Knee Arthroscopy (Meniscus Trimming)

What it is

Each knee has two menisci: wedge-shaped pads of cartilage that sit between the thigh bone and the shin bone and spread load across the joint. A tear in one can catch, lock, or ache. In arthroscopic surgery the surgeon makes two or three small cuts around the knee, fills the joint with sterile fluid to open it up, and works with a camera and narrow instruments while watching a monitor. There are two quite different ways to deal with a torn meniscus: trimming the torn portion away, or stitching the tear so it can heal. They are separate operations with separate codes and different recovery times. This code is the trimming version, done on one meniscus.

Why it is done

• To treat a meniscus tear that is catching or locking the knee, or causing pain that hasn't settled with rest and other non-surgical care
• To remove a torn flap or a loose fragment of cartilage floating in the joint
• To look directly at the inside of the knee when imaging has not explained the symptoms

What to expect

The operation is usually outpatient, under general or regional anesthesia, and most people go home the same day. Crutches are common for a short while, and the surgeon typically prescribes exercises or physical therapy to get strength and motion back. Recovery from a trimming procedure is generally measured in weeks; a stitched repair takes longer, because the cartilage has to heal. Worth knowing before you decide: for degenerative meniscal tears and for knees with arthritis, the evidence that arthroscopy outperforms non-surgical treatment is contested, and some clinical guideline groups recommend against it in those situations.

Questions worth asking

• Is the plan to trim the tear or to stitch it? They are different codes at different prices, and the decision is sometimes made in the operating room.
• If both menisci or another part of the knee are treated in the same session, how does that change the billed codes and the total?
• Is this at a hospital outpatient department or an ambulatory surgery center, and what is the facility fee at each?
• How many physical therapy visits are expected afterward, what does a visit cost, and how many does my plan cover in a year?
• Is anesthesia billed by a separate group, and is that group in network?