medial meniscectomy

The meniscus itself has poor blood supply and weak repair ability. Once it is damaged, it is difficult to repair it by itself. If it is not treated in time, it can cause arthritis in the late stage. Therefore, patients diagnosed with meniscus injury, discoid meniscus, meniscus cysts should be removed early. After excision, it will be repaired by fibrous tissue to form fibrocartilage instead of meniscus function. If the treatment is correct, it generally does not affect the knee function. However, it should also be pointed out that meniscal resection is an intra-articular procedure that, if not handled properly, can cause complications and affect joint function. At the same time, the incision of this operation is small, and the meniscus is tightly embedded between the tendon, the femur, and the external malleolus. It is difficult to see all of the surgery during the operation. Only after the removal, the injury can be seen. The method of diagnosis is not appropriate. Therefore, the diagnosis must be confirmed before surgery, and timely surgical resection. Treatment of diseases: meniscus injury of meniscus injury Indication The meniscus itself has poor blood supply and weak repair ability. Once it is damaged, it is difficult to repair it by itself. If it is not treated in time, it can cause arthritis in the late stage. Therefore, patients diagnosed with meniscus injury, discoid meniscus, meniscus cysts should be removed early. Preoperative preparation 1. The diagnosis of meniscus lesions mainly depends on clinical symptoms and signs. The medical history and physical examination should be detailed before surgery to confirm the diagnosis. Those with a history of severe injury should pay attention to the combined damage of the ligament. Knee arthroscopy should be performed if necessary. 2. The pre-operative church encourages patients to exercise quadriceps to overcome the quadriceps atrophy caused by the knee; it is also necessary to pay attention to early exercise after surgery. 3. Check the general condition, if there is a purulent lesion, it should be cured first. Meniscus resection is an intra-articular procedure that should be prepared for the skin. Surgical procedure 1. Position: The patient is supine, the inflatable tourniquet is placed in the upper part of the thigh, the knee is routinely disinfected, and the foot and calf are wrapped with sterile dressing, the limb is raised, the blood is expelled, and the tourniquet is inflated. Shake the foot of the operating table so that the patient flexes 90° on both knees and the legs hang down. 2. Incision: starting from the medial edge of the middle part of the humerus, first parallel to the patellofemoral ligament, longitudinally downward, to the joint gap about 0.5cm, the arc is backward, and then parallel to the joint space, extending to the posterior part of the joint space. When cutting the skin and subcutaneous tissue according to the incision, pay attention to the subgingival branch of the saphenous nerve. The advantage of this incision is that the injury is small, the postoperative reaction is small, and the exposure is sufficient, and the anterior portion of the upper sac, the iliac cartilage surface, the knee articular cartilage surface, the cruciate ligament and the bilateral meniscus can be explored. 3. Cut the switch joint and probe: After cutting the skin and subcutaneous tissue, separate the flap and open it up and back to see the medial collateral ligament. On the anterior and posterior edges of the ligament, along the joint capsule fibers, each made a longitudinal incision. Before the incision, the blood vessels on the joint capsule should be sutured first. After cutting the capsule and the synovial membrane, there is synovial fluid overflow. Use two right angle hooks to gently extend into the joint capsule to open the anterior part of the medial and lateral meniscus, part of the anterior cruciate ligament, femoral condyle, The cartilage surface of the humerus and the sacral sac of the iliac crest should pay special attention to the presence or absence of softening of the tibial cartilage and the presence or absence of free body in the joint. If the front and inner sides of the medial meniscus are damaged, they can be seen; if the injury is on the back side, it is not easy to see. If there is no damage in the front of the medial meniscus, no other lesions are found in the joint, and the clinical diagnosis is clear, the meniscus should still be removed. 4. Excision of the meniscus: From the anterior incision of the medial collateral ligament, the anterior portion of the meniscus was cut with a sharp-edged knife and the anterior portion of the meniscus was clamped with a toothed hemostat. The anterior horn was attached to the anterior horn and the front part of the meniscus was released. Pull the meniscus forward and outward to reveal the junction of the body's edge and the medial joint capsule, and cut it with a meniscus knife or scissors against the edge of the meniscus. The free meniscus is then delivered from the anterior collateral ligament to the posterior incision. The posterior incision is opened with a meniscus hook, and the calf is abducted and externally rotated to expand the medial space of the knee joint. The meniscus is pulled in the forward direction, and under direct vision, the sharp edge of the meniscus is cut with a sharp-edged knife or a meniscus knife to cut the connection of the posterior portion to the synovial membrane. When cutting to the back angle, the meniscus knife is changed from the front to the back of the back corner to cut the back angle, completely free and remove the meniscus. 5. Stitching: After removing the meniscus, flush the joint with saline, loosen the tourniquet, carefully stop the bleeding, shake the foot of the operating table, and suture. The synovial membrane was sutured with a thin gut, and the other layers were sutured with silk thread. 6. Bandage: After suturing, stretch the knees, use a cotton pad to wrap around the knee joint, and then use a bandage to make a uniform pressure dressing from the foot to the thigh to stop bleeding and prevent fluid accumulation in the joint cavity.