What Causes Knee Pain 1 Year After Meniscus Surgery?

By Chris Centeno, MD /

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Knee Pain 1 Year After Meniscus Surgery

Knee pain 1 year after meniscus surgery is much more common than most people realize. Why? Let’s dig in.

What is Meniscus Tear Surgery?

More than 95% of meniscus tear surgeries are partial meniscectomies (1). This means that the doctor removes the torn part of the meniscus. The meniscus is NOT repaired.

When I tell this to patients, they’re often surprised, as they thought that they were getting their meniscus repaired. In fact, when parts of the meniscus are removed the meniscus is not able to be a good shock absorber. Hence, more force is placed on the cartilage, leading to more wear and tear (2,3).

Does Meniscus Tear Surgery Work?

One reason for knee pain 1 year after meniscus surgery is that the procedure has been shown to be ineffective (4,5,8). Surprised? Yep, we have multiple high-level studies showing that partial meniscectomy is no better than physical therapy or fake surgery. Meaning, knee meniscus surgery doesn’t help a patient’s pain or function.

Can the Meniscus Tear Again after Surgery?

A possible cause for knee pain 1 year after meniscus surgery would be a retear of the meniscus. Realize that, as discussed above, the torn part of your meniscus was removed. That means that the remaining meniscus is smaller, but still taking the same pressure. Hence, that remaining meniscus is more and not less likely to tear again.

What Happens to the Knee After Meniscus Surgery?

Another reason for knee pain 1 year after meniscus surgery is new-onset arthritis. As per the research, the knee is more susceptible to arthritis after meniscus surgery (7). The researchers looked at structural changes on knee MRIs over an 18-month period after surgery. The results? In the knee meniscus surgery group, 60% (compared to 33% in the physical therapy group) had damage to the cartilage and more-advanced bone spurs. The conclusion, meniscus surgery is causing more arthritis. 

What Can You Do If You Have Pain?

First, don’t get another meniscus surgery! Second, consider new orthobiologic treatments rather than more surgery. Platelet-rich plasma has been shown to be effective in many different high-level clinical trials (9,10).

The upshot? Meniscus surgery where the doctor yanks the torn piece out is not a good idea. In fact, it causes more and not less arthritis. If you find yourself in this bad spot, don’t get more surgery. Find a Regenexx physician to see if we can help you make your next move.

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References:

(1) Montgomery SR, Zhang A, Ngo SS, Wang JC, Hame SL. Cross-sectional analysis of trends in meniscectomy and meniscus repair. Orthopedics. 2013 Aug;36(8):e1007-13. doi: 10.3928/01477447-20130724-15.

(2) Fairbank, TJ. Knee Joint Changes after Menisectomy. Vol. 30B, NO. 4, Nov 1948 https://3n30av2dln0g4fmlc03hpv0p-wpengine.netdna-ssl.com/wp-content/uploads/2013/10/Fairbank-Menisectomy-causes-Arthritis-Journal-of-Bone-and-Joint-Surgery-1948.pdf

(3) Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med. 1986 Jul-Aug;14(4):270-5. https://www.ncbi.nlm.nih.gov/pubmed?term=%203755296

(4)  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
(5) 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.
(6) 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.

(7) 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.

(8) 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

(9) 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.

(10) 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.

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Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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