MENISCUS ROOT REPAIR
The meniscus is a pliable substance made up of soft tissue that sits between the two bones of the knee joint, the femur (thigh bone) and tibia (shin bone). Some patients with meniscus tears can be treated with a combination of activity modification and a focused physical therapy program. Other patients with persistent symptoms or certain tear patterns require surgery.
The meniscus attaches to the tibia bone at two points, one in the front of the knee (anterior root) and one in the back of the knee (posterior root). In patients with a root tear, the tension in the entire meniscus is lost, and Dr. Keller usually recommends surgical repair to restore the function of the meniscus.
If Dr. Keller recommends meniscal repair, he will repair the meniscus with strong sutures using a minimally invasive technique (arthroscopic technique). During surgery, Dr. Keller passes the sutures through each side of the torn meniscus with sharp needles or a “suture-passing” device. Dr. Keller then uses a device to create a small tunnel(s) in the tibia bone. Next, Dr. Keller pulls the sutures (already passed through the meniscus) out through the tunnel(s) in the tibia bone. Finally, Dr. Keller ties the sutures over a “button” on the front of the tibia with square knots. This technique is called a “transtibial pullout repair.”
Following surgery, patients are placed in a hinged brace that is locked straight. Dr. Keller recommends partial weight bearing for 4-6 weeks in the brace. When the patient is sitting or lying down, Dr. Keller encourages knee range of motion exercises with the brace removed. Dr. Keller also recommends intermittent icing and straight leg raises to strengthen the quadriceps muscles. Dr. Keller recommends starting formal physical therapy one week after surgery. Physical therapy focuses on reducing swelling in the knee, restoring full range of motion, and eventually, restoring strength to the knee. Most patients can start full weight bearing on the affected leg 4-6 weeks after surgery. Most patients start cutting activities and sporting activity approximately 4-6 months after surgery.