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The menisci are made of fibrocartilage and act as shock absorbers for the joint. They have a blood supply on the outer third, with the inner portion of the meniscus not having any blood supply. In addition, the inner portion is much thinner than the thicker outer portion, which attaches to the joint lining. For this reason, tears of the inner portion of the meniscus, which does not have a blood supply, almost always have to be resected. In these circumstances, a partial meniscectomy is necessary to remove the torn portion of the meniscus that is causing pain.
The technique of partial meniscectomy is performed arthroscopically. In these circumstances, the torn portion of the meniscus is resected with an attempt to try to preserve and sculpt as much of the remaining meniscus to both try and leave as much shock-absorbing capacity as possible, but also to try to minimize the chance of a re-tear.
The surgical technique involves making 2 small incisions on either side of the patellar tendon, with one being used for the arthroscopic camera and the second being used for the arthroscopic instruments. The meniscus tear is trimmed down and “saucerized” in order to remove any edges which could catch in the joint and cause further pain, but at the same point in time trying to preserve as much meniscus as possible.
In almost all circumstances, we allow patients to weight-bear as tolerated, using crutches for the first week, but fully weight-bearing, and than to slowly increase their activities over the course of the next few weeks.
We generally recommend that patients avoid those activities in the future which cause pain or swelling after partial meniscectomy. This is because almost all patients who do have pain or swelling after a partial meniscectomy have this not because of a recurrent meniscus tear, but rather because of the development of arthritis from the lack of the cushion of the meniscus. Thus, participating in low-impact activities to include walking, swimming, cycling, use of an elliptical machine would be recommended for all patients after a partial meniscectomy. However, impact activities such as running, basketball, and racquetball should be monitored very carefully to make sure one does not develop pain or swelling with these activities.
There are hundreds of thousands of partial meniscectomies performed in the United States every year. It is by far the most common orthopaedic surgery. While it is usually a day surgery procedure, with 2 or 3 small incisions, this does not negate the fact that this has to be closely monitored over time and the patient is educated to make sure that they know when they may be causing damage to their knees. Even in professional athletes, it has been demonstrated that athletes that have a partial meniscectomy have a worse prognosis in the shortening of their career compared to athletes who have an ACL reconstruction, which is considered a much more serious surgery.