Meniscal Tear (Torn Meniscus)

What the menisci do

Each knee has two menisci sitting between the thigh bone (femur) and shin bone (tibia):

• the medial meniscus on the inner side, more often torn
• the lateral meniscus on the outer side

They act as shock absorbers, spread load across the joint, add stability and help lubricate the cartilage. Only the outer third (the "red zone") has a good blood supply, which affects whether a tear can heal or be repaired.

Types of meniscal tears

Causes and risk factors

• Acute tears: twisting or pivoting on a bent knee with the foot planted, deep squatting, tackles. Common in soccer, basketball, football and skiing, often with an ACL injury.
• Degenerative tears: age-related weakening; can happen with simple movements like getting up from a squat. Often coexist with knee osteoarthritis.
• Risk factors: age over 40, contact and pivoting sports, jobs with frequent kneeling and squatting, obesity, previous knee injury.

Symptoms

• a pop at the time of injury (in some)
• pain along the inner or outer joint line, worse with twisting or squatting
• swelling and stiffness developing over 24 to 48 hours
• difficulty fully straightening the knee
• mechanical symptoms: catching, clicking with pain, or locking (the knee gets stuck)
• the knee giving way
• a Baker's cyst at the back of the knee in some degenerative tears

Many degenerative tears found on MRI cause no symptoms at all.

Diagnosis

• History: how it happened, swelling timeline, locking.
• Examination: tenderness along the joint line, pain with deep bending, and tests such as the McMurray test (a click or pain when the knee is rotated and straightened) and the Thessaly test.
• X-rays: to look for arthritis, fractures or loose bodies, especially in people over 40.
• MRI: shows the tear's location and pattern, and other injuries. MRI findings must match symptoms; meniscal tears are common in middle-aged people without knee pain.

Treatment

Non-surgical treatment

Recommended first for most degenerative tears and for many small, stable acute tears:

• relative rest from painful activities, ice and elevation
• NSAIDs or acetaminophen, following the label
• physical therapy: restore range of motion, then strengthen the quadriceps, hamstrings and hips, with balance training
• gradual return to activity over 6 to 12 weeks
• a steroid injection may help pain in people with associated arthritis

Large trials have shown that for degenerative tears in middle-aged and older adults, arthroscopic partial meniscectomy generally gives no better results than physical therapy.

Surgery

Considered for:

• a locked knee or a bucket-handle tear
• persistent mechanical symptoms or pain despite 6 to 12 weeks of rehab
• repairable tears in younger, active people, especially with an ACL reconstruction
• root tears

Options:

• Meniscal repair: stitching the tear, preferred when possible because it preserves the meniscus and protects against arthritis. Best for tears in the outer, well-supplied zone in younger patients.
• Partial meniscectomy: trimming the torn part. Faster recovery but removes cushioning tissue, raising arthritis risk.
• Meniscal transplant: rarely, for young people who have lost most of a meniscus.

Recovery time

Complications

• persistent pain or swelling
• recurrent tears
• knee osteoarthritis, especially after removing large amounts of meniscus or untreated root tears
• surgical complications such as infection or blood clots (uncommon)

Prevention

• strengthen the thigh and hip muscles
• warm up and use good landing and pivoting technique
• avoid deep squatting with heavy loads if you have degenerative knees
• maintain a healthy weight

Frequently asked questions

What does a torn meniscus feel like?

A torn meniscus usually causes pain along the inner or outer side of the knee, swelling that develops over a day or two, stiffness and difficulty straightening the knee. Some people feel catching, clicking or locking, or the knee gives way.

Can a torn meniscus heal on its own?

Small tears in the outer edge, which has a good blood supply, can heal. Tears in the inner part usually do not heal but often stop causing symptoms with physical therapy. Degenerative tears in older adults frequently improve without surgery.

How long does it take to recover from a meniscus tear?

With physical therapy, many people improve within 6 to 12 weeks. After partial meniscectomy, return to sport often takes 4 to 6 weeks. After meniscal repair, full recovery and return to pivoting sports usually take 4 to 6 months.

Do I need surgery for a torn meniscus?

Not usually. Most degenerative tears and many small tears do well with physical therapy. Surgery is recommended if the knee locks, symptoms persist despite rehab, or the tear is repairable in a young, active person.

Can I walk with a torn meniscus?

Usually yes, although it may be painful and the knee may feel stiff or swollen. If the knee locks, gives way repeatedly, or you cannot bear weight, see a doctor promptly.