Knee Arthroscopy

Types of Knee Arthroscopy

Arthroscopic meniscectomy, meniscal repair, and meniscus balancing are three different surgical approaches used to treat meniscus injuries, depending on the severity, location and type of tear.

Arthroscopic Meniscectomy

– A minimally invasive procedure where the damaged portion of the meniscus is trimmed or removed.

Indications
– Irreparable meniscus tears where healing is unlikely.

Types
– Partial Meniscectomy: Only the damaged portion is removed.
– Total Meniscectomy: The entire meniscus is removed (rare due to long-term risk of arthritis).

Recovery
– Faster than meniscus repair but may lead to increased risk of osteoarthritis over time due to loss of shock absorption.

Meniscal Repair

– A procedure where the torn meniscus is sutured together to promote natural healing

Indications
– Tears in the red zone where blood supply aids healing
– In younger patients.

Recovery
– Longer than meniscectomy due to the need for healing but requires strict rehab adherence.
– Patients may require crutches and restricted weight-bearing initially.

Meniscus Balancing

– A technique used to preserve as much of the meniscus as possible while ensuring even distribution of forces across the knee.

Indications
– Applied in cases where meniscus tears can be smoothed or reshaped to optimize function without full removal.

Recovery
– Similar to a partial meniscectomy, but with better long-term outcomes due to preservation of meniscal tissue.

Choosing the Right Procedure

– Meniscus repair is preferred if the tear is repairable, especially in young, active patients.
– Meniscectomy is done when repair isn’t possible, but it increases the risk of osteoarthritis.
– Meniscus balancing is ideal for cases where preservation and stability are priorities.

ACL Injuries

An ACL tear is a common knee injury that affects the anterior cruciate ligament, one of the key ligaments that stabilize the knee joint. It often occurs during sports or activities that involve sudden stops, pivots or awkward landings.

Causes & Risk Factors

– Sudden changes in direction
– Stopping suddenly while running
– Jumping and landing incorrectly
– Direct blow to the knee
– Sports like soccer, basketball, football, skiing

Treatment Options

Non-Surgical Treatment – for partial tears or low-activity individuals
– Physical therapy to strengthen surrounding muscles
– Knee brace for support

Surgical Treatment – for complete tears or active individuals
– ACL reconstruction surgery (using a graft from a tendon)
– Post-surgery rehab

Types of ACL Procedures

– ACL Repair – If the ligament is only partially torn and still attached, it may be stitched back together (less common).

– ACL Reconstruction – The torn ligament is replaced with a graft, usually from patient’s own tissue, e.g., hamstring, patellar or quadriceps tendon.

Which Graft is Best?

– Athletes: Patellar tendon or hamstring autograft (stronger, quicker healing).
– Less active individuals: hamstring or peroneal autograft
– Revision ACL surgery: Quadriceps tendon or allograft.

Who is a candidate

– Strength Training – Focus on quadriceps, hamstrings, glutes, and core to improve knee stability.
– Balance & Proprioception – Use balance boards and single-leg exercises to enhance coordination.
– Proper Jumping & Landing Techniques – Land softly with knees bent, avoiding inward collapse.
– Agility & Flexibility – Stretch regularly and incorporate agility drills to improve movement patterns.
– Use Proper Footwear – Supportive shoes help prevent slips and knee strain.

PCL Injuries

A PCL tear (posterior cruciate ligament tear) is an injury to one of the major ligaments in the knee. The PCL is located at the back of the knee and helps stabilize it by preventing the shin bone from moving too far backward relative to the thigh bone.

Causes of a PCL Tear

– Direct impact to the front of the knee (e.g., car accidents, where the knee hits the dashboard)
– Sports injuries (e.g., falling on a bent knee or getting tackled)
– Hyperextension of the knee.

Treatment

– Mild cases: medication, Rest, ice, compression, physical therapy, bracing.

– Severe cases: Requires surgery, especially for athletes or those with multiple ligament injuries

PCL Surgery Options

– Repair: If the PCL is torn but still attached, sutures or anchors may be used to reattach it.

– Reconstruction: If the PCL is severely damaged, a graft (typically from the patient’s hamstring, patellar tendon, quadriceps or peroneal tendon) is used to replace it.

Recovery Time

– Non-surgical: 6-12 weeks with rehab
– Surgical: 6-12 months for full recovery.
– Full recovery: can take 6-12 months, depending on the severity of the injury and adherence to rehabilitation.