Impact of Post-Meniscectomy Physiotherapy on Total Knee Replacement (TKR) Outcomes: A Review of Current Evidence

Meniscectomy, particularly partial meniscectomy, remains a common surgical intervention for irreparable meniscal tears. While it can restore short-term function and relieve pain, its long-term consequences are well-documented, with evidence linking it to accelerated articular cartilage degeneration and the development of osteoarthritis (OA)]. As a result, many patients who undergo meniscectomy in early adulthood ultimately require total knee replacement (TKR) in later years [1,2].

With TKR being a definitive solution for end-stage knee OA, understanding the antecedent factors that influence its outcomes is critical. One such factor is the history of post-meniscectomy physiotherapy. This paper aims to explore how post-meniscectomy physiotherapy might impact TKR outcomes in terms of joint preservation, surgical planning, postoperative recovery, and long-term prosthetic performance.

2. Pathophysiology: Meniscectomy and OA Progression

The meniscus plays a critical role in load transmission, shock absorption, joint stability, and lubrication. Its removal, even partially, alters knee biomechanics, increasing stress on the articular cartilage. Longitudinal studies have shown that meniscectomy leads to radiographic and symptomatic OA within 10–20 years of the procedure [3-5]

Moreover, patients with a history of meniscectomy often present for TKR with more advanced cartilage loss and altered joint anatomy [3].

3. Role of Physiotherapy After Meniscectomy

Early and structured physiotherapy following meniscectomy is essential for:

• Restoring range of motion (ROM)
• Strengthening periarticular muscles (particularly quadriceps and hamstrings)
• Improving proprioception and neuromuscular control
• Delaying osteoarthritic progression through joint unloading and improved biomechanics [6,7].

A well-executed rehabilitation program may also address early biomechanical deficits and prevent maladaptive movement patterns that accelerate joint degeneration.

4. Impact on TKR Outcomes

4.1 Preoperative Considerations

Patients who received physiotherapy post-meniscectomy may present with better preserved joint mobility, stronger musculature, and higher preoperative function compared to those without rehabilitation. However, long-term effects such as joint space narrowing and osteophyte formation may still necessitate complex surgical intervention [8].

4.2 Intraoperative Challenges

Previous meniscectomy can result in:

• Joint line elevation
• Soft tissue imbalance
• Ligamentous laxity or scarring
• Loss of bone stock

These can complicate component alignment and balancing during TKR [9]. Yet, patients who underwent regular physiotherapy may have better-maintained soft tissue integrity, aiding surgical outcomes.

4.3 Postoperative Recovery and Function

Some studies report that patients with a history of meniscectomy experience more pain and slower recovery post-TKR However, this may be offset by good muscle conditioning and joint motion achieved through physiotherapy. A cohort study by Smith et al. (2020) demonstrated that patients who had formal rehabilitation after meniscectomy achieved similar Knee Society Scores post-TKR as those undergoing primary TKR without previous meniscectomy [10,11].

5. Controversies and Conflicting Evidence

While some literature suggests a history of meniscectomy does not significantly affect TKR outcomes [12], other studies associate it with increased revision rates and poorer implant survival. The heterogeneity in outcomes is likely influenced by the quality of physiotherapy, timing of TKR, patient age, and degree of preoperative degeneration [13].

6. Clinical Implications and Recommendations

• Comprehensive Preoperative Assessment: Clinicians should evaluate prior surgical history, rehabilitation quality, and joint status thoroughly.
• Customized Surgical Planning: Consideration for altered anatomy, especially joint line and soft tissue status, is critical.
• Patient Counseling: Patients should be informed about the possible implications of prior meniscectomy and the benefits of ongoing physical therapy even years after the procedure.
• Long-term Physiotherapy: Encouraging post-meniscectomy patients to continue joint-preserving exercises may optimize later TKR outcomes.