Arthroscopic meniscectomy is a minimally invasive surgical procedure performed to remove torn or damaged portions of the meniscus within the knee joint. It is primarily indicated for patients whose symptoms persist despite conservative treatments and whose tear type or location makes repair unfeasible.

Why meniscal tears occur

Meniscal tears arise from two broad settings:

1. Traumatic tears - typically in younger, active patients after a twisting injury, often associated with ACL injuries. These tears may cause mechanical symptoms and are often amenable to repair.

2. Degenerative tears - common in middle-aged and older adults; result from chronic meniscal wear, mucoid degeneration, or minor stresses on a weakened meniscus. These tears may coexist with early osteoarthritis and often respond to conservative therapy.

When arthroscopic meniscectomy is considered

Arthroscopic partial meniscectomy (APM) is most commonly considered when:

1. There is a displaced meniscal fragment causing mechanical locking or catching that impairs daily function.

2. The patient has persistent symptomatic pain and impairment despite an adequate course of conservative care (physiotherapy, activity modification, analgesia).

3. The tear is not repairable due to location (white-white avascular zone), poor tissue quality, or chronic degenerative changes.

4. For traumatic tears in younger patients, meniscectomy may be used when immediate stabilization is required or repair is not possible; however, repair is preferred when possible to preserve meniscal tissue.

Important clinical change (evidence-based): For degenerative meniscal tears in middle-aged/older adults, multiple randomized trials and analyses have shown that structured exercise-based physical therapy is often noninferior to arthroscopic partial meniscectomy for improving pain and function at mid-term follow-up. Consequently, many guidelines now recommend trying a course of conservative therapy first, reserving APM for patients who fail conservative care or have true mechanical symptoms from displaced fragments.

The symptoms and signs leading to an arthroscopic meniscectomy are primarily related to a torn or damaged meniscus in the knee joint. These symptoms can vary in severity from mild discomfort to significant mobility limitations, depending on the extent of the meniscal tear.

Typical symptoms that bring patients to care

1. Knee pain, usually localized to the joint line (medial or lateral).

2. Mechanical symptoms: locking, catching, or a sense that the knee “gives way.” True locked knee (inability to fully extend) often suggests a displaced fragment and is a common indication for arthroscopic intervention.

3. Swelling/effusion, sometimes after activity.

4. Reduced range of motion or stiffness, especially with prolonged sitting or after activity.

5. Pain with twisting or pivoting activities.

Clinical examination findings

1. Joint-line tenderness on palpation (medial or lateral).

2. Positive provocation tests (e.g., McMurray's test) may reproduce pain or cause an audible click.

3. Mechanical block to extension suggests a trapped fragment.

4. Assessment of associated ligamentous injury (e.g., ACL) is essential in traumatic cases.

5. For degenerative tears, exam findings may overlap with osteoarthritis (crepitus, diffuse joint tenderness).

In short, when a displaced piece of meniscus produces mechanical symptoms or conservative care fails to relieve symptoms, arthroscopic meniscectomy can be considered. However, clinical context (age, activity level, degree of osteoarthritis) strongly influences decision-making.

The diagnosis leading to arthroscopic meniscectomy involves a combination of clinical examination, imaging studies, and diagnostic arthroscopy to confirm the extent and location of the meniscal injury before surgical removal or repair.

Imaging

1. Plain radiographs (X-rays) - weight-bearing AP and lateral views to evaluate for osteoarthritis or joint deformity (important because degenerative tears often coexist with OA).

2. Magnetic Resonance Imaging (MRI) - the imaging modality of choice for diagnosing meniscal tears: shows tear pattern/location, tissue quality, displacement, and associated cartilage or ligament injuries. MRI is especially useful when exam findings are ambiguous or when planning repair vs resection.

3. Ultrasound - limited role, operator dependent; occasionally used for dynamic assessment but not standard.

When to image

1. Imaging is indicated if the diagnosis is uncertain, if mechanical symptoms suggest displaced fragments, or if surgical planning is under consideration. For clear traumatic tears with significant mechanical symptoms, some surgeons may proceed to arthroscopy based on clinical findings and plain films alone, but MRI is commonly obtained to plan repair vs meniscectomy.

Preoperative evaluation

1. Document symptom duration, prior nonoperative trials, activity level, comorbidities (BMI, diabetes, smoking).

2. Discuss possibility of meniscal repair vs partial meniscectomy-repair is favored when feasible because it better preserves meniscal function and reduces long-term osteoarthritis risk.

Treatment options for arthroscopic meniscectomy include conservative approaches, surgical removal (partial meniscectomy), and meniscal repair. Current evidence shows that meniscal repair offers superior clinical outcomes compared to meniscectomy where feasible, while conservative physical therapy may provide similar results in certain patients.

Conservative (Non-surgical) Management - the first step for degenerative tears

For degenerative meniscal tears, recommended initial care often includes:

1. Exercise-based physical therapy (strengthening, neuromuscular training, range-of-motion). Randomized trials show exercise therapy is often noninferior to immediate arthroscopic partial meniscectomy for many patients with degenerative tears.

2. Activity modification and temporary avoidance of aggravating activities.

3. Analgesics / NSAIDs for pain control as appropriate.

4. Intra-articular injections (corticosteroid or newer biologics) may be considered in selected patients for symptomatic relief.

5. If conservative care fails after an adequate trial (often 6-12 weeks) or mechanical symptoms persist, surgery may be considered.

Arthroscopic Procedures - options and goals

Arthroscopic Partial Meniscectomy (APM)

1. Procedure: trimming and removal of unstable or symptomatic torn meniscal fragments; preserve as much meniscus as possible.

2. Indications: displaced fragments causing mechanical symptoms, irreparable degenerative fragments after failed conservative care, or when tissue is poor for repair.

3. Benefits/Limitations: can provide rapid symptom relief but removes load-sharing tissue - partial meniscectomy is associated with an increased long-term risk of osteoarthritis compared with meniscal repair or intact meniscus.

Meniscal Repair

1. Procedure: suturing the torn meniscus back to native tissue to allow biological healing (inside-out, all-inside, or outside-in techniques).

2. Indications: younger patients, tears in the vascular zone (red-red or red-white), vertical longitudinal tears, root tears in selected cases.

3. Advantages: preserves meniscal tissue and function, associated with lower rates of later osteoarthritis compared with resection; higher reoperation rate early on (repair failures) but better long-term joint preservation when successful.

Root Repair and Complex Repairs

1. Posterior root tears (especially medial root) are biomechanically equivalent to meniscal loss and often lead to rapid cartilage degeneration - root repair (transosseous or suture anchor techniques) is increasingly performed to restore hoop stresses when anatomy and cartilage status allow.

Open / Combined Procedures

1. Occasionally meniscectomy/repair is combined with other procedures - e.g., high tibial osteotomy for varus malalignment, cartilage restoration procedures - to address the whole-joint pathology and improve long-term outcomes.

Which treatment to choose? A practical algorithm

1. Younger, traumatic tear, repairable pattern → Favor meniscal repair.

2. Degenerative tear, no true mechanical locking, older patient → Trial of physiotherapy/medical management first (APM not first-line).

3. Persistent mechanical symptoms from displaced fragment → Arthroscopic partial meniscectomy to remove offending tissue.

4. Associated pathology (malalignment, cartilage defect) → consider combined or staged procedures.

The prevention and nonoperative management of conditions requiring arthroscopic meniscectomy focus on protecting knee health, managing meniscal tears conservatively when possible, and optimizing recovery before and after surgery.

Prevention (primary and secondary)

1. Maintain muscle strength and neuromuscular control - quadriceps and hamstring conditioning reduces knee joint overload and may lower acute injury risk.

2. Sport-specific training and technique - pivoting mechanics and landing technique education can lower traumatic tear risk.

3. Address modifiable risk factors: maintain healthy BMI, avoid smoking (impairs healing), manage metabolic health.

4. Correct underlying alignment (e.g., varus malalignment) when symptomatic to reduce progressive meniscal and cartilage damage.

Nonoperative rehabilitation principles (before or after APM)

1. Criterion-based, milestone-directed rehab is preferred over rigid time-based protocols: restore pain-free range of motion, normalize gait, regain strength and neuromuscular control, and return to activity progressively. Recent consensus and rehabilitation frameworks emphasize outcome-based progression.

2. After partial meniscectomy, many patients begin early range-of-motion and progressive weight-bearing as tolerated; rehabilitation speed depends on concurrent procedures (e.g., repairs require protected weight-bearing and limited ROM).

3. Post-repair protocols are more conservative (protected weight bearing, gradual ROM) to protect healing tissue; surgeons vary protocols by repair type and tear location.

Arthroscopic meniscectomy is considered a low-risk procedure, but complications—though rare—can occur. Most studies show that serious complication rates remain below 1%, while minor issues can reach up to 3–5% depending on patient factors and surgeon experience.

Early/short-term complications

1. Superficial or deep infection (rare; reported rates generally <1%).

2. Deep vein thrombosis (DVT) / pulmonary embolism (PE) - rare but the most frequently reported symptomatic adverse event in some series. Screening and prophylaxis according to risk profile are used.

3. Hemarthrosis (bleeding into the joint).

4. Nerve injury (saphenous or peroneal branches) - uncommon but possible due to portal placement or instrumentation.

5. Persistent pain or stiffness / arthrofibrosis in a minority of patients.

Longer-term risks

1. Progression of osteoarthritis: Partial meniscectomy removes load-distributing meniscal tissue and is associated with an increased long-term risk of radiographic and symptomatic osteoarthritis compared with meniscal repair or nonoperative management in many cohorts. Several recent analyses show higher OA progression after meniscectomy vs repair. This is an important counseling point, especially for younger patients.

2. Reoperation: rates vary by tear type, age, and whether repair was attempted. Repair has higher early reoperation for failure but better joint preservation long term; meniscectomy may require later cartilage procedures or even knee arthroplasty if OA progresses.

How common are complications?

Large national and multicenter analyses report 30-day complication rates <1-1.5% for routine arthroscopic meniscal procedures in many series; however, complication rates rise with patient age, comorbidities, and complex procedures. For instance, a 2023 analysis reported low early complication rates (<1%) but emphasized that careful patient selection is essential.

Living after an arthroscopic meniscectomy generally brings strong functional recovery and relief from pain, though long-term outcomes depend on tear type, surgical technique, and rehabilitation quality. Most patients regain normal daily activity within weeks, but preserving knee health becomes a lifelong focus.

Short-term recovery expectations after APM

1. Many patients experience rapid pain relief and improvement in mechanical symptoms within days to weeks following partial meniscectomy. Early mobilization and progressive return to function are typical.

2. Typical timeline (variable by surgeon and patient):

   1. Day 0-3: reduce swelling, analgesia, partial weight bearing as tolerated.

   2. Week 1-4: progressive ROM and strengthening; many return to low-impact daily activities.

   3. 6-12 weeks: return to higher level activities depending on recovery and absence of cartilage disease.

After meniscal repair

1. Recovery is longer: many surgeons recommend protected weight-bearing and ROM restrictions for 4-6+ weeks to allow meniscal healing, with formal physiotherapy guidance. Full return to pivoting sports may take 4-6 months.

Long-term outlook & important counseling points

1. Meniscal preservation matters. Where possible, repair is preferred for long-term joint health. Repairs can fail acutely more often than meniscectomy but successful repairs better protect against OA.

2. Degenerative tears and OA: In middle-aged and older adults, arthroscopic partial meniscectomy often yields symptom improvement but has limited disease-modifying benefit; exercise therapy is an acceptable first line and may obviate surgery for many. Discuss expectations clearly with patients.

3. OA risk after meniscectomy: Several studies show higher rates of radiographic OA progression and later need for knee arthroplasty in patients who undergo meniscectomy versus repair or nonoperative care - a key counseling point, especially for younger patients.

1. What is Arthroscopic Meniscectomy?

Arthroscopic meniscectomy is a minimally invasive surgical procedure to remove or repair a damaged meniscus in the knee joint. The meniscus is a C-shaped cartilage that cushions and stabilizes the knee. This procedure is performed using a small camera (arthroscope) and specialized instruments, allowing the surgeon to operate with minimal disruption to surrounding tissues.

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2. Why is Arthroscopic Meniscectomy performed?

It is typically recommended for patients who:

1. Have a torn meniscus causing pain, swelling, or knee locking.

2. Experience limited range of motion due to meniscal injury.

3. Have failed conservative treatments like physical therapy, anti-inflammatory medications, or rest.

4. Suffer from mechanical symptoms like popping, clicking, or catching in the knee.

The goal is to relieve pain, restore knee function, and prevent further joint damage.

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3. What are the types of meniscal tears treated?

Arthroscopic meniscectomy can treat various tear types, including:

1. Longitudinal tears

2. Horizontal tears

3. Complex or degenerative tears

4. Bucket-handle tears

Some tears are repairable rather than removed, especially in younger patients, to preserve meniscus function.

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4. How is Arthroscopic Meniscectomy performed?

The procedure involves:

1. Anesthesia: General or spinal anesthesia.

2. Small incisions: Typically 2-3 tiny incisions around the knee.

3. Arthroscope insertion: A small camera provides a clear view of the meniscus.

4. Removal or trimming: Damaged meniscus tissue is removed or reshaped.

5. Closure: Small sutures or bandages are applied.

The procedure generally takes 30-60 minutes and is often done on an outpatient basis.

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5. What is the recovery process after Arthroscopic Meniscectomy?

Recovery is usually faster than open knee surgery:

1. Immediate post-surgery: Ice, elevation, and compression to reduce swelling.

2. First few days: Pain and swelling are managed with medications; partial weight-bearing may be allowed.

3. 2-6 weeks: Physical therapy is initiated to restore strength, flexibility, and range of motion.

4. 6-12 weeks: Most patients can resume normal daily activities, sports, or work, depending on their individual recovery.

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6. Are there any risks or complications?

While arthroscopic meniscectomy is generally safe, potential risks include:

1. Infection at the incision site or inside the joint

2. Blood clots (deep vein thrombosis)

3. Persistent swelling or stiffness

4. Damage to surrounding cartilage, ligaments, or nerves

5. Recurrent meniscal tears, especially in younger or highly active patients

Choosing a board-certified orthopedic surgeon significantly reduces these risks.

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7. How successful is Arthroscopic Meniscectomy?

1. Success rates are high, particularly in patients with isolated meniscus tears and minimal arthritis.

2. Most patients experience pain relief, improved mobility, and return to normal activities.

3. Long-term outcomes depend on age, activity level, and the presence of osteoarthritis.

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8. Can Arthroscopic Meniscectomy prevent knee arthritis?

While the procedure relieves pain and restores function, it does not fully prevent the development of osteoarthritis. Removing meniscus tissue reduces cushioning in the knee, which may increase the risk of joint degeneration over time, especially in older patients. Meniscus repair is generally preferred when possible to preserve joint health.

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9. What should I do to prepare for Arthroscopic Meniscectomy?

Preparation includes:

1. Medical evaluation: Blood tests, X-rays, or MRI scans to confirm the meniscus tear.

2. Medication review: Adjustments may be needed for blood thinners or anti-inflammatory drugs.

3. Pre-operative physical activity: Strengthening surrounding muscles can aid recovery.

4. Arrange post-surgery support: Assistance for the first few days after surgery may be needed.

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10. How soon can I return to sports or physical activities?

1. Low-impact activities: Walking, swimming, or cycling may resume within 2-4 weeks, depending on recovery and surgeon recommendations.

2. High-impact sports: Activities like running, football, or basketball are usually resumed 6-12 weeks after surgery, once the knee is fully rehabilitated.

3. Physical therapy: Essential for regaining strength, stability, and preventing future injuries.