What is the expected timeline for the cessation of swelling and protrusion after meniscus repair surgery in a 12-week post-operative patient?

Expected Timeline for Resolution of Swelling and Protrusion After Meniscus Repair

At 12 weeks post-operative, you should expect swelling and protrusion to have largely resolved, though some residual swelling may persist up to 6 months as the meniscus continues its healing process.

Standard Recovery Timeline

The typical recovery from arthroscopic meniscus repair follows a predictable pattern:

• 2-6 weeks: Primary recovery period where most acute swelling and functional limitations resolve 1
• 6 weeks: Full recovery expected in uncomplicated cases with pain and swelling brought under control 2
• 2-4 weeks: Athletic training typically resumes 2
• 3-4 weeks: Return to competition possible in athletes 2

Your Patient's Current Status at 12 Weeks

At 12 weeks post-operative, persistent swelling and protrusion is outside the typical recovery window and warrants further evaluation. The BMJ guidelines indicate that recovery typically occurs between 2-6 weeks, with most patients experiencing resolution of swelling during this timeframe 1.

Ongoing Healing Process

However, it's important to understand that:

• MRI studies demonstrate continuous healing occurs throughout the first 6 months postoperatively, with signal alterations still present even when patients achieve good clinical results 3
• At 6 months follow-up, menisci are classified as only 55.9% healed, 35.3% partially healed, and 8.8% non-healed despite good functional outcomes 3
• The biological healing process extends well beyond the resolution of clinical symptoms 3

Expected Timeline for Complete Resolution

You should expect complete resolution of swelling and protrusion by 6 months post-operatively in most successful repairs 3. However:

• If significant swelling and protrusion persist beyond 12 weeks, this may indicate:
  • Incomplete healing (occurs in 19.5% of modern repairs at 5+ years) 4
  • Potential repair failure (3.3% failure rate in early repairs, 20% in delayed repairs) 5
  • Need for re-evaluation with MRI to assess healing status 3

Critical Red Flags at 12 Weeks

At this timepoint, evaluate for:

• Mechanical symptoms suggesting repair failure or incomplete healing 1
• Inability to bear full weight (should have resolved by 2-7 days post-op) 1
• Persistent pain beyond expected recovery timeline 2
• Recurrent effusion suggesting ongoing pathology 3

Management Recommendations

If swelling and protrusion persist at 12 weeks:

• Obtain MRI to assess meniscus healing status using Henning's criteria (healed, partially healed, or non-healed) 3
• Continue conservative management with compression, activity modification, and physiotherapy 1
• Expect gradual improvement through 6 months, as this represents the typical healing timeline for meniscal tissue 3
• Consider that 23% of repairs may ultimately fail and require subsequent intervention 6

Important Caveat

The evidence shows that clinical improvement often precedes complete biological healing. Young athletes achieve 100% return to sport rates at 6 months despite ongoing MRI signal alterations indicating incomplete healing 3. Therefore, persistent mild swelling at 12 weeks may be consistent with normal healing if functional improvement is occurring.