Knee Really Hurts Again 2 Years After Menisussurgery

Marc Darrow Dr.,JD

Many people that we meet  in our examination rooms have had a meniscus surgery. They are seeking our assistance in relieving the knee pain that they continue to have following the surgery. For some the pain started immediately after surgery, for others the pain became progressively worse and as the months and years went past significant hurting ready in. How did this happen?

For many people, it happened because they had a belief that the surgery volition help them. Typically, someone who considers surgery and decides to have the meniscus procedure, exercise so because they believe that the meniscus surgery is the best road for them to go and their doctors have demonstrated that the meniscus surgery volition or should assist them. Indeed, for many people, they have a successful surgery and successful recovery.  At to the lowest degree in the brusk-term. For many people I meet, they did have initial success but eventually the knee pain returned. For others, knee pain and functional loss was almost immediately later the surgery.

Too much meniscus removed

Surgery comes with risks. General risks include infection, nerve damage, reaction to anesthesia. Sometimes there is a adventure that the surgery can cause further damage and hurting. How? Also much meniscus is removed.

People take knee pain later meniscus surgery considering some of them had too much meniscus removed. The meniscus is a pad. It acts every bit a shock absorber to prevent the lesser of the thigh bone from crashing into the elevation of the shin bone. People are "bone on bone" because the meniscus is "gone" and the articular cartilage that covers the bones has also worn abroad.

This problem is described in a September 2022 paper presented in the Sports medicine and arthroscopy review.(1)

"The meniscus has an important role in stabilizing the human knee joint and protecting the articular cartilage from shear forces. Meniscus tears are common injuries and can disrupt these protective properties, leading to an increased take a chance of articular cartilage damage and eventual osteoarthritis. Certain tear patterns are often treated with arthroscopic partial meniscectomy, which can finer save symptoms. However, removal of meniscal tissue can also diminish the ability of the meniscus to dissipate hoop stresses (weight bearing pressure on the outside of the meniscus), resulting in altered biomechanics of the knee joint articulation including increased contact pressures."

"Altered biomechanics of the knee joint including increased contact pressures" describes a situation of accelerated knee osteoarthritis.  This can exist where the more pain after surgery is coming from. What may occur is that the surgery removed a portion of the meniscus to convalesce the patients pain. In doing so, the surgery made the meniscus smaller in size and compromised and weakened  the meniscus' ability to provide the needed absorber Nature designed it for.

Another surgery to confirm that the first meniscus surgery failed

For the person who continues to endure from knee pain after meniscus surgery, a failed meniscus repair may exist seen within days, weeks or months. Their doctors may expect a few months to permit the surgery to heal before diagnosing a failed surgery. At this point you lot and your doc will need to map out a plan to set up the surgery. Initially you lot may be prescribed a more conservative care option to include knee joint braces, reduced activity or strain on your human knee, physical therapy and anti-inflammatory medication. In many cases your md will then recommend a second surgery to go inside your knee to encounter what is going on. In this second surgery the surgeon may look for a re-tear of the repaired meniscus area, a new tear caused by a modify in your genu dynamics later the surgery, or "if something was missed" in the beginning surgery.

In this second or revision surgery, the treatment goal remains the same every bit the kickoff surgery. Treat that role of the meniscus that is causing hurting. Either repair information technology or remove it. But what if too much meniscus was removed? There is non much a revision surgery can do to repair that. Meniscus transplant or eventual knee joint preplacement may be given the patient as their just handling options.

Doctors sympathise that knee pain tin can be worse after meniscus surgery

In the last decade there have been many papers and studies demonstrating that there is a very existent probability that many people will accept more pain after knee arthroscopic meniscus surgery. A review of the literature from 2022 (2) demonstrated "meta-analyses of randomized controlled trials have failed to show superior effect of arthroscopic surgery compared with placebo surgery or in addition to practice for middle-aged and older patients with degenerative meniscal tears. Self-reported mechanical symptoms (i.eastward., the sensation of communicable and/or locking) are typically considered an of import indication for surgery. Nevertheless, a recent study in patients with degenerative meniscal tears constitute no added do good of surgery over that of placebo surgery in patients with preoperative mechanical symptoms. Furthermore, the proportion of patients with preoperative mechanical symptoms satisfied with their knee condition and reporting improvements at ane twelvemonth after arthroscopic surgery is lower compared with those without preoperative mechanical symptoms. In (this paper), (human knee) mechanical symptoms merely improved to a small extent one twelvemonth post-obit meniscal surgery. To some extent, this supports the findings from a secondary analysis of an randomized controlled trials demonstrating that meniscal surgery has no added benefit over sham surgery in relieving knee communicable or occasional locking."

A July 2022 study (iii) examined the effectiveness of arthroscopic partial meniscectomy past reviewing six previously published studies. In all six reviews of randomized controlled trials, arthroscopic partial meniscectomy did non show clinically important do good over bourgeois treatment for knee function and hurting.

Meniscus repair surgery success and failure

Most meniscus surgeries practice not try to repair the meniscus, instead the surgery removes the meniscus tissue that is damaged. A 2022 study in The archives of bone and articulation surgery (four) offers an updated opinion on meniscus repair surgery. Hither are some points brought up by the surgeon researchers.

Rehabilitation after meniscal repair is slower and different from rehabilitation after meniscectomy or meniscus removal

• "Rehabilitation subsequently meniscal repair is slower and different from rehabilitation after meniscectomy. The physiotherapist and surgeon should respect the wearisome process of biological healing of the meniscus and therefore they need to be careful with the rehabilitation program peculiarly in active flexion. The render to sport should exist delayed for upward to 6 months; however, 86 to 91% of patients could dorsum to play. It is also crucial for the patient to know there is 8 to 20% risk of failure and re-operation . . ."

Meniscus repair is not a pocket-sized surgery without complexity.

• "Meniscus repair is not a small surgery without complication. It is technically challenging . . . specific complexity including nervus injuries, ligamentous injury, iatrogenic (surgery caused) cartilage lesions, and poor suture techniques tin happen during meniscal repair. . . "

Failure of meniscal repair occur in upwardly to 25 % of patients

• "Failure of meniscal repair occur in upwards to 25 % of patients. Failures in the first six months of surgery are commonly related to technical issues during repair, while failures betwixt 6 and 24 months are indicating poor healing process. Failure later than 2 years of repair testify re-tear or degenerative processes in the meniscus. . . Secondary meniscectomy is a handling for failed meniscal repair. The corporeality of meniscal resection is less in 35% of cases, which shows partial healing of the meniscus. Revision of meniscal repair is another choice and two small series reported 25 to 33% failure rate for the procedure."

Treatments: Meniscus transplant surgery

A meniscus replacement is surgery to supersede a damaged or torn meniscus. This is likewise called meniscal allograft transplantation (MAT). Allograft tissue is a meniscus that comes from a cadaver. The goal of replacing the meniscus with a donor meniscus is to save human knee pain and improve knee role. The transplant can also be seen as a means to assist prevent osteoarthritis.

This surgery is not for everyone. This surgery is more designed for active people or people with enervating lines of work who are under the historic period of 50. It is also seen every bit being more successful in patients where osteoarthritis of the knee has non already set in.

In December 2020, an editorial in the medical journal Arthroscopy (v) presented this opinion on the meniscus transplant surgery.

"Meniscal allograft transplantation for symptomatic knees afterward meniscectomy decreases pain and often improves function, but it does not replicate a normal meniscus. The ability of to delay arthritic changes is an ongoing area of written report, and it is known that outcomes and graft survivorship deteriorate with longer follow-up. Recommended indications are symptomatic patients later meniscectomy with mild (or at most moderate) degenerative changes and absence of (or surgically corrected) associated malalignment or ligament deficiency. When these indications are followed, 80% of patients improve, with survivorship of 83% at ten years and 56.2% at xx years."

More handling options:

In the following articles I talk about the various injection treatments that may help afterwards meniscus surgery.

Platelet Rich Plasma Therapy | Meniscus Tear Injections

Biological genu replacement – Meniscal allograft transplantation – microfracture articulatio genus surgery

Platelet Rich Plasma Therapy | Meniscus Tear Injections

Do you take questions? Enquire Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300or310-231-7000

Stem prison cell and PRP injections for musculoskeletal atmospheric condition are not FDA approved. We exercise not care for affliction. We do non offer IV treatments. There are no guarantees that this treatment will help you lot. Prior to our treatment, seek communication from your medical physician. Neither Dr. Darrow, nor whatsoever associate, offer medical advice from this transmission. This data is offered for educational purposes only. The manual of this information does not create a physician-patient relationship betwixt you and Dr. Darrow or any associate. We do not guarantee the accuracy, abyss, usefulness or adequacy of any resource, data, product, or procedure available from this transmission. We cannot exist responsible for the receipt of your electronic mail since spam filters and servers ofttimes cake their receipt. If you have a medical issue, delight call our office. If you have a medical emergency, delight call 911.

References:

ane Bedrin MD, Kartalias 1000, Yow BG, Dickens JF. Degenerative Articulation Disease Later Meniscectomy. Sports Medicine and Arthroscopy Review. 2022 Sep 4;29(3):e44-50.
two Skou ST, Pihl K, Nissen Due north, Jørgensen U, Thorlund JB. Patient-reported symptoms and changes up to one twelvemonth after meniscal surgery: An observational cohort study of 641 adult patients with a meniscal tear. Acta orthopaedica. 2022 May 4;89(3):336-44.
3 Blom AW, Donovan RL, Beswick Advert, Whitehouse MR, Kunutsor SK. Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level one testify. bmj. 2022 Jul 8;374.
4 Razi M, Mortazavi SJ. Salve the meniscus, a adept strategy to preserve the knee. Archives of Os and Joint Surgery. 2022 Jan;eight(1):1.
5 Carter T. Editorial Commentary: Medial and Lateral Meniscus Allografts Using Bone Plug Fixation in Patients Without Advanced Arthritis Have eighty% Positive Outcomes at 10 Years.

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