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When your meniscus is healthy, it acts to absorb shock and provides a smooth surface for your knee to glide on. When you have a meniscal tear, also known as a torn meniscus, it can catch which causes pain, swelling and sometimes locking. These types of injuries are fairly common, particularly among athletes and patients over 40.
On each side of the joint, between the cartilage femur and tibia surfaces, are the medial meniscus and lateral meniscus. The menisci act to absorb shock and reduce stress between the tibia and the femur. They are C-shaped pieces of cartilage that act as shock absorbers and stabilizers for the knee joint, cushioning the bones and preventing them from grinding together during movement.
When a forceful twisting or rotating motion is applied to the knee, you may tear your meniscus. You may also tear a meniscus when you do deep squats which can put excessive stress on the meniscus and potentially lead to a tear. You may also tear your meniscus due to wear and tear over time, this usually occurs in patients over 40 without any specific trauma.
A meniscal tear can make you feel like your knee is unstable and swollen, and sometimes stuck. Other times it may just hurt on the sides or back of your knee, especially if you are squatting and twisting.
Pain is typically the most prominent symptom; you can feel it along the joint line of the knee. The specific location of the pain may offer clues about the type of tear. For instance, pain on the inner side of the knee suggests a medial meniscus tear, while outer knee pain indicates a lateral meniscus tear.
It’s common to have fluid in the knee joint due to inflammation after a tear. This swelling can cause a sensation of tightness or stiffness, limiting the range of motion in your knee.
Sometimes, a torn meniscus fragment can get wedged between the bones of the knee joint, causing you to feel a catching or locking sensation. This can restrict your ability to fully bend or straighten your injured knee.
The meniscus plays an important role in stabilizing your knee joint. A meniscal tear can compromise this stability, leading you to feeling like your knee is giving way or feeling weak, particularly when you are doing activities that involve twisting or pivoting.
You might hear or feel a clicking or popping sensation in your knee during movement, especially if a torn meniscus fragment catches or moves within the joint.
The severity of these symptoms varies depending on the size and location of the tear.
Minor tears, for example, might only cause you mild discomfort and stiffness, while larger tears may result in significant pain, swelling, and difficulty walking.
If you’re experiencing any of these symptoms in your knee, especially after a twisting injury or direct blow, it’s advisable to consult a doctor for a proper diagnosis. Early intervention can help ensure a faster recovery and prevent further complications.
A torn meniscus can happen in a couple of ways, typically involving forceful twisting or rotation of the knee joint. Here’s a breakdown of the most common scenarios:
This is a frequent cause, especially in sports that involve sudden changes in direction or pivoting movements. Imagine playing basketball and planting your foot to make a quick cut, while your upper body twists in the opposite direction. This forceful twisting motion with a weight-bearing knee can put stress on the meniscus and lead to a tear.
When your knee twists with a planted foot, the bones in the joint (femur and tibia) can rotate in opposite directions. The meniscus, which is between these bones, gets caught in this twisting motion. This can cause your meniscus to tear, particularly if the force is significant.
A hard impact on the knee, such as a fall or collision during contact sports, can directly damage the meniscus. This is less common than twisting injuries but can still cause a tear.
A forceful blow to your knee can compress the joint and damage the meniscus. The specific type of tear depends on the direction and location of the impact.
Over time, the meniscus can weaken due to aging due to wear and tear. The meniscus only has blood flow in the outer 30% — which makes it more susceptible to tears, even with minimal stress. Everyday activities that involve twisting or bending the knee can put stress on the weakened meniscus, leading to small tears over time. This type of tear is more frequent in older adults and might not be associated with a specific injury.
Factors that can increase the risk of a torn meniscus include activities that involve repeated twisting or pivoting movements, such as soccer, basketball, and football. This repetitive stress can put a strain on the meniscus and increase the risk of tears.. And if you’ve had a previous knee injury, you might be more susceptible to future meniscal tears due to ligament instability or scar tissue.
Medial meniscus tears occur in the inner meniscus and are more common than lateral meniscus tears. These tears are often associated with twisting motions that put stress on the inner knee. Lateral meniscus tears occur in the outer meniscus and are more likely to happen during forceful pivoting motions, with an ACL tear, or due to direct blows to the outer knee.
Your first step is to schedule an appointment with your doctor or a healthcare professional specializing in orthopedics or sports medicine. The doctor will ask about your medical history, including any previous knee injuries, symptoms you’re experiencing, and how they began (sudden injury, gradual pain, and so on). The doctor will also physically examine your knee, assessing it for swelling, tenderness, and range of motion. Specific tests, such as McMurray’s test, are usually performed to check for meniscal tears.
While X-rays are not typically used to diagnose meniscal tears (because X-rays primarily show bones), your doctor might order them to rule out other potential causes of knee pain, such as arthritis. However, doctors usually use other imaging tests to definitively diagnose a meniscal tear:
Magnetic Resonance Imaging (MRI): An MRI uses strong magnetic fields to create detailed images of the soft tissues within your knee, including the meniscus, revealing the size, location, and type of tear.
CT Arthrogram (CTA): Less frequently, a doctor might request an CT, which is a scan performed with a contrast dye injected into the knee joint to better visualize the meniscus and surrounding structures in cases where a patient cannot have an MRI such as patients with pacemakers or aneurysm clips in their brain..
Early diagnosis and treatment of meniscal tears can help you recover faster and prevent potential complications. Addressing the tear promptly can help reduce pain, inflammation level, and improve your overall comfort. For minor tears, early intervention can promote better healing if you care for the injury appropriately. A neglected tear can also worsen over time, potentially leading to damage to other knee structures, such as cartilage or ligaments. Identifying a mensical tear early allows you more options for treatment, including non-surgical approaches.
Once you have a confirmed diagnosis of a tear, discuss treatment options with your doctor, which will vary based on the severity and type of tear, your age, activity level, and overall health.
Treatment for a meniscal tear depends on the severity of the tear, its location, and your individual circumstances. Some initial options include:
Large or complex tears, particularly bucket handle or displaced flap tears, can cause significant pain, locking, and instability in the knee. You may need to repair or resect these tears arthroscopically to restore proper knee function.
Small tears, especially in the well-vascularized outer region of the meniscus, might heal on their own with non-surgical treatment.
The outer one thirds of the meniscus have a good blood supply, which aids healing. Tears in this area have a better chance of healing with non-surgical methods. Tears in the avascular zone, the two thirds of the meniscus, have a limited blood supply, reducing healing potential. Tears in this zone more often require surgical intervention for repair or removal of the torn fragment.
Younger people who participate in sports or activities that put stress on the knee might benefit more from surgery to repair a significant tear. Restoring full function and stability enables these patients to return to their active lifestyle. For older adults, particularly those who have a less active lifestyle, a minor tear may not impact their daily activities significantly, so conservative treatment may be appropriate.
If pain medication and physical therapy don’t effectively manage pain and inflammation caused by your meniscal tear, you may want to discuss your options with an orthopedic surgeon. Tears that cause your knee to lock or catch during movement can be frustrating and limit your ability to perform daily activities, and surgery may be the best way to address these issues. And if your torn meniscus causes knee instability that significantly impacts your daily life, a surgeon can help you decide on a course of action.
You can often quiet down the symptoms of a torn meniscus with time, anti-inflammatory medication or a cortisone injection, and physical therapy. However, if symptoms such as pain, swelling, and instability persist, I recommend arthroscopic meniscectomy or arthroscopic repair. This is a clipping or smoothing of flaps of unstable meniscal cartilage within the knee.
In a knee arthroscopy, I make two small incisions. Using an arthroscope (or scope) the knee joint is expanded using saline solution. I can see inside the joint using the scope’s camera. Next, I insert a surgical instrument through the other incision to either trim away the torn piece of meniscus or repair the meniscus using sutures.
The whole procedure takes about 30 minutes and is done with sedation and spinal anesthesia. Patients typically return to work within a few days and are able to return to active sports in four to eight weeks after a meniscectomy or 3-4 months after a repair.
Recovery time for a meniscal tear varies depending on the severity of your tear and what type of treatment you received. Minor tears might heal within a few weeks with proper care, while surgical repair could take a couple of months for full recovery.
Take care of yourself after surgery to ensure a successful recovery.
A physical therapist will guide you through exercises to strengthen the muscles around your knee, improve flexibility, and restore your range of motion. Plan to go to all scheduled physical therapy sessions and make sure you perform prescribed exercises at home.
Your doctor will advise you on weight-bearing restrictions, which vary depending on the severity of the tear and the surgical procedure performed. Initially, you may need to use crutches or a walker for support. Gradually, you can progress to putting more weight on the affected leg.
These are general guidelines; make sure you follow your doctor’s specific post-operative instructions, which may vary depending on your individual case and the surgical procedure performed.
Before you undergo surgery for a meniscal tear, consider your overall health, the recovery time and commitment to physical therapy to regain full function, and make the decision to undergo meniscal tear surgery in consultation with an orthopedic surgeon who has the knowledge and expertise to provide guidance based on your specific situation.