Dr. Millstein: We're now getting ready for a Meniscus surgery; this is an arthroscopic
surgery of the knee.
It's the most common surgery performed by orthopedic surgeons.
The meniscus is call fibril cartilage.
It's actually a piece of tissue that works as a shock absorber in the knee.
It helps protect the cartilage that lines the bones and prevent arthritis.
When we're young, the meniscus is soft and moist and as we get older, it gets a bit harder
and dried out6, and it tends to tear over time, even from no injury.
Our goal today is to remove the torn piece and to help allow the healthy remaining meniscus
to continue to cushion the knee and act as a shock absorber.
Typical signs and symptoms of a meniscus tear are pain either on the inner or outer side
of the knee that often radiates to the back of the knee.
This pain can occur with walking, jumping, running or sometimes just standing up from
a chair.
The best way to diagnose a meniscus tear is by physical examination.
Often, your physician or surgeon will order an MRI to confirm that diagnosis.
Fortunately, MRIs are about 99% accurate in diagnosing a meniscus tear.
This surgery for a torn meniscus first involves, like any arthroscopic surgery, a diagnostic
arthroscopy -- that's just a formal name for looking around.
I'll put the camera in the knee through a small incision and then have a second incision
for tools and instruments.
I'll look at all parts of the knee, including the inner or medial aspect, the lateral or
outer aspect, as well as the kneecap joint and we call it the Patella femoral joint.
I'll look at the cartilage, the meniscus on both sides.
The ACL and PCL of the ligaments that we hear about athletes injuring, as well as other
places in the knee to look for problems that need to be addressed.
The surgery lasts about an hour.
Patients typically go home an hour later with very little pain.
Some patients will take pain pills for a day or two after surgery.
Most people are up walking around within two or three days and back to everyday normal
activities by three or four days.
Patients often come back to my office in a week with significant pain relief, meaning
they feel much better that they did before surgery.
Then they'll either start to exercise on their own or go to a physical therapist for rehabilitation/
I tell patients they can expect to be 80 to 85% better and back to their full activities
in one month and 90 to 95% at two months.
Here's the inner compartment or medial compartment of the knee.
You can see the thigh bone right here; it's round, it's smooth and has healthy-looking
cartilage.
Down here is the shinbone, it's more flat but also smooth with health-looking cartilage
and in between is the meniscus.
It's this pad right here.
It's shaped like a C, it starts in front here... tight here, it shoots around here so it's
shaped like a C and it should be perfectly smooth everywhere.
The reason we're here today is because this meniscus is torn, so first of all you can
see this frayed area, it doesn't look very healthy.
Then if you feel and reach, this piece is all torn.
You can see underneath, this area is all torn all the way beneath the meniscus, and that's
the reason for her pain.
There's also tearing way at the back here.
That piece is flipped up, it should be sitting down properly; that's torn as well.
So we use some specialized instruments to start cutting away the torn meniscus.
This is an instrument that has sharp cutting teeth that open and close; it allows us to
cut just the torn part, and leave the healthy part.
We now use a shaver, which is a tube which suctions.
You can see when I turn the suction on, things get drawn in and then the teeth rotate, so
it cuts bad tissue to get sucked into here.
Now we'll use the suction and the teeth together.
It sucks in bad tissue, cuts it and leaves the bad tissue intact.
And the key is to leave healthy tissue that's smooth and not going to be prone to tearing
again in the future.
Now we're done, you can see that there's now a smooth margin with no more loose pieces.
I can't pull at anything; when I pull it stays put.
That's a nice healthy what we call meniscus rib.
There's still some meniscus left here at the back we can see, but the torn portion is gone.
When she stands up and these two bones touch again, the meniscus will be a cushion rather
than a hindrance or a mechanical irritant.
She should have a pain-free knee, hopefully in a couple of weeks when she's rehabilitated
from the surgery.
So that patient with the meniscus surgery should have excellent pain relief.
As you can see from the video, this procedure moves relatively quickly and is completed
in a short period of time, and that allows the patient to wake up from the anesthesia
quickly and get home, usually with very little pain, and get back to their daily activities
within a week or so, and hopefully return to sports within the next three to four weeks.
That's the great benefit of doing a surgery like this at an outpatient surgery center
like La Peer.
We have fantastic staff here that make the preoperative process, the check-in process
very easy and comfortable.
We have excellent anesthetic staff and surgical support, and that allows the surgery to move
smoothly.
Our post-operative nurses are also excellent, paying close attention to pain management
and making our patients comfortable before they go home.
All the other patients here are here with similar problems.
Nobody is ill, nobody is here because they have an infection; everyone's here because
they have a problem that can be properly managed at an excellent outpatient surgery center
with a friendly staff, and get home safe and recover quickly.