Many people experience knee pain, popping or cracking, or swelling following their meniscus surgery. While these symptoms can be uncomfortable and irritating, usually they resolve with time as the knee continues to heal. This article will briefly review the anatomy of the knee, meniscal injury, treatments, and common symptoms that you may experience following surgery.
Anatomy of the Knee
The 4 main bones involved in the knee joint include:
Ligaments are a type of tissue that connect bone to bone. They are strong, fibrous, structures that are absolutely necessary in stabilizing the knee joint.
There are many important ligaments in the knee joint:
- Collateral ligaments
- Medial collateral ligament (MCL)
- Lateral collateral ligament (LCL)
- Cruciate ligaments
- Anterior cruciate ligament (ACL)
- Posterior cruciate ligament (PCL)
- Other stabilizing ligaments
- There are many other ligaments that help to stabilize the knee. A few examples of these include the capsular ligaments, popliteofibular ligament, and oblique popliteal ligament.
Anatomy of the Menisci
These c-shaped, strong, yet somewhat flexible structures of the knee are made of collagen and act as shock absorbers. They also help to stabilize the knee joint. They are located on the tibial plateau. There are two menisci: named “medial” and “lateral” based on where they are located.
- Medial menisci: More stable and fixed (doesn’t move as much) and therefore is more likely to become injured.
- Lateral menisci: More mobile (moves around some) and is therefore somewhat less likely to become injured.
A meniscus tear occurs when the meniscus is damaged or torn. The medial meniscus is most commonly torn as it is less mobile (moves less) than the lateral meniscus.
Meniscal tears can occur with trauma or overuse. In the younger patient, it usually occurs after a forceful twisting injury on a planted foot that may occur to the knee while playing sports– particularly ones that require a lot of pivoting (basketball, tennis, soccer, football, etc). It can also occur with running or overloading of the joint i.e. with weight lifting.
As we age, the menisci become weaker, and can become injured with just minor trauma. Meniscal tears also commonly occur with normal activities (squatting, sitting) as the cartilage of the knee starts to wear down (osteoarthritis).
Tears that occur in an arthritic knee are called degenerative meniscal tears. As the soft and smooth cartilage of the knee wears down, the rough underlying bone is exposed. Exposed bone feels very similar to sand paper. Thus, in the arthritic knee, the rough bony ends rub on the menisci and almost always lead to tearing of these structures.
There are many different patterns of meniscal tears. The pattern of meniscal tear is one important factor that the surgeon will use to decide whether or not the tear is repairable or not. The entire inner rim of the medial meniscus can be torn — this is called a bucket-handle tear (the torn area looks like a handle). The meniscus tear can look like a simple flap or can be complex (be torn in multiple directions). Meniscal tears aren’t always associated with symptoms, but when they are, these symptoms may include: pain, swelling, stiffness or locking of the joint, popping, or difficulty straightening the leg out.
There are various options for treating meniscal tears (see below). Should you and your surgeon decide to proceed with surgery, it is helpful to keep in mind that following arthroscopic surgery,pain, swelling, or popping of the knee can be common.
Treatment options for meniscus tears
- Physical therapy
- Pain management with nonsteroidal anti-inflammatories (e.g. ibuprofen, naproxyn)
- Ice and rest
- Using a brace
- Steroid injections
- Arthroscopic Repair
- Arthroscopic Partial Meniscectomy
- Arthroscopic Total Meniscectomy
Is surgery for me?— The need for surgery really depends on the degree or severity of the meniscal tear. Some people have tears and are completely asymptomatic (have no symptoms). Obviously, in these situations, no treatment is necessary. However, if the meniscal tear is symptomatic, depending on your age, activity level, goals of surgery, etc. surgery may be the next step for you.
The type of surgery to be done will be based off of the age of the tear, the pattern of tear (described above), the location of the tear, and your age and activity level.
If a repair is not able to be performed, then the torn meniscus may need to be removed.
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 through skin and into the joint space to perform the surgery.
How long does it take?
Depending on what else needs to be done during surgery (repair, removal, additional procedures) surgery can take anywhere from 30 minutes to 2 hours. It is typically done as an outpatient procedure
What kind of scar will I have?
At most, there will be a few small incisions around the knee after the operation. Scarring is usually minimal and often fades over time as the incisions are quite small.
How long is the recovery?
Recovery time will depend on the severity of the injury and type of surgery that is performed. If a meniscal repair is performed, the recovery time is typically longer. Depending on the surgery performed, your surgeon may or may not limit your weight bearing after surgery.
Ask your doctor what medications they recommend for you to take during your recovery. They will likely prescribe a pain medication and 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 usually recommended after meniscus surgery. Consult with your surgeon or physical therapist before trying any exercises on your own. Some physicians will recommend non-weight bearing activities for a period of time (depending on the surgery performed) and others may want you to start trying weight-bearing activities sooner in your recovery. Always consult your surgeon 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.
Although complications are rare and the surgery is considered low-risk, the following are possible complications of having meniscus surgery.
- Damage to cutaneous (skin) nerves
- Knee pain and/or stiffness
- Blood clots
- Need for future surgery
- Knee popping after surgery
Knee Popping After Surgery
Causes of knee popping after surgery may be due to inflammation of structures within the knee. Sometimes, if implants were used — although this is much less likely — popping can occur with different knee movements.
During arthroscopic surgery, fluid is inserted into the joint through the arthroscope. While the fluid is absorbed by the body with time, initially, it can contribute to stiffness and popping sounds. Popping sounds can also occur due to stiffness from scar tissue after surgery. It may take a while for the joint to move smoothly again as the joint heals.
Knee snapping or popping can understandably be irritating and uncomfortable. For those who experience knee popping, studies have shown that leg strengthening exercises and other physical therapies can help to reduce knee popping.
The following measures may help to reduce knee popping:
- Strengthening of leg muscles
- Increasing leg and hip flexibility
- Increasing ankle range of motion and flexibility
Most often, knee popping usually resolves with time and with exercise as the knee continues to heal.
Although uncommon, despite exercise and time, popping may become the new norm and there may not be much else that can be done.
Knee Swelling after Meniscus Surgery
Swelling is an indicator of inflammation, which is part of the normal healing process after surgeries such as a meniscus repair. It can sometimes persist for a few weeks following meniscal surgery.
Treatment of knee swelling is quite simple. Many people are familiar with the acronym RICE: Rest, Ice, Compression, and Elevation. Not only is RICE an excellent treatment for swelling in general, but it is important in preventing and treating knee swelling after meniscus surgery.
After surgery, the knee is typically wrapped with an elastic bandage– to help reduce and prevent excessive swelling. If you have knee swelling at home, continued use of a wrap to gently compress the area can be helpful.
Ice is often used to reduce swelling and pain after meniscal surgery. When icing the affected area, it is important to remember to keep a cloth of some sort between the ice pack and the skin and not to ice for more than 20-30 minutes at a time.
Resting and elevating the knee above the level of the heart with a few pillows can help to prevent, reduce, and minimize swelling. Lay with your back flat on a bed or couch and elevate the foot/lower leg with a few pillows until the knee is above the level of your heart.
Most importantly, follow your doctor’s recommendations on weight bearing restrictions.
While in most cases, knee swelling following surgery is normal and improves with time, there are certain situations where swelling may be associated with a more serious problem. In the following situations, you should immediately contact your surgical team or head to the nearest emergency room:
- A sudden increase in swelling or swelling of other extremities, arms, or face
- There is a foul odor, increasing redness, unrelenting pain, or pus draining from the wound
- If swelling is associated with a fever higher than 100.4℉ or 38℃
- If associated with difficulty breathing, you should call 911
In the worst case scenarios, popping, swelling, and pain following surgery — particularly if new, may indicate another knee injury. If you have continued symptoms that are concerning, you should schedule a visit with your surgeon to discuss these issues.
Note that the information in this article is purely informative and should never be used in place of the advice of your treating physicians.