Although arthroscopic surgery of the meniscus is minimally invasive, you may still experience knee pain after the surgery. For some, long-term complications such as arthritis, reinjury, or bone death (osteonecrosis) can occur within months or years of the surgery.
Themeniscusis a round piece of cartilage that acts as a shock absorber between the shin bone (tibia) and thigh bone (femur). It provides stability to the knee and reduces weight-bearing stress on the lower leg. Arthroscopic surgery is a minimally invasive procedure used to repair meniscal injury using one or more small incisions, a fiber-optic scope, and narrow operating tools.
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Long-Term Problems After Meniscus Surgery
Arthroscopic knee surgery is the frontline surgical approach to treating severemeniscal tears. The success rate can be high depending on the aims of the surgery. For meniscal body tears at the front of the knee, the success rate approaches 100%, while the rate falls to around 69% for the treatment ofposterior tearsat the back of the knee.
A review of 27 studies published in 2022 reported an overall failure rate of 19.5% five years or more after meniscal repair surgery. For these people, revision surgery may be needed.
Some of the more common complications include:
Chronic Knee Pain
People sometimes developchronic(persistent) mechanical knee pain after recovering from meniscus surgery. Some of the causes of long-term knee pain include:
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Postoperative Arthritis
The type of meniscus surgery you undergo may determine your risk of kneeosteoarthritis. Generally speaking, a partial meniscectomy (in which some meniscus is removed) places you at lesser risk of knee OA than a total meniscectomy (in which all the meniscus is removed).
Although total meniscectomy is less commonly performed since the introduction of arthroscopic surgery back in the 1980s, it is sometimes performed prior to a meniscal transplant.
If you have pre-existing knee OA, surgeons will aim to preserve as much cartilage as possible to avoid postoperative acceleration of the disease.
Meniscus Reinjury
Having had surgery to repair a torn meniscus may increase the risk of future meniscus injuries. This can occur when a partial meniscectomy thins areas of cartilage, creating weaknesses that can cause them to crack, split, or tear when placed under stress.
This is due in part to the fact that the lateral meniscus has more of an O-shape and can remain more stable even after the repair. By contrast, the medical meniscus has more of a C-shape and can be more easily destabilized after a repair.
A 2020 study reported that 36% of medial meniscus surgeries required a repeat surgery, usually after five years or more. The risk is reinjury is greater in older adults and those who play contact sports.
Nerve Damage
The knee joint is populated with nerves that regulate movements and provide sensations like pain. These include the tibial nerve (which supplies the back of the knee), theobturatornerve (which supplies the inner knee), and theperonealnerve (which supplies the front and outer knee).
Although rare, arthroscopic knee surgery can causeneuropathy(nerve damage) due to problems before and after surgery.
Examples include:
A great many cases involve the peroneal nerve, leading to decreased sensation in the knee, inner thigh, and groin. There may also bechronic nerve pain,paresthesia(pins-and-needle sensations), and muscle weakness affecting your ability to walk or even stand for long periods.
Spontaneous Osteonecrosis
Spontaneous osteonecrosis of the knee (SONK) is bone tissue death due to the loss of blood supply to the affected bone.
This can occur after arthroscopic knee surgery when the removal of the meniscus increases weight-bearing stress on the knee and lower leg. The overloading of the joint can, in turn, lead to the compression of blood vessels that supply the bones of the knee. The medial (inner) meniscus is most commonly affected.
Symptoms of SONK include:
SONK often resolves on its own when using crutches to reduce vascular compression. Severe cases can cause major bone loss, requiring either apartialortotal knee replacement.
How Is a Long-Term Meniscus Injury Treated?
The treatment of complications of arthroscopic knee surgery will depend on several factors, including:
If pain and swelling persist following surgery (or reinjury occurs), revision surgery may be needed if conservative measures fail to provide relief.
This may involve:
Alternatives to Surgery
Surgery is not always needed to heal a meniscus injury. Among the conservative options:
Summary
Chronic knee pain, osteoarthritis, reinjury, nerve pain, and spontaneous osteonecrosis are potential long-term complications of arthroscopic knee surgery. Causes include insufficient rehabilitation, a premature return to sports, surgical errors, and improper traction. Speak with your healthcare provider if pain and other symptoms persist or recur after surgery for a meniscal injury.
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