How long does pain last after meniscus surgery

Most meniscal surgeries (95%) are partial meniscectomies where part of the meniscus is actually removed, not just repaired. Therefore, the remaining meniscus is now smaller and does not perform as well. The Meniscus is a ring-shaped piece of cartilage whose purpose is to act as a shock absorber for the knee. When a piece is removed it can’t function as well as it is meant to. Thus, when equal forces are placed onto a smaller piece of cartilage, more wear and tear and increased risk for in jury takes place.

Most recent studies have shown meniscal surgery to be no better than physical therapy or Cham surgery. This includes to recent studies from the New England Journal of Medicine, as well as a study from an orthopedic surgical journal. (1,2,3).

2 reasons why people have increased risk for pain after meniscal surgery are:

1. The meniscus can re-tear. Remember the remaining meniscus is smaller but having to work harder since pressure is on the meniscus have not changed.
2. The knee now has a significant increase in developing arthritis since part of the meniscus was removed. A study looking at knees 18 months after surgery showed 60% of knees treated with surgery had developed arthritis compared to 33% and patient’s only receiving physical therapy. (4)

What are your treatment options?

First, do not have another meniscal surgery. This will only worsen the problem. Second consider Ortho-biologic treatment such as PRP or stem cells which have been shown to be very effective in multiple trials. (5,6).

The bottom line is do not have meniscus surgery. This will only weaken your knee and lead to a significant increase in developing arthritis later in life. Come see us at Regenexx Pittsburgh for state of the art ortho-biologic treatments with PRP and Stem Cells so you can get back to high level function.

(1) Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis N Engl J Med. 2013;368(18):1675–1684. doi:10.1056/NEJMoa1301408
(2) Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL; Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013 Dec 26;369(26):2515-24. doi: 10.1056/NEJMoa1305189.
(3) Beaufils P, Pujol N. Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus. Orthop Traumatol Surg Res. 2017;103(8S):S237-S244.DOI: 10.1016/j.otsr.2017.08.003
(4) Collins JE, Losina E1,2, Marx RG3, Guermazi A, MeTeOR Investigator Group. Early MRI-based Changes in Patients with Meniscal Tear and Osteoarthritis. Arthritis Care Res (Hoboken). 2019 Apr 1. doi: 10.1002/acr.23891
(5) Filardo G, Kon E, Buda R, Timoncini A, Di Martino A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2011 Apr;19(4):528-35. doi: 10.1007/s00167-010-1238-6.
(6) Southworth TM, Naveen NB, Tauro TM, Leong NL, Cole BJ. The Use of Platelet-Rich Plasma in Symptomatic Knee Osteoarthritis. J Knee Surg. 2019 Jan;32(1):37-45. doi: 10.1055/s-0038-1675170

What is the Meniscus?

The largest joint in the body is the knee, making it one of the most susceptible to injury as it carries much of the weight of the body. Injury and pain can occur due to disruptions of the intricate structures that keep the joint together.

To understand the function of the meniscus, we must first understand the structure of the joint. The knee is one of the body’s most complex joints. The knee is a joint that connects the thigh bone (femur) to the shin bone (tibia). The other bones that make up the knee joint are the fibula (the smaller bone that runs beside the tibia) and the patella (kneecap).

Soft tissues that surround the joint include ligaments, muscles, and tendons. Each of these structures provides a service – ligaments connect the thigh bone to the shin bone and provide stability. Muscles help with the motion of the joint while supporting it as well. Tendons are used to form connections like ligaments, but they also connect muscles to bones.

Between the knee bones is cartilage which acts as protection from the bones – without cartilage, bones can rub against one another, causing pain and damage to the surrounding area. There are two major types of cartilage in the knee joint, each with a particular function:

• Articular Cartilage: located at the ends of the bone, articular cartilage acts as a barrier between bones. This prevents the discomfort that comes with bones rubbing against each other. Articular cartilage can become damaged from long-term use or sudden injury.
• Meniscus: located between the thigh and shin bones, the meniscus absorbs shock in the joint. There are two types of the meniscus, medial and lateral. The medial meniscus is larger and more prone to injury. The lateral meniscus is smaller and less prone to injury, though it is not immune. The meniscus also provides stability to the joint and helps with weight distribution.

Injury to the cartilage can occur during sports, a car accident, a fall, among many other incidents. Meniscus tears occur most commonly in athletes who participate in high-impact sports that involve twisting the knee. There is also a risk of cartilage deteriorating over time naturally, or from repetitive motion. Symptoms may vary, but there are some prominent ones to look out for:

• Popping noises
• Pain
• Difficulty with balance
• Less range of motion

Symptoms may begin as manageable and get worse over time, or they can occur suddenly depending on the cause. Pain could be short and sharp, or it could be more of a dull ache – or anywhere in between. Some minor injuries can heal on their own, but when knee pain persists after several weeks and begins to impede daily activities, it is time to consult a doctor.

How a Meniscus Injury is Treated?

The first step to treating knee pain is finding the cause. Injury to the meniscus can often be spotted when a doctor performs a small series of tests to diagnose it. This may include watching the patient walk, bending the knee, and finding where the pain is located.

Doctors may order an MRI or other imaging techniques such as X-Rays or CT Scans. The images produced can give doctors a clear idea of what is causing knee pain and from where. An MRI is a common technology used to diagnose a meniscus injury because it takes an image of the soft tissue, which includes cartilage.

Once the diagnosis is certain, doctors can begin to devise a treatment plan that is specific to the patient’s individual needs. A meniscus injury can vary in severity, some tears are minor and cause very few symptoms, while others can be more severe and may require surgery.

Treating a meniscus injury generally includes a few important steps before surgery is considered:

• Pain Management: many patients take over-the-counter drugs to relieve pain, such as Ibuprofen or Naproxen. Relieving pain can make it easier to perform daily activities that would otherwise be too difficult.
• RICE: Rest, Ice, Compression, and Elevation can help reduce swelling while providing comfort.
• Corrective Gear: knee braces can help keep the joint stable while it heals. Assistive devices such as crutches or a cane may be used so that less weight is put on the joint.
• Physical Therapy: certain exercises can help restrengthen the joint after an injury, especially if some muscles have atrophied during the healing process. Some of the goals of physical therapy are to restore range of motion, build strength, and reduce pain during certain activities.

Patients who go through these treatments may have some success, as the body is capable of healing itself. Some injuries are beyond natural repair, however, and require surgical intervention.

What Happens During Meniscus surgery?

Surgery is often considered a “last resort” for patients with knee pain. Though many patients begin to recover after only 6 weeks, it can be a difficult process. Every surgery comes with a set of risks that should be discussed thoroughly with doctors and surgeons before the operation begins. Some common concerns involve receiving anesthesia and the risks of infection or blood clots, for example.

The most common form of meniscus surgery is done arthroscopically. This means that the surgery begins with a small incision, into which surgeons insert a tiny camera and tools which they use to repair the damage. This may involve shaving away damaged tissue or repairing a tear.

As arthroscopy is a minimally invasive surgery, the recovery time is much shorter than that of a total knee replacement or other, more involved procedures. Many patients choose to try this form of surgery so that damage can begin to heal again. As with any treatment, however, there is a risk that symptoms do not go away, even after surgical intervention.

How Can Knee Pain Persist After Surgery?

There are several reasons why knee pain may continue after meniscus surgery. These reasons may vary depending on what was accomplished during the surgery. These are the most common reasons why pain persists:

• Poor Rehabilitation: patients must follow the instructions of doctors and physical therapists closely after an operation. This is a vulnerable time for the knee, and exercising in certain ways or developing a limp could cause more damage to the joint. This can be prevented by listening closely, practicing, and sticking to the regimen even when it’s difficult.
• Developing Arthritis: arthritis occurs when the cartilage lining the joint bones begins to deteriorate. Meniscus surgery does not address the loss of articular cartilage. Certain damage to the cartilage that occurs due to arthritis can be difficult and even impossible to repair using arthroscopic surgery. Damage may occur after surgery, in which case patients face the option of a total knee replacement surgery. The vast majority of patients with continued knee pain after a meniscus surgery have pain associated with the loss of articular cartilage.  In these cases, the use of autologous stem cell-rich bone marrow or adipose (fat) tissue is an excellent option.
• Damaged Meniscus: many surgeries that are performed to repair the meniscus involve simply removing damaged tissue. When this occurs, the meniscus becomes smaller in size, but it must absorb the same amount of shock. This can lead to a retearing of the meniscus, as well as increased pain and discomfort.

Though these are some common reasons why pain persists, there are several others, such as swelling and infection, that should be considered as well. Doctors will order new tests to determine the cause of persistent pain. These may include blood tests and image testing.

Some medical professionals are skeptical of the efficacy of meniscus surgery, with some studies implying that it is ineffective and unnecessary. Luckily, there are alternative treatments for meniscus injury that offer promising results for short- and long-term treatment.

Alternative Treatments for Knee Pain

Regenerative medicine is an emerging field of medical science that offers long-term and effective treatment for meniscus tears, as well as a myriad of other conditions. These treatments work well on soft tissue, making them a good option for repairing damage to many types of cartilage.

These treatments work by using a patient’s own cells to enhance natural healing processes in the body. When damage occurs anywhere, the body sends certain cells to the area to begin making repairs. These treatments have found a way to inject a more densely packed version of some of these cells into the area where injury exists.

Two of the most promising treatments, both offered at CELLAXYS, are platelet-rich plasma (PRP) therapy and autologous stem cell therapy, specifically using your own fat or “adipose tissue.” The process for both is similar, beginning with a sample from the patient, which most often comes in the form of a blood draw. The samples are then processed to concentrate the healing properties and then transplanted into the area where healing is most necessary.

Doctors use imaging technology such as ultrasound or fluoroscopy to guide the needle to the location where its effects will be strongest. Both are outpatient procedures that can most often be performed in about two hours.

Though these treatments can be used to ease pain and discomfort in patients after surgery, they may also be a good option for someone who is considering surgery. Some patients can surpass the need for meniscus surgery. This eliminates the need to cut and remove tissue that could be otherwise used to support the knee and absorb shock.

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