Neurological Symptoms After Meniscal Repair: Current Concepts in Prevention, Risk Stratification, and Clinical Evaluation.

Neurological symptoms after meniscal repair are uncommon but clinically relevant complications that may result in persistent sensory disturbance, neuropathic pain, motor dysfunction, delayed rehabilitation, and occasionally permanent neurological impairment. Their evaluation remains challenging because similar postoperative manifestations may arise from transient perioperative phenomena or structural nerve injury. Current diagnostic practice relies primarily on neurological examination and correlation with regional anesthesia, tourniquet use, portal placement, repair technique, and the anatomical location of meniscal instrumentation. Serial clinical assessment remains the cornerstone of evaluation, while high-resolution ultrasound, magnetic resonance neurography, nerve conduction studies, and electromyography may provide complementary anatomical and functional information when structural injury is suspected. Management ranges from observation of mild, non-progressive deficits showing early improvement to targeted investigation and, in selected patients with progressive neurological deterioration, persistent motor dysfunction, or suspected mechanical nerve entrapment, consideration of surgical exploration. However, the available evidence specifically addressing neurological complications after meniscal repair remains limited and consists predominantly of anatomical investigations, technical reports, case reports, small clinical series, and evidence extrapolated from the broader peripheral nerve literature. Reliable incidence estimates, validated diagnostic thresholds, and procedure-specific criteria for escalation remain unavailable. This Current Concepts Review summarizes the mechanisms and neural structures at risk during meniscal repair and proposes an expert-informed, risk-stratified framework integrating neurological phenotype, procedure-specific factors, serial examination findings, imaging, and electrodiagnostic assessment. Postoperative timing should be interpreted as a modifier of clinical suspicion rather than as an isolated determinant of injury mechanism. Prospective multicenter studies are required to validate risk-stratification strategies, standardize reporting, and determine the optimal indications and timing for advanced imaging, electrodiagnostic testing, and surgical intervention.