Meniscal repair, performed through the technique of meniscal suturing, is nowadays a fundamental procedure to treat meniscal tears while preserving the meniscus’s function and preventing long-term joint issues. The evolution of surgical techniques has made it possible to perform these procedures arthroscopically, minimizing invasiveness and promoting faster recovery.
We will explore the topic through the following sections:
Anatomy and Function of the Meniscus
The medial and lateral menisci of the knee are semicircular fibrocartilaginous structures that act as shock absorbers and transmit forces between the femur and tibia. They are often subject to injuries, which can vary in severity and may be either repaired or trimmed depending on the patient’s characteristics and the nature of the tear. Injuries to this crucial component of the knee can result from trauma or degenerative wear and significantly affect mobility and quality of life.
Structure and Types of Meniscal Injuries
Meniscal injuries can be classified according to their shape and location and include longitudinal, transverse, radial, or bucket-handle tears. The severity and type of lesion directly influence the therapeutic approach and recovery outlook.
Symptoms and Diagnosis of Meniscal Tears
Typical symptoms include pain, swelling, difficulty with knee flexion and extension, and sometimes a sensation of joint locking. Diagnosis involves medical history, physical examination, and imaging techniques such as MRI.
Arthroscopic Meniscal Repair Techniques
Basic Principles of Arthroscopy
This minimally invasive technique uses a camera and specialized surgical instruments to repair or partially remove the damaged meniscus without the need for large incisions.
Repair Methods: Suturing vs. Meniscectomy
The choice between meniscal suturing or meniscectomy (partial meniscus removal) depends on the location and nature of the tear. Suturing is preferable as it aims to preserve meniscal structure and function.
The advantages of suturing include maintaining the meniscal tissue, reducing the risk of osteoarthritis, and improving long-term joint function.
Meniscectomy, while sometimes necessary, may increase the risk of joint degeneration over time due to the reduced load-distribution capability of the knee—especially when more than 50% of the meniscus is removed.
The Arthroscopic Repair Process
Arthroscopic meniscal repair follows a standardized procedure, including pre-operative preparation, surgical intervention, and post-operative care.
Hospitalization is usually conducted in a Day Surgery setting, with patients admitted in the morning and discharged in the afternoon. Preparation involves a complete evaluation, fasting before surgery, and planning for rehabilitation.
Diagnosis of meniscal tears is confirmed through clinical tests and detailed MRI analysis, which is essential during outpatient consultation.
Surgical Procedure Description
During the arthroscopic procedure, small incisions are made to insert the camera and instruments (Fig. 1).
Meniscal sutures are performed with specific techniques to optimize healing.
Similarly, meniscal trimming (meniscectomy) is also performed arthroscopically (Fig. 2).
Removing more than 50% of the meniscus increases the risk of developing knee osteoarthritis. [1]
Repairing the meniscus through suturing is preferable, as it helps prevent joint degeneration.
This can now be achieved using automatic suturing devices (Figs. 3 and 4) via minimally invasive arthroscopic techniques (“closed technique”). [2–3]
Post-operative Care and Rehabilitation
Post-operative care includes rest, ice application, leg elevation, and medications to manage pain and inflammation.
The knee is sometimes immobilized with a brace in extension for a few days.
Rehabilitation begins with light exercises, progressively restoring strength and mobility.
Crutches are used initially and gradually discontinued. Typically, patients can return to daily activities within 20 days and resume sports after about 45 days.
In the case of meniscal suturing, timelines are longer: everyday activities resume after about 45 days, and sports after 3–4 months.
Post-operative Outcomes and Prognosis
The prognosis after meniscal suturing is generally positive, with high success rates. Patient age, lifestyle, and the type of injury can influence recovery times and surgical success.
When can you walk after a meniscal suture?
Walking with crutches is usually possible the day after surgery, based on the surgeon’s instructions.
Pain is usually mild to moderate and can be easily managed with painkillers. Walking begins immediately post-op and continues over the following days, initially aided by crutches.
How long should you rest after meniscal surgery?
Absolute rest is recommended for the first 24–48 hours, followed by gradual activity increase. Walking progressively normalizes thereafter.
Running and strenuous activities should be avoided for the first 10–15 days to prevent knee swelling. After the first week, patients may begin rehab exercises to maintain mobility and muscle tone.
How long do you need crutches after a meniscal suture?
Crutch use varies from a few days to several weeks, depending on surgical severity and medical advice.
When to bend the knee after arthroscopy?
Knee flexion may begin immediately post-op under physical therapy supervision, following a specific rehab program. From day two, patients usually start quadriceps and hamstring isometric contractions, calf isotonics, and progressive stretching exercises in flexion and extension.
How long does physiotherapy last after knee arthroscopy?
The duration of physiotherapy varies individually but commonly extends over weeks or months for complete recovery.
When can you shower after knee arthroscopy?
Showering is typically allowed 48 hours after surgery using waterproof dressings, avoiding direct contact with the incisions until they’re fully healed and sutures are removed (about 21 days).
How should you sleep after knee arthroscopy?
It’s recommended to sleep with the knee slightly elevated using pillows to reduce swelling.
Meniscal Repair and Suturing in Arthroscopy: Prof. Marcheggiani Muccioli’s Background
Prof. Giulio Maria Marcheggiani Muccioli has distinguished himself in orthopedics, graduating with honors in Medicine and Surgery at the University of Bologna in 2006, specializing with honors in Orthopedics and Traumatology at the Rizzoli Orthopedic Institute, and earning a PhD in Surgical Sciences.
He is an Associate Professor of Orthopedics at the University of Bologna’s Faculty of Medicine and Surgery, with a focus on biomechanics and lower/upper limb pathology.
He expanded his expertise through international fellowships in the UK, Japan, and the USA, establishing himself as an orthopedic surgeon with extensive experience, performing over 250 surgeries annually.
He plays a key role in training new generations of doctors through academic teaching in various medical and surgical disciplines.
He is one of only ten Italian surgeons selected in the last 20 years by the American Knee Society for the prestigious John Insall Knee Surgery Fellowship. His contributions include over 250 scientific publications and constant academic and conference involvement, demonstrating his commitment to advancing minimally invasive techniques, sports medicine, and innovations in knee and shoulder treatment.
Bibliography
- Knee joint changes after meniscectomy. Fairbank TJ. J Bone Joint Surg Br. Nov 1948;30B(4):664-670.
- Unicompartmental osteoarthritis: an integrated biomechanical and biological approach as alternative to metal resurfacing. Marcacci M, Zaffagnini S, Kon E, Marcheggiani Muccioli GM, et al. Knee Surg Sports Traumatol Arthrosc. 2013 Nov;21(11):2509-17.
- Le suture meniscali. Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Visani A, Marcacci M. In: Adravanti P., Denti M., Mazzola C., Randelli P., Zorzi C. Artroscopia base ed avanzata. 2012 – CIC Edizioni Internazionali. Capitolo 22, pp. 191-200.
- Arthroscopic treatment for symptomatic discoid lateral meniscus during childhood. Stilli S, Marchesini Reggiani L, Marcheggiani Muccioli GM, et al. Knee Surg Sports Traumatol Arthrosc. 2011 Aug;19(8):1337-42.
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