (the first, second and fourth images below).   Radial tears (image eight) can be repaired on rare occasions.

Examples of meniscal tear types

MENISCAL  RECOVERY PLAN

Diet: You may resume a regular diet when you return home. Start with tea or broth and advance slowly with crackers or toast, then a sandwich. If you become nauseated, return to clear liquids.

Pain Control:  Take pain medication as prescribed by Dr. Reznik.  Please call our office with any questions regarding your medication.  Ice as needed (never place ice directly on skin) and elevate leg above heart level using 2-3 pillows. This will also decrease swelling.

Stop smoking: Smoking slows the healing process by interfering with the making of new DNA. Smoking also increases the risk of infection and pneumonia after surgery by slowing your body's white blood cells.

Deep Breathing: Be sure to regularly take a deep breath and blow it out. This helps to clear the lungs after anesthesia.

Immobilizer :  Meniscal Repair patients are to wear the knee immobilzer full time for the first 3 weeks.  This includes while you are sleeping.  It is to be removed only for physical therapy directed exercises and showers.   Note:  Patients should not flex the knee past 90 degrees for the first 3 weeks.   After 3 weeks, you will change from the immobilizer to a knee hinged brace (This is normally done by the physical therapist). You can then start bending the knee from 90 degrees to a maximum of 120 degrees.  When switching to the knee hinge brace, using crutches again will help with balance if needed.

Crutches:  Patients are to use two crutches for the first week, putting light weight on the operative leg with each step with the immobilizer on. Remember to put the involved foot flat on the ground. Most patients can be fully weight bearing by the end of the first week while continuing to wear the immobilizer.  After the first week, you may then increase weight as tolerated and advance to one crutch for a few days and then a cane if needed.

Meniscus (cartilage) Repair patients cannot do twisting, pivoting, squatting, deep knee bends or impact activities for four months.  It is vital that meniscus repair patients do not squat for at least four months after the repair.

Return to Work:  People with light work (desk work with no squatting, lifting or kneeling) can return to work within a week to ten day with the brace on. The exception is for people who may have long commutes.  By staying still with the leg down for long periods, THEY ARE AT RISK FOR BLOOD CLOTS. Patients with active office work or very light labor with variable tasks can sometimes go back to work at two or three weeks, depending on lifting requirements.  Heavy work, (lifting or unprotected heights) cannot usually return before 6 weeks.  Most will need to be cleared by their physical therapist.

Driving: Right knee patients and left knee patients with a standard transmission car cannot drive until out of the knee immobilizer, off all pain meds and can fully weight bear without pain.
 
Blood Clots:  Those at high risk of blood clots include patients who have long car or train commutes, may be overweight, and have a history of cancer, women on birth control pills or males over the age of 40. These patients should be taking an aspirin per day (unless allergic) Doing the exercises Dr. Reznik prescribed will also reduce the risk of blood clots.

Call the Physician If:

**You develop excessive, prolonged nausea or vomiting
**Fever above 101.
**You develop any type of rash
**You experience calf pain

Post-Operative Exercises

Start doing exercises while still in the recovery room. Dr. Reznik or your nurse will instruct you on what to do. At home, while resting in bed after surgery do the following every hour or with each set of TV commercials.

	Ankle Pumps: Pump your ankle up and down for 1 minute (like pressing on the gas pedal). This will increase circulation and reduce the risk of developing a blood clot.
	Straight Leg Raise: Tighten your quads (muscle in the front of your thigh) with the knee immobilizer on and raise your leg 8 to 12 inches off the bed.

Add other exercises as your therapist gives them to you.

Knee bends/heel slides: With your heel on the bed, bend your knee while sliding your heel toward you. Start with bending 30-45 degrees and work toward 90 degrees during the first week.

If you find yourself in bed or resting frequently, move your arms regularly. You can use weights for upper arm exercises to keep your muscles ready for the demands of using crutches.

Revised 1/2/09