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Treatment

Meniscal Root Repair

Dr. Pramod Bhor - Expert Orthopedic & Joint Replacement Surgeon

Dr. Pramod Bhor

Expert Meniscal Root Repair Surgeon

Meniscal Root Injury. The root attachments of the posterior horns of the medial and lateral meniscus play a critical role in maintaining joint health. When these attachments are torn, it can lead to increased joint loading, similar to having no meniscus on the affected side. Consequently, patients may be at risk of early-onset arthritis, bony edema, insufficiency fractures, and potential failure of concurrent cruciate ligament reconstruction grafts. As a result, extensive research has been conducted on meniscus root repairs in recent years.

What's the process of Meniscal Root Repair?

The process of performing a meniscus root repair involves the isolation of the root, placement of at least two sutures in the remaining meniscal attachment, and an attempt to reposition it to a more anatomically correct location. In certain cases, the meniscus posterior horn may require release from scar tissue to enable repositioning. This step is crucial as current technology makes these repairs delicate, thus it's important to place the meniscus in a position where there is minimal tension on the repair during knee range of motion.

Following the arthroscopic placement of sutures into the meniscal attachment, a small-diameter tunnel, usually around 5 millimeters in size, is created to the meniscal root attachment site. The sutures are then pulled down the tunnel and tied over a button on the anterior cortex of the tibia. At this point, it's essential to assess the range of motion that can be safely performed to prevent excessive flexing during this time frame.

Post-Operative Protocol for Meniscus Root Repair

The post-operative protocol for meniscus root repair involves a more restricted progression of range of motion compared to standard meniscus root repairs. Typically, patients are limited to a range of motion of 0-60 or 0-90 degrees for the first 4 weeks, with a gradual increase in range of motion as tolerated. Weightbearing can be initiated at 6 weeks, but patients should avoid significant squatting, lifting, or sitting cross-legged for at least 5-6 months. They may begin using a stationary bike and gradually wean off crutches starting at 6 weeks post-operatively.

Literature findings suggest that meniscus root repairs have yielded encouraging results, but there is still room for improvement. These repairs have shown potential in delaying or improving the presence of bony edema and early-onset arthritis in many patients. Research has indicated that a single suture for the repair is not as effective, emphasizing the need for a minimum of 2 sutures to optimize meniscal healing. Ongoing studies in our research laboratory are focused on further understanding meniscus root tears and radial root tears to enhance the treatment of these complex issues.

Symptoms of a Meniscus Root Repair

  • Pain and discomfort around the knee joint
  • Swelling at the surgical site
  • Difficulty bearing weight on the affected leg
  • Limited range of motion in the knee
  • Sensitivity or numbness around the incision area
  • Muscle weakness in the leg
  • Stiffness in the knee joint

FAQs For Meniscus Root Repair

What is meniscus root repair?

Meniscus root repair is a surgical procedure that reattaches a torn meniscal root back to its attachment site on the tibia bone. The meniscal root is critical for maintaining the meniscus's function as a shock absorber, and when torn, it can lead to increased joint loading, early-onset arthritis, and other complications. The repair involves isolating the root, placing sutures in the remaining meniscal attachment, and repositioning it to its anatomically correct location.

How is the meniscus root repair performed?

Meniscus root repair is performed arthroscopically using minimally invasive techniques. The procedure involves: isolating the root, placing at least two sutures in the remaining meniscal attachment, repositioning it to an anatomically correct location, creating a small-diameter tunnel (around 5 millimeters) to the meniscal root attachment site, and tying the sutures over a button on the anterior cortex of the tibia. This technique ensures minimal tension on the repair during knee range of motion.

What are the benefits of meniscus root repair?

Meniscus root repair offers several significant benefits including: prevention of early-onset arthritis by restoring normal joint loading, preservation of knee function and shock absorption capability, reduction of bony edema and insufficiency fractures, improved outcomes for concurrent cruciate ligament reconstruction grafts, and potential to delay or prevent the need for knee replacement surgery. Research has shown that repairs using at least two sutures optimize meniscal healing and provide better long-term outcomes.

What is the recovery process like after meniscus root repair?

The recovery process after meniscus root repair requires a more restricted protocol compared to standard meniscus repairs. For the first 4 weeks, patients are typically limited to a range of motion of 0-60 or 0-90 degrees, with gradual increase as tolerated. Weightbearing can begin at 6 weeks, but patients should avoid significant squatting, lifting, or sitting cross-legged for at least 5-6 months. Stationary bike use may begin at 6 weeks, and crutches can be gradually weaned off starting at 6 weeks post-operatively. Physical therapy is essential for strengthening and regaining full function.

Are there any risks associated with meniscus root repair?

As with any surgical procedure, meniscus root repair carries some risks, though they are generally low. Potential risks include infection, blood clots, nerve or blood vessel damage, stiffness, failure of the repair, and persistent pain. However, the benefits of preventing early arthritis and preserving knee function typically outweigh these risks. It's important to follow your surgeon's post-operative protocol carefully to minimize complications and optimize outcomes.

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