5 Long-Term Problems After Meniscus Surgery

Although arthroscopic surgery of the meniscus is minimally invasive, you may still experience knee pain after surgery. For some people, other problems can occur after surgery, such as arthritis, re-injury, incomplete rehabilitation, and more.

This article explores the potential long-term problems after meniscus surgery.

What Is the Meniscus?

The meniscus is a c-shaped rubbery cartilage that works as a shock absorber between the tibia (shin bone) and the femur (thigh bone). It provides stability to the knee and protects the lower leg from the load created by your body weight.

Long-Term Problems After Meniscus Surgery

There are several potential long-term problems that can develop years after meniscus surgery.

Knee Pain

People sometimes develop knee pain well after recovering from meniscus surgery. Some of the causes of long-term knee pain include:

• Persistent swelling or inflammation
• Infection (though this is rare)
• Difficulties with postsurgical rehabilitation
• Re-injuring the cartilage
• Developing arthritis

Arthritis in the Joint

The type of meniscus surgery may make a difference in how likely it is that someone develops arthritis years later.

A partial meniscectomy involves removing only the torn portion of the meniscus, whereas a full meniscectomy involves removing the entire meniscus to help reduce pain. Full removal of the meniscus has a higher risk of developing osteoarthritis (OA).

Arthroscopy is rarely recommended for people with osteoarthritis (OA) in the knee because arthroscopy has not been shown to relieve the pain associated with cartilage damage caused by OA.

Damaged Meniscus

Having had surgery to repair a torn meniscus may make people more likely to have meniscus tears or other meniscus injuries in the future.

Each knee has a lateral meniscus (on the outer side of the knee) and a medial meniscus (on the inner side of the knee). Depending on which meniscus is repaired, there may be a greater risk of re-injury. A 2020 study reported that 36% of medial meniscus surgeries required a repeat meniscus repair or partial removal of the meniscus after five or more years.

Other factors that can increase the risk of a re-tear include being older and playing contact sports.

Difficulty Walking

With knee pain before or after surgery, you may unknowingly limp or develop an abnormal gait (the manner in which you walk) in order to protect the joint and reduce pain.

Physical therapy, or rehabilitation, may be necessary after meniscus surgery to correct a limp, gait issues, or other problems with knee function once the surgery is done. Rehabilitation programs usually last four to six weeks and are designed to help improve joint strength, stability, and mobility.

Correcting these issues is important to prevent further injury.

Physical therapists warn that insufficient rehabilitation can be a cause of persistent knee pain after an injury. Examples of insufficient rehabilitation include:

• Missing physical therapy appointments
• Not doing necessary exercises as recommended
• Returning to certain physical activities too soon

Spontaneous Osteonecrosis

Spontaneous osteonecrosis of the knee, or SONK, is a condition that causes a lack of blood supply to the bone. Osteo means "bone" and "necrosis" means "tissue death."

This complication of knee arthroscopy is thought to be the result of microscopic fractures of the bone around the knee joint. These fractures cause inflammation within the bone and significant, persistent pain, typically along the inner (medial) side of the knee. The pain is typically worsened by activity and relieved by rest.

SONK is most often found in middle-aged women.

Treatment of SONK can be very frustrating. Many patients find the pain is worse than the pain they had before arthroscopy. While the pain eventually settles down, often the only way to find relief is to use crutches for weeks or months after knee arthroscopy.

Braces and medications can also help with the symptoms. In some patients, the symptoms can be so severe that they end up having either a partial knee replacement or a full knee replacement.

How Is a Long-Term Meniscus Injury Treated?

The treatment will depend on a number of factors, including:

• Your age
• Your symptoms
• Your activity level
• Type, size, and location of the injury

If someone underwent a surgical meniscus repair and still experiences pain and swelling, or if a re-tear occurs in the cartilage, a revision meniscus repair may be necessary if non-surgical options don't provide relief. If it's determined that surgery is needed, treatment may involve:

Partial meniscectomy: The damaged meniscus tissue is trimmed off. This procedure usually allows for immediate weight bearing, and full range of motion soon after surgery.

Meniscus repair: This procedure involves stitching the torn cartilage pieces together to repair it. Whether this procedure can be done depends on the type of tear and the overall condition of the injured meniscus. Because the meniscus must heal back together, recovery time for a repair is longer than for a partial meniscectomy.

Physical therapy: Once the initial healing is complete, your healthcare provider will provide rehabilitation exercises or refer you to a physical therapist. You will start with exercises to improve your range of motion and then strengthening exercises will gradually be added. Rehabilitation time for a meniscectomy is about three to six weeks, while a meniscus repair is about three to six months.

Alternatives to Surgery

Many times surgery is not always needed to heal a meniscus injury. Non-surgical therapies may include:

 R.I.C.E. protocol is an initial treatment:

• Rest with modified activity.
• Apply ice or a cold pack to your knee for 15- to 20-minute sessions, several times a day.
• Compress your knee with a brace or knee sleeve to prevent additional swelling.
• Elevate your leg above your heart while icing it or whenever resting/relaxing.

Nonsteroidal anti-inflammatory drugs (NSAID) can further reduce pain and swelling.

A steroid (cortisone) injection into the knee joint is sometimes given to reduce inflammation and pain.

Physical therapy after the R.I.C.E. protocol and other treatments can provide specific exercises to help restore optimal function in your knee.

Summary

Meniscus tears and injuries may require non-surgical treatments or arthroscopic surgery depending on the type and location of the injury and the overall condition of the cartilage. While this surgery is less invasive than other surgeries and often involves a quick recovery period, it doesn't always improve knee pain.

Knee pain, osteoarthritis, re-injury, inadequate rehabilitation, and spontaneous osteonecrosis are potential long-term problems after meniscus surgery. Talk with your healthcare provider about treatments to help you find relief if you're experiencing pain or other post-surgery problems.