Post-Surgery Knee Cartilage Damage: What to Expect and Next Steps

Knee cartilage tear, post-surgery?

Hello Doctor, I am currently 23 years old.
It has been a year since I underwent cartilage debridement surgery.
The surgeon mentioned that my left knee cartilage was severely damaged, but did not provide any follow-up treatment plan.
Now, a year later, I still cannot climb stairs; my knee lacks strength when climbing, and I cannot lift my leg.
I often feel a sense of instability in my knee (with popping sounds), and I cannot walk for long periods without experiencing pain in my knee.
I feel like the meniscus in my knee is missing, as there seems to be a gap between the bones of my thigh and calf, which is different compared to my right knee.
Doctor, I am only in my twenties; do I need a knee replacement? I am unsure of what to do.

Yongqing Tongxue, 20~29 year old female. Ask Date: 2017/11/20

Dr. Li Yongheng reply Orthopedics

Hello, based on your symptoms, you should return to the original surgical hospital and consult with your primary surgeon to clarify whether your meniscus tear was treated with partial meniscectomy or meniscus repair surgery.
The feeling of looseness in your knee may be related to an injury to the anterior cruciate ligament (ACL), so you should also ask your surgeon if your ACL has been injured.
The popping sound in your knee may still be associated with the meniscus tear.
Therefore, I recommend that you return for a follow-up evaluation, which may require an MRI, and if necessary, arthroscopic surgery.
As you are only in your twenties, there is currently no need for a knee replacement, so please do not worry.
Wishing you a speedy recovery.

Reply Date: 2017/11/20

More Info

Post-surgery knee cartilage damage can be a challenging situation, especially at a young age like yours. It’s understandable to feel concerned about your knee's functionality and the potential need for more invasive treatments, such as knee replacement surgery. Let's break down your situation and explore your options.

Firstly, it’s important to recognize that knee cartilage damage, particularly to the articular cartilage and meniscus, can lead to significant functional limitations. After a cartilage debridement surgery, the expectation is that you will experience some improvement in symptoms, but this is not always guaranteed, especially if the underlying damage is severe. The fact that you are experiencing persistent pain, instability, and difficulty with activities such as stair climbing suggests that your knee may not be healing as hoped.

1. Understanding Cartilage Damage: The knee joint is composed of several structures, including the femur, tibia, fibula, patella, ligaments, and cartilage. The cartilage serves as a cushion and allows for smooth movement. When cartilage is damaged, it can lead to pain, swelling, and a feeling of instability. In your case, the severe damage noted during your surgery could mean that the cartilage has not healed adequately, or that there is ongoing degeneration.

2. Symptoms of Instability: The "popping" sound and feeling of instability you describe could indicate that there is an issue with the ligaments or remaining cartilage. This sensation can be due to loose bodies in the joint, meniscal tears, or ligamentous laxity. It’s crucial to have a thorough evaluation to determine the exact cause of these symptoms.

3. Next Steps: Given that you are still experiencing significant limitations a year post-surgery, it would be advisable to consult with an orthopedic specialist, preferably one who specializes in sports medicine or joint preservation. They may recommend imaging studies such as an MRI to assess the current state of your cartilage, ligaments, and any other potential issues within the knee joint.

4. Non-Surgical Options: Before considering knee replacement, there are several non-surgical options that may help improve your condition. These include physical therapy focused on strengthening the muscles around the knee, improving range of motion, and enhancing stability. Additionally, treatments such as corticosteroid injections or hyaluronic acid injections may provide temporary relief from pain and inflammation.

5. Surgical Options: If conservative management does not yield satisfactory results, there are surgical options to consider before jumping to a total knee replacement. These may include arthroscopic procedures to repair or remove damaged cartilage, osteotomy to realign the knee joint, or even cartilage restoration techniques such as microfracture or autologous chondrocyte implantation (ACI). These procedures aim to restore function and alleviate pain without the need for a total knee replacement.

6. Knee Replacement Consideration: While knee replacement is a viable option for severe cartilage damage, it is generally reserved for older patients or those with significant degeneration that cannot be managed through other means. At 23, it is typically recommended to exhaust all other options before considering this major surgery, as knee replacements have a limited lifespan and may not be ideal for someone so young.

In conclusion, your situation requires careful evaluation and a tailored approach to treatment. It’s essential to work closely with your healthcare provider to explore all available options and develop a comprehensive plan that addresses your specific needs and goals. Remember, you are not alone in this journey, and there are many resources and treatments available to help you regain your knee function and improve your quality of life.

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