Arthroscopic meniscectomy

Chapter synopsis

• Meniscal tears are common. Partial meniscectomy is indicated when patients have persistent mechanical symptoms. Proper use of arthroscopic tools and portals allows for a successful meniscectomy. Good to excellent results can be achieved in the appropriately indicated patient.

Important points

• Repair the meniscus if possible

Indications

• Symptomatic meniscal tears that have failed conservative measures

• Locked knee with an irreparable meniscus tear

• Acute tears causing mechanical block

Contraindications

• Septic knee

• Significant medical comorbidities

• Significant osteoarthritis

Classification

• Description of meniscus tear by tear location and tear pattern

Surgical technique

• Proper arthroscopic setup

• Be comfortable with a variety of portals or viewing angles

• Have a complete set of meniscal biters

• Variety of shavers

• Utilization of percutaneous “mini” release/“pie-crusting” of the medial collateral ligament (MCL) if needed for exposure

Clinical and surgical pearls

Use of instruments

• Keep meniscal baskets in contact with meniscus at all times for consistent resection

• Appropriate resection may require the use of other portals or 90-degree side-biters or back-biters

Resection of meniscus

• Preserve the meniscocapsular junction

• Smooth edges

• Conservative resection

Clinical and surgical pitfalls

• Iatrogenic cartilage injury

  • Make sure you have adequate visualization

  • Ensure controlled entry and removal of instruments

  • Percutaneous “mini” release/“pie-crusting” of the MCL for medial lesions if needed