Total (Full) Meniscectomy

SURGICAL REMOVAL OF THE ENTIRE MENISCUS WHEN REPAIR OR PARTIAL EXCISION IS NOT POSSIBLE

The meniscus is a vital cartilage structure in the knee that acts as a shock absorber and stabiliser between the thighbone (femur) and shinbone (tibia). Each knee has two menisci; one on the inner side (medial meniscus) and one on the outer side (lateral meniscus). These crescent-shaped structures play an essential role in distributing load during movement and protecting the joint surfaces from wear and tear.

Meniscus tears are common knee joint injuries, especially in young athletes. A total meniscectomy involves the complete removal of the meniscus and is typically reserved for cases where the meniscus is so severely damaged that it cannot be effectively repaired, or where removing only part of it would not sufficiently alleviate pain or restore knee function. By removing the entire meniscus, this procedure aims to eliminate symptoms and improve knee stability, although it may require longer-term lifestyle adjustments to protect the knee.

When a Total Meniscectomy may be recommended

Dr Liddell may recommend a total meniscectomy under these specific conditions:

Extensive Meniscal Damage: In cases of severe or widespread meniscal damage, particularly where degeneration has progressed extensively, complete removal may be the most effective way to relieve pain and prevent ongoing joint damage.
Complex or Irreparable Tears: Some tears occur in areas of the meniscus with very limited blood supply, where healing is unlikely. If these tears are extensive and cannot be repaired or partially removed, a total meniscectomy may be necessary.
Failed Previous Surgeries: For patients who continue to experience symptoms following previous surgeries, such as partial meniscectomy or meniscus repair, a total meniscectomy may be considered as a last-resort solution to manage pain and instability.

THE TOTAL MENISCECTOMY SURGICAL PROCEDURE

Total meniscectomy is typically performed using arthroscopic (keyhole) surgery, and involves:

Anaesthesia: To ensure comfort, you will receive either general anaesthesia (to put you to sleep) or spinal anaesthesia (which numbs you from the waist down).
Arthroscopic Procedure: A total meniscectomy is performed as a minimally invasive outpatient procedure using arthroscopy, allowing Dr Liddell to view and access the knee joint with minimal disruption to surrounding tissue. During the procedure, Dr Liddell will make small incisions around your knee to insert an arthroscope, a slender tube equipped with a camera that provides a detailed view inside your knee joint on a monitor. Additional small incisions allow the use of surgical instruments.
Removing the Meniscus: Dr Liddell will carefully detach the entire meniscus from its attachment points on the tibia and femur and remove it using arthroscopic instruments. Removing all damaged tissue helps eliminate pain and instability while preventing fragments from causing further issues.
Completing the Surgery: Once the meniscus has been completely removed, the surgical instruments are withdrawn, and the small incisions are closed with sutures or adhesive strips. The knee is bandaged, and you will be taken to a recovery area for post-operative care.

The procedure typically takes 30 to 60 minutes and is usually performed as day surgery, allowing patients to go home on the same day.

RECOVERY AFTER A TOTAL MENISCECTOMY

Recovery is generally faster than after meniscal repair, as there are no healing tissues that require protection. The entire meniscus is removed, the knee loses one of its main shock absorbers, which may have implications for long-term joint health.

Typical recovery timeline:

First Week: Patients are typically able to bear weight shortly after surgery, though crutches may be provided for support. Swelling and mild discomfort are common and can be managed with prescribed medications and regular icing. Gentle exercises are encouraged early on to maintain knee flexibility.
2 to 4 Weeks: As healing progresses, you’ll begin physiotherapy focusing on strengthening the muscles around the knee, particularly the quadriceps and hamstrings. These exercises help provide stability in the absence of the meniscus and are essential to supporting knee function.
4 to 6 Weeks: Most patients can resume regular daily activities at this point, though high-impact activities that could strain the knee should be avoided. Dr Liddell will guide you on appropriate activity levels and ensure your knee is recovering properly.
6 to 12 Weeks: By this stage, you can typically return to low-impact activities, although ongoing care is essential. Due to the absence of the meniscus, high-impact sports may increase the risk of joint wear, and long-term adjustments to exercise routines may be recommended to protect knee health. Maintaining a consistent physiotherapy regimen can be beneficial in preventing joint degeneration and supporting knee stability in the long term.

Dr Liddell will provide you with a tailored rehabilitation plan to support your recovery and guide your return to activity.

Risks and Long-Term Considerations

While a total meniscectomy can provide significant symptom relief in the short to medium term, it does come with some important long-term considerations:

Increased risk of osteoarthritis: Without the cushioning effect of the meniscus, joint surfaces are exposed to greater stress, which can accelerate cartilage wear over time.
Reduced shock absorption: The knee may be more sensitive to high-impact activity, especially running or jumping.
Changes in joint mechanics: Loss of the meniscus can slightly alter how the knee moves and feels, particularly during high-demand tasks.

To help mitigate these risks, Dr Liddell may recommend:

Low-impact exercise (e.g. swimming, cycling)
Maintaining a healthy weight to reduce joint stress
Ongoing physiotherapy to strengthen the surrounding muscles and support joint function
Regular monitoring to assess long-term joint health

In selected cases, future procedures such as meniscal transplantation or joint preservation surgery may be considered if symptoms return or arthritis progresses.