Preparing for Arthroscopic Meniscus Surgery: A Checklist

Preparing for Arthroscopic Meniscus Surgery: A Checklist

A practical guide to preparing for arthroscopic meniscus surgery: pre-operative tests, medicines, fasting rules, exercises to learn in advance, getting your home ready and how long you stay in hospital.

Arthroscopic meniscus surgery, often called keyhole meniscus surgery, uses a small camera and fine instruments inserted through a few tiny incisions to either repair a torn meniscus or trim the part that cannot be repaired. Most patients go home the same day or after one night in hospital. Preparing well means completing pre-operative tests on time, reviewing your medicines with your doctor, following the fasting rules, setting up your home for the first days after surgery and learning some simple muscle exercises in advance.

This guide sets out what to do between the decision to operate and the day of surgery as a practical checklist, followed by what to expect on the day itself and during your hospital stay.

What is arthroscopic meniscus surgery?

Knee arthroscopy allows the surgeon to see inside the joint with a pencil-thin camera, usually through two or three small incisions. Depending on the type, location and tissue quality of the tear, there are two main approaches:

• Meniscus repair: suitable tears in areas with a good blood supply are stitched to preserve the meniscus. Recovery takes longer, and weight-bearing and bending may be restricted in the first weeks.
• Partial meniscectomy: the damaged portion that cannot be repaired, or that is causing catching, is removed while preserving as much healthy tissue as possible. Return to daily activities is usually quicker.

The approach is usually planned using MRI and examination, but the final decision may be made during surgery once the tear is seen directly. That is why it is worth discussing both possibilities, and how each affects recovery, with your surgeon beforehand. Our article on meniscus repair versus trimming explains the difference, and how knee arthroscopy is performed walks through the procedure itself.

Pre-operative tests and the anesthesia consultation

A few days before surgery, or on the morning of the operation, some tests are usually done. Their scope depends on your age and other health conditions:

• Basic blood tests such as a blood count, clotting tests and biochemistry
• An ECG and sometimes a chest X-ray, depending on age and heart health
• Assessment by the relevant specialist if you have heart, lung or diabetic conditions
• A consultation with the anesthesiologist to discuss the type of anesthesia, such as spinal or general, previous experiences with anesthesia and any allergies

Tell the team about every medicine, herbal product and supplement you take, along with previous operations and drug allergies.

Medicines, smoking and general health in the days before

Some medicines may need to be paused or adjusted before surgery. This decision is always made by your doctor; do not stop medicines on your own.

• Blood thinners: if you take aspirin, warfarin or newer anticoagulants, the prescribing doctor and your surgeon will decide together when to pause them.
• Diabetes and blood pressure medicines: agree in advance how to take them during the fasting period.
• Herbal products and supplements: some can increase bleeding, so stopping them for a while before surgery is often advised.
• Smoking: stopping or cutting down before surgery can support wound healing and, particularly after a meniscus repair, tissue healing.

If you develop a fever, cough or other sign of infection, or notice a cut, graze, spot or skin infection on the leg to be operated on, let your team know; the operation may need to be postponed. Do not shave the leg with a razor yourself; if hair removal is needed, the hospital will do it appropriately.

Exercises and crutch practice before surgery

Working your thigh muscles and learning your post-operative exercises in advance makes the first days easier. As long as they do not increase your pain, these simple movements are usually suitable:

1. Quadriceps sets: lying on your back, press the back of your knee into the bed and tighten the thigh muscle for 5 seconds; repeat 10–15 times.
2. Straight-leg raises: with the knee straight and the thigh muscle tight, lift the leg a hand's width and hold for 3–5 seconds.
3. Ankle pumps: move your ankle up and down; this is also used after surgery to support circulation.

It also helps to practice walking with crutches beforehand. How much weight you can put through the leg afterwards depends on the procedure: after a partial meniscectomy you can often bear weight as tolerated, whereas after a repair weight and bending may be restricted in the first weeks.

Preparing your home for the first days

• Remove rugs, cables and clutter you could trip over, and keep everyday items within easy reach.
• Have an ice pack or gel pack ready for cold therapy.
• Set aside shorts or loose trousers that fit easily over a bandaged knee.
• Arrange for someone to take you home and stay with you the first night; you should not drive after anesthesia.
• Consider a non-slip bath mat and a shower stool.
• If you work at a desk, discuss your return-to-work plan with your employer in advance.

Questions to ask your surgeon before the operation

• Is a repair or a partial meniscectomy planned for my tear, and could the plan change during surgery?
• How much weight can I put on the leg afterwards, and will I need crutches or a brace?
• When does physiotherapy start, and which exercises should I do at home?
• How should I care for the dressing and when will the stitches come out?
• Which symptoms mean I should contact you before my follow-up date?

The day of surgery: how long will you stay in hospital?

Follow the fasting instructions you are given carefully. You will usually be asked not to eat solid food for a set period before surgery and not to drink for a shorter period; timings vary by hospital and anesthetic plan, so go by the instructions you receive. Remove jewelry, make-up and nail polish, and leave valuables at home.

The length of the operation depends on the procedure: a partial meniscectomy is usually brief, while a repair or additional procedures take longer. Afterwards you will be monitored in the recovery area for a few hours. If your pain is controlled, you can pass urine and walk safely with crutches, many patients go home the same day and some after one night. Ask for written instructions on medication, dressings and showering, your exercise program and your follow-up date.

When should you contact an orthopedic surgeon?

• Fever, signs of infection or a skin wound on the operative leg in the days before surgery
• A knee that locks in one position and will not straighten, which may mean surgery needs to be brought forward
• A fever above 38°C, wound discharge or increasing redness after surgery
• One-sided calf swelling and pain; go to the emergency department for shortness of breath or chest pain
• Pain that keeps increasing and does not respond to painkillers

In Prof. Dr. Gökhan Polat's practice, the tear type, age, activity level and expectations are considered together before meniscus surgery, and the expected post-operative plan is shared with the patient in advance. For more on treatment options, see our page on meniscus tears.

In summary

• Arthroscopic meniscus surgery either repairs the meniscus or trims the part that cannot be repaired, depending on the tear.
• Pre-operative tests, a review of your medicines and following the fasting rules are key to a safe process.
• Learning thigh exercises and crutch walking in advance makes the first days easier.
• Most patients go home the same day or after one night, although this varies from person to person.

This article is for general information only; diagnosis and treatment decisions are made individually after examination and the necessary tests.