The meniscus is an extremely important structure in weight-bearing at the knee. Following arthroscopic debridement, altered load distribution and recurrent impaction result in progressive chondral damage and accelerated osteoarthrosis in the longer term.

Post-meniscectomy insufficiency fracture and osteonecrosis have also been described. Although the exact pathophysiology is unclear, these may be related entities. A combination of disuse osteopenia and increased focal contact pressures can result in a subchondral insufficiency fracture, with the ensuing bleeding and bone "edema" causing vascular insufficiency and thus osteonecrosis.

Conversely, vascular insufficiency could be the primary cause of osteonecrosis, with subsequent trabecular failure and fracture.