Sports injuries
Meniscus Tear: Symptoms, Treatment and Recovery
In short
A meniscus tear is a tear in the C-shaped cartilage that cushions the knee between the thighbone and shinbone; in young people it usually follows a twisting sports injury, while in middle age it often results from wear. For most wear-related tears, exercise and physiotherapy are the first treatment; arthroscopic surgery is considered for a truly locked knee or a repairable traumatic tear. Recovery takes a few weeks after trimming part of the meniscus and a few months after stitching it.
What is a meniscus tear?
Each knee has two menisci, an inner and an outer one. They are firm, rubbery, wedge-shaped pieces of cartilage sitting between the thighbone and the shinbone. They spread load across the joint, absorb shock and help keep the knee stable [1].
A tear can happen in two ways. In young people and athletes it is usually a traumatic injury caused by a sudden twist. With age, the meniscus tissue weakens, and even a simple twist when getting up from a chair can tear it. This second type is called a degenerative, or wear-related, tear [1][3].
Symptoms
Some people feel a 'pop' at the moment of injury. Many can still walk on the first day, but over the next 2–3 days the knee may become gradually stiffer and more swollen [1]. Common symptoms include [1][2]:
- Pain on the inner or outer side of the knee
- Swelling and stiffness
- A catching or locking feeling
- The knee giving way or feeling unstable
- Difficulty bending or fully straightening the knee
Causes and risk factors
Sports that involve twisting, sudden stops and changes of direction, such as football and basketball, raise the risk of a traumatic tear. A meniscus tear can also happen together with other knee injuries, such as an anterior cruciate ligament tear [1].
In middle age and later, the meniscus becomes thinner and weaker, so a tear can occur without any clear injury. In this age group a meniscus tear often goes hand in hand with early wear-and-tear arthritis (osteoarthritis) of the knee [1][3].
Diagnosis
Diagnosis starts with an examination. The doctor checks for tenderness along the joint line and bends and rotates the knee to see whether this causes pain or a click. This is known as the McMurray test [1].
The meniscus does not show on X-ray, but an X-ray helps rule out other causes of similar pain, such as arthritis. Magnetic resonance imaging (MRI) gives the best view of soft tissues, including the meniscus [1]. In people over middle age, a tear seen on MRI is not always the true cause of pain, so treatment decisions rest on the examination and symptoms rather than the scan alone [3].
Treatment without surgery
Many tears, especially wear-related ones, do not need surgery. Early on, rest, ice, gentle compression and raising the leg are advised. Pain-relieving and anti-inflammatory medicines recommended by the doctor may also help [1].
For wear-related tears, the main treatment is a regular exercise programme guided by a physiotherapist. In a randomised trial of middle-aged patients, 12 weeks of supervised exercise and arthroscopic partial removal of the meniscus gave no meaningful difference in knee function at two years, and thigh muscle strength improved more in the exercise group [4].
An international clinical guideline made a strong recommendation against arthroscopy for nearly all patients with degenerative knee disease, with or without a meniscus tear. A Cochrane review also found that arthroscopy adds little or no meaningful benefit for pain or function in this group [3][5].
Surgical treatment
Arthroscopic (keyhole) surgery may be considered if symptoms do not settle with exercise and other measures, if the knee is truly locked and cannot straighten, or if a young patient has a traumatic tear that can be repaired [1][3].
Two techniques are used. In partial meniscectomy, only the torn, damaged part is trimmed away. In meniscus repair, the torn pieces are stitched together. Whether a repair is possible depends on the type and location of the tear, because only the outer part of the meniscus has a blood supply and can heal [1].
The decision about surgery should be shared with the patient, weighing age, tear type, the degree of arthritis in the knee and personal goals [3].
Recovery
With non-surgical treatment, the exercise programme usually lasts a few months, and sticking with it is the main factor in a good outcome [4].
After a partial meniscectomy, recovery takes about 3–6 weeks. After a meniscus repair the tissue needs longer protection to heal; recovery takes around 3–6 months. In both cases physiotherapy is important to regain movement and muscle strength [1].
When to see a doctor urgently
Seek medical help or go to an emergency department without delay if [2]:
- The knee is locked and will not straighten
- The knee keeps giving way or clicks painfully
- You cannot put any weight on the leg, or the knee looks deformed
- The knee is red and hot and you have a fever
- The pain has not improved within a few weeks
Frequently asked questions
+Can a torn meniscus heal on its own?
The inner part of the meniscus has no blood supply, so a tear there usually does not heal by itself. However, symptoms of wear-related tears often improve a great deal with exercise and physiotherapy [1][4].
+Does every meniscus tear need surgery?
No. For wear-related tears in middle age and later, exercise therapy is the first choice. Surgery is mainly considered for true locking, a repairable traumatic tear, or symptoms that persist despite treatment [1][3].
+Can you walk with a torn meniscus?
Most people can walk after the injury. Swelling and stiffness may build up over a few days, and if the knee locks or gives way you should see a doctor [1][2].
+How long is recovery after meniscus surgery?
About 3–6 weeks after partial meniscectomy and about 3–6 months after meniscus repair. Return to work depends on how physical the job is [1].
Sources
- [1]Meniscus Tears — American Academy of Orthopaedic Surgeons (OrthoInfo).
- [2]Knee pain — NHS (nhs.uk), 2023.
- [3]Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline (Siemieniuk RAC, et al.) — BMJ, 2017.
- [4]Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up (Kise NJ, et al.) — BMJ, 2016.
- [5]Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears) (O'Connor D, et al.) — Cochrane Database of Systematic Reviews, 2022.
This article is general information and does not replace an examination or personal medical advice. In an emergency, go to the nearest emergency department.