Arthritis after a meniscus tear

I realize it has been a long time since I have written an Ask Dr. Geier column. Since I answer so many of these questions on my weekly show, I have neglected writing full columns on the blog. As I continue to get questions and comments from previous Ask Dr. Geier columns, I have decided to start writing them more frequently and regularly. So please keep sending your questions and comments, and I will do everything I can to respond either in these columns or on my show.

As always, please remember my disclaimer that I cannot and will not offer specific medical advice in this column or elsewhere on the blog, on my show, by email, or in social media. This is meant for general information and education. Please consult with your doctor for specific medical advice.

Will K. in Buffalo, New York asks:

I am 24-year-old male, not overweight at all, and I do not play sports. I had a partial meniscectomy done on my left knee due to a work-related injury. About half of my medial meniscus was removed. Am I guaranteed to get osteoarthritis and need a knee replacement when I’m older? Is there a chance that I wont need one at all? Is there anything I can do to prevent arthritis?

Great question! Unfortunately there isn’t a yes or no, black or white, answer.

The meniscus serves a role of shock absorber between the bones of the knee. Both menisci in every knee absorb much of the stress across the knees with every step. In theory, if a patient tears the meniscus and requires surgery that involves trimming out the torn part (a partial meniscectomy), then more of the stress transfers to the knee’s bone and cartilage.

Meniscus tear
This type of meniscus tear can not be repaired and must be trimmed out.
With less protection against repetitive stress, it makes sense that degenerative changes could develop over time. True osteoarthritis and the need for later medical and surgical treatments can result. Yes, some patients with a history of partial meniscectomy could one day require knee replacement.

However, there is no guarantee that this degeneration will definitely occur. That is a key reason I rarely shut people down from sports or exercise. Many experts debate the idea of jogging after the surgeries due to fear of degenerative changes. Even if arthritis does occur, I think the value of exercise to overall health might outweigh that risk.

If people do wish to remain active, I think varying the types of sports and exercise can help slow potential wear and tear. People could add swimming, biking, upper body weight lifting, and other non-repetitive impact activities a few days each week.

A final point worth mentioning lies in the fact that the patient has little control over the outcome. Usually the pain of the meniscus tear causes enough difficulty that nonoperative treatment is unsuccessful. The surgeon decides to repair the meniscus or trim part of it out based on the location and orientation of the tear and not personal or patient preference. While active people often want to save the meniscus as a shock absorber, that possibility may have been hampered at the time of injury.

18 Responses to Arthritis after a meniscus tear

  1. I had a r knee arthroscopy in July of this year part med med meniscectomy. Chondroplasty had been going to PT 2x/week. Injured knee doing new extension exercise with one lb weight on ankle in PT saw my surgeon who ordered repeat MRI for ? Retear results no tear but narrowing in meniscal area. My question to you is he wants to try Synvisc One injection I have specific symptoms of pain catching in med meniscal area have stopped PT. but did light exercise the other day with increased pain noted the next day do you think the Synvisc would help or is there a tear not seen on MRI. Thank you

    • It would be a better question for your surgeon, since he can give recommendations based on your individual case. Viscosupplementation can be effective in decreasing pain in some patients with osteoarthritis.

  2. I am 43 and had knee reconstruction and 1 stable medial posterior horn (1.20 cm) tear and 2 stable lateral meniscus tear that were left in situ during the operation.
    I am assuming meniscus tear left in situ are better outcome with regards to future development of OA rather that menisectomy.

    Could you please let me know what is your understanding on that ?

  3. Regarding the article above about meniscus tear and partial menisectomy. What about leaving the meniscus tear in situ ? Does that lower the chance of OA in the longer run ? I have had knee reco and I have 2 small lateral meniscus tear and 1 larger medial posterior horn (1.2 cm) meniscus tear. All appear to be not too symptomatic( I am 6 weeks into knee reco rehab).

    My understanding is even a meniscus tear left untouched can lead to OA what I am hoping for is that it won’t happen as quickly as if a partial menisectomy happens.

    • Honestly we don’t know. It would be hard to do a study where the researchers forced people to leave meniscus tears untreated.

  4. Thanks for your reply. It would appear logical to me that if a meniscus tear even a larger one like mine (1.2 cm) not too symptomatic and stable that leaving it in situ would be a better option than a partial menisectomy . Does that sound right to you ?
    A partial menisectomy would take more of the meniscus away then my understanding is that a meniscus tear left in situ would have the potential to propagate, can a meniscus tear left in situ also damage the articular surface ? I assmume this type of damage would also happen after partial menisectomy on a larger surface.

  5. What is the risk of a slightly symptomatic or asymptomatic lateral or medial meniscus tear left in situ during a knee reconstruction to propagate ? Would it need to knee to get re – injured with twisting motion for this to happen ? Can just walking on a tear make it bigger ?

  6. I have a medial meniscus tear (1.2 cm) . The surgeon who operated on me for a knee reconstruction left it as he thought it was a degenerative tear. He mentioned that the risk was that he might propagate. What can I do so it doesn’t propagate ? Why not do a partial menisectomy to avoid this propagation ? Is it better to leave a tear in situ with a risk of propagation ?

  7. Hi,

    Are small partial thickness lateral meniscus tears likely to heal themselve when left in situ after knee reco. If they don’t heal does that mean that OA will happen few years down the road ?
    Also what is the likelihood of a medial posterior horn very peripheral tear to heal on itself ? ( around 12mm)

    Cheers

    • Small, stable longitudinal tears of the material meniscus in certain locations found at the time of ACL reconstruction have been thought to heal without repair.

  8. I had arthroscopy surgery on my right knee in December 2014 for a meniscus tear. Prior to that I had no pain in that knee (my left knee is bone on bone). The pain did not subside after surgery. Physical therapy made it worse. Orthovisc injections did not work. I had to quit nursing of 39 years and apply for disability. My other knee has flared up and the orthovisc injections no longer work for that knee either. I am now walking with a cane and going up and down stairs is agonizing. I also have chronic back pain and take Percocet 7.5/325 but that does not help my knees. A recent xray of my right knee show bone spurs. Shouldn’t that have been seen during the arthroscopy?

    • I can’t say in your case, but chronic damage to bone and joints to the bones of the knee can usually be seen with arthroscopy.

  9. I am 37 years old . Had meniscus tear( bucket handle) 19 years ago, got it operated. Since then i jogg 3-4 times a week for 20-30 minutes. Off late having pain in knee but not much to give up running . Its not swollen, just pain while bending specially when running on road or hard surfaces. Am I risking something by continuing jogging/ should i stop or i can continue with my obsessive habit of jogging
    Please need your advice on future risk vis a vis active life
    Regards

  10. I have a grade 3 horizontal tear in the outer 1/3rd of the posterior horn of medial meniscus. I am 28 and a physically active male and I would like to continue remaining physically active. Should the surgeons repair or trim my meniscus?

  11. I have condition as outlined in excerpt from MRI report below – in short, degenerative meniscus tear and stress fracture. Would I be a candidate for Synovisc?

    MRI LEFT KNEE Medial compartment:

    There is a free edge radial tear of the lateral aspect posterior horn medial meniscus with displaced meniscal fragment within the posterior aspect intercondylar notch. There is a cleavage tear of the posterior horn as well with extension to inferior articular surface.

    Stress insufficiency fracture with subchondral double line sign involving almost the entire weight bearing surface medial femoral condyle with overlying moderate chondral wear. Medial tibial plateau unremarkable. MCL unremarkable.

    ACL/PCL/extensor tendon mechanism.

    Lateral compartment: No abnormality of lateral meniscus/lateral collateral ligament complex. Mild chondral wear.

    CONCLUSION:

    Stress insufficiency fracture of almost the entire weight bearing surface medial femoral condyle with subchondral double line sign.

    Free edge radial tear of the posterior horn medial meniscus with displaced meniscal fragment within the intercondylar notch and probable cleavage tear posterior horn remnant.

  12. Hi!

    I am 33, female and had a meniscectomy 15 years ago (internal menisc). For the last 5 years have been running 3-4 times a week, between 20-30 km/week. Have not had any problems till this summer, when i started having pain in that knee that only went completely away 2 months after not having run at all. Went to my GP and did an x-ray of the knee, and there are no signs of arthritis. Still, as soon as i run i get the pain again. Started cycling instead, but it´s not the same 🙁

    Could it be some small lesion in the cartilage? What does a normal x-ray mean? Would an MRI be more sensitive?

  13. ,,
    iam 19 years old my lateral meniscus was trimmed around75% was removed during the surgery also my acl was repaired is there any chance of me getting arthritis ??

  14. Is it possible that the synovial membrane has not sealed after an ACL surgery, and for 30 years I have slowly been losing synovial fluid? I’ve always wanted to know that answer……

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