Back

I was in Europe last month when I suddenly found myself in need of knee surgery. I had an old meniscal tear that locked up on me while I was playing soccer with some friends. Wrenched the heck out of my knee and what was left of the meniscus. A surgeon here did an operation called a CMI, and now I'm headed home with a brace on my knee but no idea what's next. What is next?

The first order of business is to find an orthopedic surgeon who can follow up on your care. If you have a primary care physician, he or she will help guide you through the referral process. If you are a university student with student health coverage, then the clinic there will be your first stop. The type of procedure you had done is called cartilage meniscus implantation or (CMI). CMI is designed to regenerate damaged cartilage instead of just removing it. This is important because studies show that meniscectomy (surgical removal of any part of the meniscus) can lead to early degenerative changes and osteoarthritis of the knee joint. A mesh of tissue from bovine (cow) tendon) has been developed for this purpose. The mesh or "scaffold" as it is called is used to fill partial defects (holes or lesions) in the meniscus. After removing the flapped over or torn piece of meniscus, the remaining meniscus is smoothed and shaped carefully to accept the graft. Tiny holes are drilled around the edges of the defect. This step helps create some bleeding that will aid healing and recovery. Once the implant is placed in the hole, the edges are stitched down to hold it in place. After surgery, a knee brace is used to hold your knee in full extension (completely straight) for six weeks. The idea of such a brace is to prevent load or compressive force through the joint that could disrupt the healing process. Most of the time, patients take the brace off three to four times each day (every four to six hours during the waking day) and use a device called a continuous passive motion (CPM) machine. The machine is set to gently but passively (no effort on your part is required) bend the knee up to about 60-degrees of flexion. After two weeks, the machine is reset to move your knee up to 90-degrees. In the final two weeks, full passive motion is allowed. At first, patients are placed on crutches and all weight must be kept off the surgical leg. Isometric exercises to contract and relax the leg muscle are allowed (actually required) from day one. Two weeks post-op, you will be instructed to start putting partial weight through that leg. And you will probably be progressed to start some cycling on a stationary bike. All of this is usually done under the supervision of a physical therapist. The rehab program is gradually moved along from a passive to very active approach. Strengthening exercises and other activities are part of the program until you are able to return to full motion, strength, and function. The entire rehab process can take four to six months or more. Every surgeon has his or her own preferences for their patients after surgery. The protocol described here may not be exactly the way it is done where you go for follow-up. But it gives you a general idea of what to expect.

« Back