As a surgeon specializing in minimally invasive arthroscopic treatment, I often encounter many patients from all over the province who come for consultation and treatment of joint diseases, the most common of which is knee meniscal injury. The patient groups range from adolescents to middle-aged and elderly, from general workers to housewives, clerks, athletes, etc. Due to the limitations of the examination methods and the lack of surgeons with specialized knowledge of joint diseases, many patients do not receive timely diagnosis and treatment at the time of their first onset or injury. This article is for those patients who are clearly diagnosed to need arthroscopic knee surgery, I hope it will help your condition. Do meniscal injuries require surgery right away? We have the following clinical indications for surgery: ① For adolescents with a clear history of strong external violence, such as sports, traffic injuries, accidental falls, etc., we recommend that surgery be completed within three weeks once the knee hematoma has been absorbed and the pain has subsided. This is because adolescents are in the peak of their growth and development, so if the knee meniscus injury is not treated in a timely manner, it will have a huge impact on their future life and work, and they may develop osteoarthritis early in their middle age. On the other hand, because adolescents are growing vigorously and are in good physical condition, early and timely arthroscopic surgery may be able to perform meniscal suturing or limited molding to promote self-healing of the injured meniscus, preserve the structure and function of the original meniscus to the maximum extent, and reduce the occurrence of sequelae. For patients who have a history of trauma but have been treated conservatively, we recommend surgery if they continue to experience recurrent knee pain with limited motion after three months of conservative treatment, especially when walking up and down stairs, squatting, standing and walking for long periods of time, and when they experience “interlocking, stuck” sensations when walking to a sharp stop, rising, or turning. This is due to the fact that the meniscus is not as strong as the knee. This is because due to the special structural characteristics of the knee meniscus, it is difficult to heal itself once it is injured. However, the damage to the meniscus itself does not heal completely or does not heal at all, and the discomfort in the knee joint soon returns when the patient stops taking medication or continues to engage in the original life and work behavior. It is for this reason that we recommend that patients who choose conservative treatment for meniscus injuries of the knee, once the symptoms have not been significantly relieved for more than three months or have reappeared after the symptoms have improved, do not wait for the results of the so-called conservative treatment and consider arthroscopic knee surgery to try to save the function of the joint and avoid serious sequelae. When a patient has acute “interlocking” meniscus rupture, that is, when the leg cannot be straightened or bent, surgery is needed to “unlock” the meniscus as soon as possible, which is usually seen in acute tears of the disc meniscus and “barrel This condition is usually seen in acute tears of the disc meniscus and “barrel-like” tears of the meniscus. What types of conditions should I not consider surgery for now? Since knee disease patients cover men, women, children, and all social and occupational groups, do we encounter patients who are not suitable for arthroscopic surgery in our daily work? The answer is yes, and the number of such patients is probably quite high. I will list the following most common cases for your reference: ① Patients who have already undergone invasive knee treatments such as small acupuncture, acupuncture, closed needle in the joint cavity, etc., or who have used some “secret recipes or plasters” on the knee joint. As a result of these operations and treatments, the injured knee joint becomes extensively red, swollen, hot, painful, has limited movement and even has skin blisters and ulcers. At this point, we are actually faced with a low level of intra-articular infection after knee treatment, and the original meniscal injury has become a secondary conflict. Routine knee arthroscopy not only does not help the swelling and fever symptoms to improve but can lead to the spread of infection and even to whole joint infection leading to bacteremia and sepsis. We ask the patient to undergo regular anti-inflammatory treatment and braking, which of course is slow and has more sequelae, but it is a desperate measure; ② The patient does show signs of meniscal damage, but also has stiffness in the morning when waking up, involuntary pain in multiple joints, and this pain is “symmetrical and wandering”. This often suggests that the patient may also have rheumatism, rheumatoid and other connective tissue diseases, simple arthroscopic treatment can not solve the patient’s systemic disease manifestations, the main focus is on internal medicine treatment, systemic comprehensive treatment; ③ patients really only simple meniscus injury, but dragged too long or did not face the disease itself, still barely engaged in work, in this case In this case, the patient has severe atrophy of the thigh muscles and ligamentous laxity around the knee joint, and in severe cases the good leg may be painful and uncomfortable. In this case, we often recommend that the patient temporarily refrain from surgery and concentrate on resting and exercising the muscle strength and ligament balance around the thigh, and then elective surgery after the above mentioned indexes have improved, so as to minimize poor postoperative recovery; ④ Although the patient shows clear signs of meniscal damage on the MRI, the main painful discomfort is the manifestation of articular cartilage softening and damage, and some patients even “it hurts to stand, and it hurts to walk a few steps less”. The patient may have a combination of knee cartilage, especially patellar chondromalacia, or even a degree of “anxiety” and other mental illness factors. ⑤ For meniscus injuries in middle-aged women, especially disc meniscus injuries, we must inform the patient that surgery can never solve all the problems and pains when the patient has all the characteristics mentioned above, and that it is often difficult to achieve the wish to solve all the existing discomfort without any sequelae and to be able to walk after getting off the ground. Especially in patients with combined intra-articular cartilage damage, the current treatment is limited, and even a perfect arthroscopic treatment can not end the process of cartilage softening and repair all the damaged cartilage, which also depends on the progress of medical science and technology. What are the preparations before surgery? For any surgical procedure, especially for elective surgery to improve bodily functions rather than to save lives, we require patients to be prepared for at least three things: ① Physical preparation Patients must maintain their physical health in a state where they can basically tolerate surgery and anesthesia normally, such as stable blood pressure for hypertensive patients, low and stable blood sugar fluctuations for diabetic patients, and long-term medication for patients such as Patients with chronic diseases such as asthma, emphysema, tuberculosis, gastroenteritis, etc. are in a stable state. In view of the fact that the incidence of anesthesia accidents can never be completely reduced to zero under the current scientific level, the anesthesiologist needs to be involved in assessing the patient’s physical status before surgery; ② Psychological preparation: the patient needs to be clear about his or her goals for surgery, preoperative and postoperative rehabilitation programs, what can and cannot be done, what problems the surgeon can help me solve, and what problems are temporary or may not be solved, and whether my treatment expectations Are they in line with the surgeon’s treatment expectations, etc. This is often overlooked by everyone in the daily surgical process. The body is the patient’s own, and all treatment results will eventually be reflected in his or her own body, so a clear understanding of surgery and reporting correct treatment expectations is very important for early postoperative recovery. The early post-operative rehabilitation process and possible sequelae require patients to leave the existing labor environment, and the corresponding losses must be prepared, which may be a degree of “paying for health”, otherwise, if patients continue to engage in inappropriate behavior, labor, it is likely to make the effect of surgery “This is the last thing we want to see in our clinical work, but we can never avoid it. Fourth, if I have a meniscectomy is there any after-effects? Is it always better to have meniscus suture? As mentioned before, if the patient has a fresh meniscus injury, the tear is rich in blood supply, and the patient is young and strong, the first choice is of course meniscus suture surgery, but in specific clinical work, the patient often comes to the clinic with a meniscus injury that has become a compound rupture, the tear is like “rotten cotton wool, mop head The meniscus is like a “rotten cotton wool, mop head”, and there is no blood supply. In this case, we can only do partial meniscectomy, even if we have all the skills. For the kind of meniscus injury between the above two cases, which has damage but the structure is largely intact, we use the low-temperature plasma radiofrequency ablation technology to “weld up” it like a “welding torch”. All of the above treatments are really just “patching” in terms of the basic principle: if the meniscus is sutured, some patients will still have a suture that is “sewn but not growing” and may rupture in the future, while partial meniscectomy or If the meniscus is partially removed or meniscoplasty is performed, there is a possibility that the weight-bearing and frictional conditions of the articular cartilage may change due to the partial loss of meniscal structures. However, as a whole, it is a minimally invasive surgery, and we will try to preserve every part of the meniscal cartilage that can still have a chance to function normally during the surgery, and avoid “total resection” as much as possible, so that patients will not have serious and obvious dysfunction and sequelae after the surgery. V. What are the possible complications and sequelae of surgery? Have you encountered them before? How were they handled? Although it is a minimally invasive surgery, because our treatment team has been carrying out this technology for more than 10 years and has seen and completed more than 4,000 surgeries, and still performs more than 400 arthroscopic meniscus surgeries every year, we have more or less been exposed to all kinds of surgical complications and sequelae, among which the least frequent but dangerous is the occurrence of anesthesia accidents, which is also a reflection of the limitations of the existing science. This is a reflection of the limitations of the existing science, but the overall probability of occurrence is very low. In addition, persistent postoperative muscle atrophy and ligamentous laxity, and lack of joint mobility due to early exercise also occur occasionally and vary from patient to patient. This also confirms the old saying “the disease is the same but the patient is different”, each patient has his or her own unique pathogenesis and habits, literacy and socioeconomic level affects their motivation to seek treatment and whether they can have normal rehabilitation treatment after surgery. We can’t cure all diseases, but we are trying to do our best to fulfill the trust of our patients.