Arthroscopic Meniscectomy

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • General indications:
    • Failure of nonoperative management
      • Nonoperative management includes activity modification, antiinflammatory medications, and rehabilitation.
      • Intraarticular steroid injections are also helpful.
    • Ongoing daily symptoms that interfere with activities of daily living or sporting activities
CONTRAINDICATIONS
  • Some meniscal lesions do not necessarily require operative intervention:
    • Vertical longitudinal tears that are stable to probing and are less than 10 mm
    • Partial thickness tears that involve less than 50% of the meniscal thickness and are stable to probing
    • Radial tears less than 3 mm
  • Significant osteoarthritis is a relative contraindication.
  • Some meniscal lesions can be repaired.
    • The most common criteria for meniscal repair include:
      • A vertical longitudinal tear more than 1 cm in length located within the vascular zone
      • A tear that is unstable and displaceable into the joint
      • An informed and cooperative patient who is active and under 40 years of age
      • A knee that either is stable or will be stabilized simultaneously with a ligamentous reconstruction
      • A bucket handle portion and remaining meniscal rim that are in good condition
EQUIPMENT
  • Standard knee arthroscopy set
ANATOMY
  • Differences between medial and lateral meniscus:
    • Medial is more semicircular.
    • Medial is larger.
    • Medial is anchored more securely to joint capsule.
      • Medial is attached securely to medial collateral ligament (MCL).
      • Lateral is not attached to lateral collateral ligament (LCL).
    • Medial undergoes less displacement on knee flexion.
  • Medial meniscus attachments
    • Anterior horn anchored immediately in front of anterior cruciate ligament (ACL)
    • Posterior horn anchored between posterior cruciate ligament (PCL) and posterior attachment of the lateral meniscus
  • Lateral meniscus attachments
    • Anterior horn anchored immediately posterolateral to ACL attachment
    • Posterior horn anchored anterior to posterior attachment of medial meniscus
    • The posterior horn of the lateral meniscus has a variable meniscofemoral ligament.
  • Primarily composed of type I collagen
  • The medial and lateral inferior genicular arteries supply the menisci.

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
TECHNIQUES
  • Post-Procedure: Vertical Longitudinal (Bucket Handle) Tears
  • Post-Procedure: Horizontal, Oblique, Radial, and Complex Tears

Post-Procedure: Vertical Longitudinal (Bucket Handle) Tears

POST-PROCEDURE CARE
  • Immediate full weight bearing
  • Active and passive range-of-motion exercises begun immediately postoperatively
  • NSAID at 2 weeks
  • Return to full activity typically at 4-6 weeks, when there is full range of motion
COMPLICATIONS
  • Deep vein thrombosis
  • Recurrent effusions
  • Incomplete removal of tear
  • Iatrogenic injury
  • Synovial cutaneous fistula
ANALYSIS OF RESULTS

Partial meniscectomy achieves good to excellent results in approximately 90% of patients at 4 years of follow-up.

OUTCOMES AND EVIDENCE
  • Bucket handle tears
    • Partial meniscectomy with preservation of meniscal rim
    • Schimmer et al reported 92% good to excellent results at 4-year and 78% at 12-year follow-up after arthroscopic partial meniscectomy in 119 patients.
      • Articular cartilage damage was the main determinant of long-term function.
        • 62% of patients had good to excellent results if chondral damage was present.
        • 95% had good to excellent results if normal articular cartilage was present at the time of arthroscopic surgery.
Procedure: Vertical Longitudinal (Bucket Handle) Tears

Post-Procedure: Horizontal, Oblique, Radial, and Complex Tears

POST-PROCEDURE CARE
  • Immediate full weight bearing
  • Active and passive range-of-motion exercises begun immediately postoperatively
  • NSAID at 2 weeks
  • Return to full activity typically at 4-6 weeks, when there is full range of motion
COMPLICATIONS
  • Deep vein thrombosis
  • Recurrent effusions
  • Incomplete removal of tear
  • Iatrogenic injury
  • Synovial cutaneous fistula
ANALYSIS OF RESULTS

Partial meniscectomy achieves good to excellent results in approximately 90% of patients at 4 years of follow-up.

OUTCOMES AND EVIDENCE
  • Bucket handle tears
    • Partial meniscectomy with preservation of meniscal rim
    • Schimmer et al reported 92% good to excellent results at 4-year and 78% at 12-year follow-up after arthroscopic partial meniscectomy in 119 patients.
      • Articular cartilage damage was the main determinant of long-term function.
        • 62% of patients had good to excellent results if chondral damage was present.
        • 95% had good to excellent results if normal articular cartilage was present at the time of arthroscopic surgery.
Procedure: Horizontal, Oblique, Radial, and Complex Tears
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