total medial meniscectomy

Medial meniscus total resection is used for surgical treatment of meniscus injury. Meniscus injury is one of the most common injuries in the knee, more common in young adults, more men than women. The ratio of internal and lateral meniscus injury is reported to be 4-5:1, while the domestic report is reversed, the ratio is 1:2.5, which may be related to congenital discoid malformation of the lateral meniscus. When there is a suspected meniscus tear in the fresh knee injury, the patient may have a magnetic resonance or knee arthroscopy. The light tearer at the edge of the meniscus, with the long leg plaster fixed knee in the straight position for 4 to 6 weeks, allowing the patient to use the crutches to carry weight, more can be cured. Surgery after symptomatic recurrence after conservative treatment. Recent studies have shown that after meniscus resection, there is a significant adverse effect on the joint. When the knee joint is active, the friction between the femoral condyle and the iliac crest is increased by about 20%. Under the same load, the stress on the articular cartilage surface is increased by more than 25%. . Decreased stability will promote the formation of cartilage degeneration and osteoarthritis. Therefore, most scholars tend to agree that for conditional cases, sutures can be performed without resection, partial resection can be performed without subtotal resection or total resection, and normal meniscus tissue is retained to maintain its main Physiological function. Meniscus resection should be based on: 1 type and extent of meniscus injury; 2 age and occupation of the patient; 3 technical proficiency of the surgeon and surgical equipment conditions. Treating diseases: meniscus injury Indication 1. Ineffective by non-surgical treatment, frequent interlocking and recurrent effusion, severe pain. 2. Congenital discoid cartilage or meniscal cyst, pain or affect joint activity. Contraindications 1. Patients with obvious degenerative changes in the knee joint, careful use of meniscus resection, unless the symptoms are severe and caused by meniscus injury. 2. If there is abrasion on the knee joint skin or infection in the body, the operation should be postponed. Preoperative preparation 1. Patients who have doubt before surgery, can be arthroscopically examined, and choose the surgical plan according to the microscopic findings and clinical manifestations. 2. In patients with obvious quadriceps atrophy, the quadriceps should be actively exercised before surgery to increase muscle strength in order to facilitate the recovery of postoperative limb function. Patients should be encouraged to do quadriceps contraction and straight leg raising exercises after surgery. 3. Meniscus injury has more effusion in the joints, to reduce knee joint activity before surgery, local physiotherapy, until the effusion subsided and then surgery. Surgical procedure Incision Most of the anterior medial arc incision was used, 1.5 cm from the inner edge of the humerus, downward and backward, and the curvature was convex to the front, 0.5 cm below the upper humerus articular surface, and about 4-6 cm long. 2. Exposing the joint Cut the skin and subcutaneous tissue, and pay attention to protecting the saphenous nerve and its underarm branches that travel to the outside. The saphenous nerve passes through the sartorius muscle, and the fascia is worn between the muscle and the gracilis muscle. It is located under the skin of the calf. The underarm branch leaves the inner side of the knee joint and dominates the anterior lateral skin of the knee joint. The fascia and joint capsule were cut on the same line to fully stop bleeding. The deep surface of the joint capsule is slightly separated from the synovial membrane, that is, the fat pad is seen and separated. Start from the femoral condyle, and cut the synovial membrane from the inside of the humerus and the medial side of the iliac crest 0.5 cm. Be careful not to damage the fat pad. At this time, there may be leakage of synovial fluid or hemorrhage, and the synovial incision is extended to both ends to absorb the joint fluid. 3. Exploring the structure of the joint Retract the synovial membrane and fat pad, expose 2/3 of the medial meniscus, first use the meniscus hook to retract, check the meniscus for damage and the location and type of injury, and then carefully observe other structures of the joint, such as articular surface, cross Ligaments and so on. Complete resection of the meniscus with severe tears; barrel stalk tear, longitudinal tear or transverse tear, should be used for partial meniscus resection or repair as described later. 4. Cut off the meniscus Use a small knife or narrow scissors to cut the anterior ligament of the meniscus under direct vision. Do not damage the anterior cruciate ligament near the anterior horn. Hold the anterior horn of the meniscus with a toothed hemostat and pull it outward to expose the edge of the outer edge of the meniscus connected to the synovial membrane. Cut the lateral margin, taking care not to injure the medial collateral ligament. At this time, the knee joint is flexed and ablated, the inner joint space is widened, the meniscus posterior angle is better exposed, and the meniscus is completely removed after cutting. It is more difficult to cut the posterior angle. Only when the assistant supports the knee joint position, recognize the posterior horn attachment part and carefully operate it. At the same time, pay attention to protect the posterior cruciate ligament, the iliac crest and the articular cartilage surface. 5. Check the joints After the meniscus is removed, it is necessary to check whether the cut specimen is intact, especially if there is any defect in the posterior horn, and there is no residual posterior angle of the meniscus in the joint cavity. If there is residue, it can be removed through the posterior medial incision. 6. Attach the posterior medial incision to remove the medial meniscus posterior angle For patients with narrow joint space and difficult to remove the intact medial meniscus, the posterior medial incision should be added, so that the posterior horn of the meniscus can be easily separated, and the joint capsule structure can be tightened and restored to overcome instability. The posterior medial incision is located between the posterior oblique ligament and the medial collateral ligament and is 4 to 5 cm long. After the synovial membrane is cut, the posterior horn of the meniscus is exposed, and the anterior and middle portions of the anterior medial incision are released into the posterior and middle portions of the meniscus through the deep side of the medial collateral ligament. The knee joint is flexed by 90°, and the knee is flexed gently. The free meniscus is free to cut the posterior horn of the meniscus under direct vision. Take care to protect the blood vessels during operation. The proximal ligament of the posterior oblique ligament is then sutured to the front of the femoral condyle, the distal end is sutured to the humeral condyle, and the central portion is sutured to the medial collateral ligament of the knee to restore the stability of the knee joint. 7. Close the incision The edge of the cut synovial membrane is sutured with a silk thread to make it everted, so as to reduce the foreign body stimulation in the joint, and then the joint capsule, the extensor device, the subcutaneous tissue and the skin are sutured according to the layer. complication Joint effusion It may be caused by rough operation, incomplete hemostasis or too early weight-bearing activity after surgery. Generally strengthen the quadriceps resistance to isotonic contraction, avoid stretching and flexing the knee, and the weight can be resolved by the late weight. If there is more effusion, the liquid can be taken out under strict aseptic operation and then bandaged with elastic bandage. 2. Joint blood In the meniscus resection, the blood vessels are damaged, or the knee is too tight, and the venous return is blocked. Uncoagulated blood can be withdrawn, and the frozen blood clots should be cut open and ligated to stop bleeding. 3. Joint infection Once the consequences of the infection are serious. The cause can be improper operation or infection in the body. The method of treatment is to use the antibiotics at the same time in the early stage, puncture the pus and rinse with the antibiotic-containing solution; the advanced patient needs to cut the pus, rinse it, use the antibiotic solution to rinse, stop the joint activity, and then start the activity after the infection subsides. . 4. Joint instability and pain Mostly caused by atrophy of the quadriceps muscle, generally through quadriceps exercise and physical therapy can be improved. 5. Neuropathic pain Common in medial meniscus surgery, damage to the suboccipital branch of the saphenous nerve caused by neuroma, clear tumor resection symptoms can disappear.

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