The meniscus is a C-shaped piece of cartilage that acts as a shock absorber in your knee. It keeps your knee stable and protects the cartilage. 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 treatments we will discuss below.
Signs and Symptoms of a Meniscus Tear
A torn meniscus can result in either sudden or gradual onset of pain. A meniscus tear often results in swelling of the knee and severe pain with walking, running, twisting, or moving the knee. The pain is usually located one the sides of the knee, although it can occasionally be located in the back of the knee (sometimes causing a Baker’s cyst). Some patients with a torn meniscus 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 meniscus tears, such as a meniscal root tear or a bucket-handle tear often need surgery. An MRI or ultrasound can 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 meniscus 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 torn 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 meniscus 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 meniscus 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 radial meniscus 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 a meniscus tear in line with the fibers of the meniscus, and usually has good healing potential, depending on where the tear is located. Meniscus tears located in the outer two-thirds of the meniscus have the best chance of healing.
A bucket handle tear usually starts off as a vertical meniscus tear that elongates to include the majority of the meniscus. Eventually the inner portion of the torn meniscus flips over into the middle of the knee, with the front and back connections still in place (similar to the handle of a bucket swinging back and forth). These meniscus 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 meniscus 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 associated with knee injury, 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 an orthopedic surgeon and sports medicine physician as soon as possible. Many meniscus tears have better outcomes if they are treated early. A knee specialist will examine your knee joint and obtain 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 joint, 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 joint.
Additional Resources About Meniscus Tears
- The Anterolateral Complex of the Knee – OJSM 2017
- Meniscal Ramp Lesions. KSSTA
- Meniscal Root Repair Article.
- Meniscal Root Tear Repair: Why, When and How? Orthopedic Reviews
Faq - Frequently asked questions
It depends. There are some types of tears that are able to heal on their own. Vertical meniscus tears in the outer one-third of the meniscus have better healing potential. 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.
The meniscus is an elastic cushion that protects and stops bone grinding that can result in injury, cartilage wear, chondral defects, and arthritis. The meniscus aids other structures in providing knee stability and is known as a “secondary stabilizer” in the context of ACL, or anterior cruciate ligament, injury. It evenly distributes its weight across your knee joint.
Meniscus tears can cause pain. The pain may become worse when the knee is moved or when walking. In some cases, the knee may feel like it “gives out.” Some people feel a popping sensation, in some cases the knee locks, and in some cases, the thigh muscles feel weak.
Symptoms associated with meniscus tears include pain and swelling of the knees and joints. A locking/catch feeling can be experienced on the knees and often becomes inflamed. The feeling of weakness in the legs and knees is possible in some instances. This is because a torn meniscus can send inhibitory feedback to the quadriceps muscles. Pain can be felt in the knee below the meniscus during lifting or twisting of a limb or when turning the knee.
Meniscal tears are treated differently, depending on the severity, chronicity, and location of the damage. Other elements that impact therapy include age, the activity level of the patient, and the cause of the tear.
If the tear is very tiny and occurs in an area with excellent blood flow (the outer edges of the meniscus, often known as the “red zone”), the meniscus tear might heal on its own.
The meniscus has limited blood supply, and some areas can't heal on their own. Symptoms of degenerative tears can improve even if it doesn't completely heal.
Recent studies showed that a tear with sufficient blood supply can recover after being sewed together. Success rate of repair is not 75-90%.
The horizontal cleavage tear was once regarded as a degenerative tear that couldn’t heal, however, newer techniques have shown success in addressing horizontal tears with surgery.
In the case of degenerative meniscal tears, the symptoms will usually improve. However, some types of meniscal tears lead to rapid arthritis or cause knee instability, lack of motion, stiffness, or weakness. It is important to see an orthopedic surgeon and knee doctor for evaluation of the type of tear you have and to help determine the prognosis.
Depending on the severity of the tear, it can take anywhere from a few weeks to several months for a torn meniscus to heal without surgery. In most cases, the body will naturally improve the damage and the symptoms over time. This is particularly true with degenerative tears. However, some tears may be more severe and require more intervention. It is important to get evaluated by an orthopedic surgeon if you think you have a meniscus tear.