Meniscus Suture - Information and Specialists

Meniscus suturing is a minimally invasive surgical procedure performed on the meniscus. It is also known as meniscus refixation (from the Latin: re = again, figere = to fasten). Fresh meniscus tears are particularly suitable for meniscus suturing. During the procedure, the surgeon repairs the meniscus tear using a special suture system. 

The goal of the surgery is to fully preserve meniscus function and minimize the risk of secondary damage. Meniscus suturing also helps prevent premature joint wear. 

During the surgery itself, your knee is not opened. Instead, the surgeon uses arthroscopy. This is a minimally invasive method for operating on your knee.

The main reasons for undergoing meniscus suture surgery are:

• Preservation of the meniscus
• Achieving pain relief
• Fully preserving the functionality of your knee
• Reducing the likelihood of premature joint wear
• Long-term ability to bear full weight
• Improved knee stability

However, the primary goal of meniscus repair is to prevent osteoarthritis: Meniscus suturing reduces the risk of long-term damage to the articular cartilage in the knee joint (knee osteoarthritis).

Knee arthroscopy serves both as a diagnostic and surgical procedure.

Depending on the findings, meniscus repair is performed on an outpatient basis under either spinal or general anesthesia. 

If there are significant reasons (pre-existing conditions, risks, concomitant injuries, etc.) against outpatient treatment, the procedure can also be performed on an inpatient basis.

Arthroscopy requires two small incisions in the knee joint. Through these so-called “keyhole” incisions, the surgeon inserts a small camera and the suture material. 

The appropriate surgical procedure depends on the location and nature of the meniscus tear. The specialist performing the procedure is a board-certified trauma surgeon, typically with expertise in orthopedics and a specialization in knee surgery.

The following methods are used:

• All-Inside Technique

The All-Inside technique allows for meniscus suturing without the need for an additional skin incision. Your doctor places two small anchors (barbs) behind the base of the meniscus on the joint capsule. A pre-tied knot secures the suture. The technique is considered stable but is not suitable for every tear. Meniscus suturing is primarily suitable for the posterior portions of the menisci, where most tears occur.

• Outside-In Technique

In the outside-in technique, your doctor inserts needles through the skin from the outside into the interior of the knee. He pulls the suture material through and ties it in front of your joint capsule. This technique is primarily used for tears in the anterior portion of the menisci.

• Inside-Out Technique

The inside-out technique is suitable for tears that are more difficult to access. Here, your doctor uses a longer, curved needle. He guides the suture thread through the meniscus from the inside of the joint to the outside. He makes a small incision in the skin, which he uses to tie off the suture thread.

In a meniscus tear, the meniscus is either torn in several places or completely severed @ bilderzwerg / AdobeStock

The most important part of follow-up care is physical therapy lasting about three months.

In addition, a recovery period of about 3–6 months is required. You should avoid high-impact sports, including all stop-and-go activities, during this time.

Joint-friendly sports such as cycling, swimming, and gym workouts are permitted again starting in the seventh week.

Depending on the type of surgery, you may only bear limited weight on your knee for four to six weeks. Limiting the range of motion when bending the knee is crucial to keeping the load low.

If you have a physically demanding job, your doctor will place you on sick leave. Typical durations range from two weeks to two months.

In rare cases, the meniscus suture may tear. This would require another surgery.

All other complications are extremely rare with this routine procedure and are complications that can generally occur with any surgical procedure:

• An immediate risk of infection, which is well below one percent. 
• Unknown allergies, such as to certain medications administered during the procedure or to materials like latex.
• Another rare complication is deep vein thrombosis in the leg or a pulmonary embolism (thrombosis in the pulmonary vessels). This risk is minimized through the prophylactic administration of anticoagulant medications (e.g., heparin injections) until mobility is regained.
• In addition, minor injuries to joint structures may occasionally occur, as well as more frequent temporary joint effusions. 
• Nerve injuries are very rare and are also temporary in nature.

From a clinical perspective, the success rate is 85 percent. However, the individual outcome for each patient depends on the nature and duration of the injury. It all comes down to the initial situation, so to speak: Was the injury caused by an accident, or is it due to wear and tear?

Other factors, such as age, body weight, and overall physical condition, are also crucial for long-term treatment success. 

Furthermore, a straight leg axis is important to prevent further meniscus tears.

A meniscus tear can be effectively treated with meniscus suturing. This routine surgical procedure is recommended to help your knee joint regain full range of motion. In addition, the procedure helps prevent osteoarthritis in the long term and restores a symptom- and pain-free knee joint following an injury.