Four years ago, I injured my knee (anterior cruciate ligament rupture), and about a month ago, I injured it again, leading to a rupture of the posterior horn of the medial meniscus.
I’m wondering if the only solution for me is knee surgery since it’s now more unstable than before, or is it possible to improve the condition with some physical therapy?

The anterior cruciate ligament is an extremely important part of the knee stabilization system. Without it, there is micro-instability during movement, which over time can cause cartilage degradation and the onset of osteoarthritis. Intensive physical activities or sudden movements under load cause clear episodes of instability, which have the potential to damage the meniscus.

In this specific case, the expression “my knee is more unstable than before” points to the real problem. Meniscus damage is just its symptom. In that sense, it is possible to attempt physical therapy to alleviate the pain. Depending on a whole range of factors, it can be very successful. In case of its failure, it is also possible to undergo arthroscopy, during which the injured part of the meniscus would be removed, thus reducing the pain. However, the underlying problem of knee instability would remain untouched, as well as the risk of future similar injuries.

There are two possible approaches to addressing the symptoms of an unstable knee. The first is conservative. It involves a list of sports and physical activities to avoid, combined with regular exercise aimed at at least partially compensating for the missing ligament stabilization with muscle strength. The good side of this approach is avoiding surgery and long rehabilitation. The downside is living with significant limitations.

The second is surgical reconstruction of the anterior cruciate ligament. The surgery itself is now a routine procedure, but recovery from it takes up to a year. The good side of surgery is a life without restrictions in the end. The downside is the long rehabilitation and possible complications (now very rare), as with any surgical approach.