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Knee Popping after Meniscus Surgery: What does it mean?

Many people experience knee popping or other cracking sounds as a result of their meniscus surgery. While this can be uncomfortable and irritating, knee popping is fairly common and normal. This article will serve to provide more information on how to minimize knee popping, discuss why it happens, and provide other helpful information regarding knee function, knee injury, knee surgery and recovery.

Anatomy and physiology of the kneeLateral view of knee tendons, ligaments and bones.

Bones

The 4 main bones involved in the knee joint include:

  • Femur
  • Patella
  • Tibia
  • Fibula

Ligaments

To provide stability, many ligaments are involved in the knee joint:

Ligaments are a type of tissue that connect bone to bone. They are strong, fibrous, and absolutely necessary in the stabilization of the knee joint. The knee joint bears much weight and is made to allow for shock absorption, stability and balance. Thus, you will note in the list below the many different ligaments involved in the joint that allow for its movements, rotations, ability to sustain jumping, squatting and lifting movements.

  • Collateral ligaments
    • Medial collateral ligament (MCL)
    • Lateral collateral ligament (LCL)
  • Cruciate ligaments
    • Anterior cruciate ligament (ACL) – Studies have revealed that the ACL actually produces 85% of the stability, flexion and rotation of the knee joint. Because of its important and frequent usage, this is also one of the most commonly injured ligaments in the knee joint.
    • Posterior cruciate ligament (PCL)
  • Other stabilizing ligaments
    • Transverse, arcuate popliteal, oblique popliteal, popliteofibular, capsular, anterolateral, arcuate, and posterior oblique

Fibrocartilaginous Menisci

These disc like structures made of fibrous material and cartilage act as shock absorbers and friction reducers between the femur and the tibia bones. They are located on the inner and outer condyles of the femur. Condyles are the round, protruding parts of bones–usually on the head of large bones.

  • Medial menisci: This menisci is more fixed (doesn’t move as much), and therefore more likely to acquire an injury.
  • Lateral menisci: This menisci is more mobile (moves around some), and therefore less likely to acquire an injury.

Bursa

Four bursae, or fluid filled sacs in the knee joint help tendons and skin to move easily over the joint.

Common knee injuries

In thinking about the function and anatomy of your knees; how often you use them; and what you use them for, it is not surprising to learn that knee injuries are fairly common!

Bursitis

Bursitis is an inflammation or infection in the bursa. Symptoms may include pain, redness and swelling.

Damaged ligament

Inflamed, damaged or torn ligaments can be common, especially among athletes. The most common ligament injured is the anterior cruciate ligament (ACL). While there are a variety of ligament related injuries, this article focuses mainly on meniscus related injuries.

Torn Meniscus

A torn meniscus or sometimes referred to as “Twisting your knee” is when the meniscus is injured, damaged or torn. Remember that there are two menisci: the lateral and medial. The most common injury is to the medial meniscus, or the one closer to the center of the body in the affected knee. This meniscus has less movement and therefore does not absorb shock, or tolerate jerking and twisting movements as well as the meniscus on the lateral side.

What is a meniscus tear?

A meniscus tear is when the meniscus, or c-shaped disc that provides a cushion between the condyles of the femur bone and the tibia bone, is damaged or torn.

Risk factors

People who are female and who are older in age have a higher risk of knee injury. Athletes, especially athletes in contact sports or sports that involve pivoting (like basketball or tennis) are at a higher risk of tearing a meniscus as well.

Causes

Most tears occur after an activity where the knee is forcefully twisted or rotated (sudden stops and turns, pivoting, landing wrong after a jump). Other activities that can cause tearing may include heavy lifting, deep squatting and kneeling.

Symptoms

  • Pain
  • Swelling
  • Stiffness and/or locking of the joint
  • Popping sounds
  • Difficulty straightening leg completely

Meniscus tear repair options

  • Rehabilitation therapy
  • Steroid shots
  • Pain management with Ibuprofen or Naproxen, ice and rest
  • Using a brace
  • Arthroscopic Repair
  • Arthroscopic Partial Meniscectomy
  • Arthroscopic Total Meniscectomy

Meniscus Surgery

Before surgery

Is surgery for me?— The need for surgery really depends on the degree or severity of the meniscal tear. Sometimes, depending on where it is damaged it can heal itself; if the tear is deep enough it cannot repair itself and will likely need surgical repair.

Surgery may not be indicated if the meniscus tear is too old. It is preferable to do surgery on a tear that is less than 12 weeks old.

Surgery may not be recommended when the tear is horizontal. Vertical tears are easier to repair.

If for some reason the doctor is unable to repair the meniscus, in some cases they are able to do a partial repair or partial extraction of part of the damaged tissue.

Procedure

The most common procedure type for meniscus surgery is called arthroscopy. Essentially this is a procedure where a scope is inserted through the skin with a light and a camera on the end. This allows the physician to view the joint without making a large skin incision. The doctor can then insert tools under the skin and perform the surgery in this way.

How long does it take?

The surgery lasts approximately 30 minutes. It can be done as an outpatient procedure.

What kind of scar will I have?

There are a few small incisions made around the knee for this operation. Because it is arthroscopic, meaning tools are inserted into the holes and the surgery is done with the skin more or less intact, scarring is less and often fades over time.

Recovery

How long is the recovery?

Recovery time will depend on the severity of the injury and type of repair that was done. Generally, for about one month after surgery patients need to use crutches to keep weight off of the affected side. Some doctors may also require the use of a stabilizing device such as wearing either a cast or brace for the first few weeks after surgery as well.

If the meniscus was only partially injured and partially repaired, recovery time will be shorter–perhaps about one month. If the whole meniscus was damaged and repaired, recovery time is expected to be longer–may be up to three months.

Postoperative medications

Ask your doctor what medications they recommend for you to take during your recovery. Likely they will prescribe a pain medication, an antibiotic (to prevent infection), an anti-inflammatory (to reduce swelling). They may also recommend the use of compression stockings or give you a medication to prevent blood clots.

Will I need to do physical or rehabilitation therapy?

Physical therapy is definitely recommended after meniscus surgery. It is of course highly recommended that you consult with your doctor, surgeon, or physical therapist before trying any exercises on your own. Some physicians will recommend non-weight bearing activities for a long time and others may want you to start trying weight-bearing activities sooner in your recovery. Always consult your physician first and follow their instructions.

Strength building exercises and other physical therapies can be a vital part of the recovery and can help to reduce popping sounds.

Complications

Although complications are rare and the surgery is considered low-risk, the following are possible complications of having meniscus surgery.

  • Damage to skin nerves
  • Infection
  • Knee pain and/or stiffness
  • Other complications of surgery: blood clots, blood loss, infection
  • Knee popping after surgery

Why knee popping after surgery?

Causes of knee popping after surgery may be due to fluid accumulation around the knee and tendons as a result of the surgery, or if an implant was placed.

Implants, usually made of plastic or metal are obviously harder than the soft menisci and can create a pop sound with different movements.

Popping sounds can also occur due to stiffness after surgery. It may take a while for the joint to move smoothly again as it gets used to using new hardware. Similarly, fluid is inserted into the joint through the arthroscope during the surgery–this also contributes to stiffness in the recovery period and can contribute to popping sounds.

How to reduce knee popping?

Knee snapping or popping is irritating and uncomfortable. For those who experience knee popping both without having had surgery or postoperatively, the following exercises may be helpful.

Studies have shown that leg strengthening exercises can help reduce knee popping. It should be noted that sometimes knee popping happens as a result of the surgery and strengthening leg muscles does not help to correct it. In these cases, popping may be the new norm and there is not much that can be done to help.

The following list are things to work on to try to reduce knee popping:

  1. Strengthen leg muscles
  2. Increase leg and hip flexibility
  3. Increase ankle range of motion and flexibility
  4. Avoid activities that cause pain to the affected joint
  5. Use a stabilization device, like a brace, if necessary

 

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