The meniscus is a C-shaped piece of cartilage that serves as the shock absorber in your knee. It is important to keep your knee stable and to protect the health of your knee. The meniscus can be torn during a twisting or impact injury to your knee, or it can develop a tear over time from overuse. There are 3 main types of meniscus tear treatment we will discuss below.
Signs and Symptoms of a Meniscus Tear
A torn meniscus can result in either sudden or gradual onset of pain. There is often swelling of the knee and severe pain with walking, running, twisting, or moving the knee. The pain is usually located one the sides or front of the knee, although it can occasionally be located in the back of the knee. Some patients may experience catching, clicking, or locking of their knee. These are referred to as mechanical symptoms.
Treatment of a Meniscus Tear
Many meniscus tears can be treated successfully without surgery. The RICE (rest, ice, compression, elevation) principle can be useful in the first several days after a meniscus tear to help reduce inflammation, swelling, and pain. Physical therapy exercises can help to improve muscle strength, knee range of motion, and decrease sensitivity to the pain.
Some patients will ultimately need surgical treatment of their meniscus tear. Most of the time these patients have a specific injury that caused the meniscus tear, and may often have reduced range of motion of mechanical symptoms such as catching or locking. Some types of tears, such as meniscal root tear or a bucket-handle tear, almost always need surgery. In general we use an MRI or ultrasound to look more closely at the meniscus and determine if it is something that needs surgical treatment, although this decision is also made based on how the patient responds to nonsurgical treatment.
Many meniscal tears can be repaired surgically. Although the meniscus has traditionally been considered a difficult structure to heal, newer techniques and biologic augmentation such as PRP, stem cells, fibrin clots, and cartilage scaffolds have led to an improved rate of healing. Current literature suggests that meniscal repair is successful between 75-95% of the time, depending on the type and location of the tear.
Occasionally, the meniscus must be trimmed back, often referred to as a partial meniscectomy. This is necessary in irreparable tears or in situations with poor healing potential. Degenerative tears, sometimes referred to as complex tears, are tears that usually can’t be repaired and can be trimmed arthroscopically if non-surgical treatment is not effective. The least amount of meniscus possible should be removed, since over resection can lead to knee instability, cartilage damage, and premature arthritis.
Types of Meniscus Tears and Prognosis
There are numerous types of meniscus tears. A radial tear is a tear that crosses through from the inner portion of the meniscus to the outer portion of the meniscus. It transects the circumferential fibers of the meniscus, and will usually continue to enlarge if untreated. At some point, if the tear completes, the resultant pressure on the articular cartilage of your knee can be similar to not having a meniscus at all. A vertical tear is in line with the fibers of the meniscus, and usually has good healing potential, depending on where the tear is located.
A bucket handle tear usually starts off as a vertical tear that elongates to include the majority of the meniscus. Eventually the inner portion of the meniscus flips over into the middle of the knee, with the front and back connections still in place. This can be compared to the handle of a bucket swinging back and forth. These tears can sometimes be repaired if located in more of the peripheral portion of the meniscus where the blood supply is better.
In general, chronic, degenerative tears are treated non operatively. These are sometimes referred to as complex tears, and usually result from a combination of smaller tears that occur over time.. However, the can be an indication for surgical treatment in these tears if they don’t improve with conservative management, if there are displaced flaps, or if there are mechanical symptoms. Acute tears, especially when in the setting of an ACL tear, usually have a positive repair prognosis. In fact, studies have shown that repair of meniscus tears is more cost-effective than meniscectomy in the long run.
What Should You Do if You Think You Have a Torn Meniscus?
If you think you may have a meniscus tear, it is recommended that you see a sports medicine physician as soon as possible. Many tears have better outcomes if they are treated early. A sports medicine specialist will examine your knee and any relevant imaging to determine which treatment you should start with first. McMurray’s test, Thessaly test, Apley compression test are all tests that may be used in helping to determine if you have a meniscus tear. The history behind the injury and determining which types of things make the pain worse can help as well. There is often swelling in the knee, known as an effusion, although this doesn’t have to be present for there to be a meniscus tear. Identifying and properly treating meniscus tears (with or without surgery) will lead to the most rapid reduction in your symptoms and is crucial to optimize the long term health of your knee.
Additional Resources About Meniscus Tears
Faq - Frequently asked questions
The answer is it depends. There are some types of tears, in some areas of the knee, that are able to heal on their own. For instance, vertically oriented tears in the outer one-third of the meniscus have better healing potential than most other types. This is because there is better blood supply in the outer one-third and because the orientation of a vertical tear allows it to be compressed with weight bearing, which encourages the torn edges to stick together and heal.
Even though complex or degenerative tears may not be able to heal on their own, the symptoms often improve over time and with conservative management.
Some types of tears can heal without surgery. Non-displaced, vertical tears in the peripheral 1/3 of the meniscus have a better chance of healing than other types. Even if the tear doesn't heal, it is possible for the symptoms to improve without surgery. However, this is very dependent on the tear type and tear location.
Yes, most of the time. However, the torn meniscus may lead to swelling, instability, or sharp pains with twisting motions. Sometimes the pain is severe enough that you can't walk. After surgery to repair a torn meniscus, it is often recommended that you limit weight bearing for 4-6 weeks to allow the meniscus to heal.
A torn meniscus in the knee often leads to swelling and pain on the inside or outside of your knee. Sometimes it is the result of an acute injury, and other times it develops over time. Mechanical symptoms can also develop, and these include catching, locking, or popping in the knee.
For a full diagnosis, a knee specialist will consider the symptoms and type of injury, perform a clinical examination of the knee, and then use x-rays and MRI (magnetic resonance imaging) to help confirm the diagnosis.
Torn Meniscus? Be Proactive with Your Knee Health
Schedule Your Sports Medicine Evaluation with Dr. Burnham Today
Dr. Jeremy Burnham is a board-certified orthopedic surgeon who is fellowship-trained in sports medicine. He specializes in the surgical treatment of complex knee injuries and his clinical and research focus centers around the diagnosis and treatment of ACL injuries, meniscus tears, cartilage restoration, and knee instability.
Dr. Burnham is the team physician for Southern University, the Baton Rouge Rougarou, and several area high schools. He is the site investigator for NIH and DoD-funded research studies examining the best treatment techniques for knee injuries.
Jeremy M. Burnham, MD