Ask a doctor on the topic of Orthopedics

Arthroscopy meniscus

February 23, 2012 | 25,00 EUR | answered by Dr. med. Ralf Berg

Hello, seven weeks ago I (male, 180cm, 76 kg, 47 years old) had an older medial meniscus tear in the posterior horn smoothed out (part of it removed) via arthroscopy based on an MRI diagnosis. Before the surgery, I had an MRI done because my leg would always become stiff when sitting. I would go to work as usual, but afterwards I could hardly walk. The next morning everything was fine again, then back to work, sitting, stiffness again, etc. This went on for 2 years. Sometimes there would be no issues for months, then problems for weeks, but always pain-free. As it was getting worse towards the end, another MRI was recommended (see diagnosis). Before the surgery, my leg was moved again, all pain-free.
On the second day after the surgery, I had my first physical therapy session and had physical therapy twice a week for three weeks. The knee would repeatedly become red and warm, so I was prescribed anti-inflammatory medication Ibuprofen 600 mg. As a result, I did not have physical therapy in the fourth week. After the fifth week, my primary care physician suggested getting a new MRI done first. Result: all ligaments okay, lateral meniscus okay, a part of the medial meniscus was removed in a way that the caudal segment was largely resected below the flap tear. The upper segment of the posterior horn of the medial meniscus still protrudes into the joint space. Currently, the knee is slightly swollen at the incision sites (7 weeks after the surgery) and I constantly feel stiffness in the knee. I can do physical therapy exercises pain-free, as well as use the stationary bike (I have such a device at home), but 10 minutes after the exercises the knee is quite stiff again. I feel like something in the knee keeps blocking. When walking, I try to walk normally but I constantly have to fight against pressure, making a normal walking motion nearly impossible. When standing on one leg and letting the other hang, it is apparent that the healthy leg hangs straight while the other leg is blocked at the knee, causing a bend. My orthopedist told me to continue with physical therapy. Am I just being impatient? Everything should have been better after 2-3 weeks, right?

Dr. med. Ralf Berg

Dear patient,

You are right, normally a "normal finding" should occur 2-3 weeks after a meniscus resection. Your situation is as unsatisfactory as the actual cause of stiffness remains unclear despite multiple MRIs. In my opinion, it must now be assumed that the damaged meniscus alone was not responsible for the stiffness and blocking. Nevertheless, it seems that the situation is slowly improving with physical therapy. It is also obvious that your tissue and joint react quickly and persistently with swelling to surgery/trauma.

Therefore, I agree with your orthopedist that there should definitely not be another procedure/manipulation on your knee in the next 6-8 weeks, and physical therapy should be given absolute priority. According to your description, there is still a deficit in extension. This can definitely be improved through physical therapy over time. But it won't help, even though I can understand your impatience (I would probably feel the same), to keep practicing and practicing......

Best regards,
Dr. R. Berg