Partial vs Total Meniscectomy

Partial vs Total Meniscectomy: Understanding Your Options

A torn meniscus, often resulting from a forceful knee twisting, typically presents with symptoms such as knee pain, swelling, stiffness, and a catching or locking sensation. While conservative treatments like medication and physiotherapy can effectively manage some meniscus tears, surgery may be necessary when these methods fail to alleviate symptoms.

A common surgical procedure to address a torn meniscus is meniscectomy, which can be partial or total. This article will explore meniscus tear surgery in more detail, helping you understand your treatment options better.

What Is Meniscectomy?

Meniscectomy is the surgical removal of all or part of the meniscus. By removing these fragments that interfere with smooth joint movement, meniscectomy aims to alleviate pain and restore normal knee function.

It is often performed arthroscopically (a minimally invasive technique that uses small incisions). However, depending on the severity and location of the tear, an open surgical approach may be necessary.

Why Is Meniscectomy Done?

Minor meniscus tears can often heal without surgery. However, more severe tears may require surgery, particularly if:

• The tear is causing significant pain or swelling despite conservative treatments.
• The knee joint frequently goes out of alignment (instability).
• The knee becomes locked, making it difficult to move.

During the procedure, the knee surgeon will carefully remove the torn portions of the meniscus (partial meniscectomy) or remove the entire meniscus (total meniscectomy). Any unstable fragments causing catching, locking or significant pain will also be removed to improve knee function and reduce irritation.

Partial vs Total Meniscectomy

What Is Partial Meniscectomy?

Partial meniscectomy involves removing only the damaged portion of the meniscus, aiming to preserve as much healthy tissue as possible. This approach is generally considered when the tear is relatively small and localised.

Pros:

• Partial Meniscectomy preserves more of the natural meniscus, which is crucial for weight distribution and shock absorption in the knee.
• It is less invasive than a total meniscectomy and has a lower risk of postoperative complications and long-term joint issues.

Cons:

• This approach may not be suitable for all meniscus tears, particularly large, degenerative, or complex tears that cannot be effectively trimmed or repaired.
• Future interventions are required if the trimmed portion fails to alleviate pain or instability.

Recovery Time

Most patients can return to desk work or light activities within 1–2 weeks. High-level sports and physically demanding activities can generally resume within 4–6 weeks. Recovery may vary depending on age, overall health, the severity of the tear, and adherence to rehabilitation protocols.

What Is Total Meniscectomy?

A total meniscectomy involves removing the entire meniscus. It is typically only considered when the meniscus is severely damaged and beyond repair.

Pros:

• This procedure can effectively address large or complex meniscus tears that are not amenable to repair or partial trimming.
• It may provide immediate relief for severe pain or mechanical symptoms caused by irreparable tears.

Cons:

• Complete removal of the meniscus compromises joint stability and significantly increases the risk of long-term complications, such as osteoarthritis and joint degeneration.
• Patients may experience reduced shock absorption and a greater likelihood of requiring future surgical interventions.

Recovery Time

Patients can typically return to work and light activities within 2–3 weeks, with full recovery and resumption of sports taking 4–6 weeks. Long-term recovery outcomes may vary more significantly, especially if arthritis develops or other complications arise. Rehabilitation and physiotherapy are crucial for optimal recovery.

What Happens During a Meniscus Surgery?

The procedure begins by administering anaesthesia to ensure the patient's comfort during the operation. Once the patient is sedated, the surgeon creates small keyhole incisions around the knee joint to insert the arthroscopic camera and surgical instruments. Specialised surgical instruments are then inserted through other incisions to perform the necessary procedures on the meniscus. Once the procedure is complete, the surgical instruments and arthroscope are removed, and the incisions are closed with stitches or surgical tape.

Choosing Between Partial and Total Meniscectomy

The orthopaedic surgeon will determine the most suitable type of meniscectomy based on the patient's individual circumstances. Factors influencing this decision include the patient's age, the size and location of the tear, the severity of symptoms, and their activity level. An MRI scan is often used to assess the extent and location of the tear accurately.

Consult an Orthopaedic Specialist

Living with an untreated meniscus tear can lead to persistent pain and instability, and may accelerate the development of arthritis. If you are experiencing knee pain, swelling, or difficulty moving your knee, consult with an orthopaedic specialist. They can accurately diagnose the cause of your symptoms, including whether you have a meniscus tear. Knee specialists can also discuss the most appropriate treatment options with you, which may include meniscectomy or other conservative approaches.