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What is the meniscus?
Each knee has two menisci: C-shaped pads of tough cartilage that sit between the thigh bone and shin bone. They spread load across the joint, absorb shock and help stability. Because they protect the joint surfaces, preserving meniscus tissue where possible is an important principle of treatment.
Types of meniscus tear
Treatment depends greatly on the type of tear:
- Traumatic tears usually follow a twisting injury, often in younger, active people, and may occur with an ACL tear.
- Degenerative tears develop gradually as the meniscus ages, often in middle-aged or older people, and frequently occur alongside early arthritis.
- Displaced tears, such as a bucket-handle tear, where a fragment flips into the joint and may lock the knee.
Symptoms include pain along the joint line, swelling, catching and sometimes locking or giving way.
How is a meniscus tear assessed?
Your surgeon will ask how the injury happened and examine the knee for tenderness, swelling, movement and stability. X-rays help check for arthritis. An MRI scan can show the tear's type and location, but it is interpreted alongside your symptoms, because many people over middle age have meniscus changes on MRI without any symptoms.
Conservative (non-surgical) care
Conservative care is a reasonable first step for many tears, particularly degenerative tears without locking. It may include:
- Relative rest and avoiding deep squatting or twisting for a time.
- Ice and elevation for swelling.
- A physiotherapy programme to strengthen the thigh and hip muscles and restore movement.
- Pain relief guided by your doctor.
- A gradual return to activity.
Research suggests that for degenerative tears, structured exercise often gives results similar to arthroscopic trimming, which is why it is commonly tried first.
When is surgery considered?
Surgery is usually performed by knee arthroscopy. It may be considered when:
- The knee is locked or cannot straighten because of a displaced fragment.
- A traumatic tear in a younger person is in a repairable zone.
- The tear occurs with an ACL injury that is being reconstructed.
- Mechanical symptoms or pain persist despite good rehabilitation.
Repair or trimming?
Repair stitches the torn meniscus to help it heal and preserve it. It is favoured where the tear and blood supply allow, but recovery is longer. Partial meniscectomy (trimming) removes only the unstable torn part. It may give quicker recovery, but removing tissue can increase load on the joint surface over time.
Why is there no one-size-fits-all answer?
Two people with a meniscus tear on MRI can need very different treatment. A young footballer with a fresh tear that locks the knee is in a different situation from a person in their fifties with gradual pain and early arthritis. The tear pattern, its location, the quality of the tissue, the state of the cartilage, knee stability and the person's goals all shape the advice.
For this reason, decisions are best made after a proper examination rather than from a scan report alone. It is also reasonable to change course. Someone who starts with physiotherapy may later choose surgery if mechanical symptoms continue, while some people who were considering surgery find their symptoms settle with time and exercise.
If you also have significant arthritis, much of the pain may be coming from the arthritis rather than the tear. In that case treatments aimed at knee osteoarthritis are often more helpful than meniscus surgery.
Making the most of physiotherapy
Physiotherapy works best when exercises are done regularly and progressed over time. Programmes often begin with gentle range-of-movement and thigh-tightening exercises, then add strengthening for the quadriceps, hamstrings and hip muscles, followed by balance and functional training such as step-ups and controlled squats within comfort.
It is normal for symptoms to fluctuate. A short increase in discomfort after exercise that settles by the next day is usually acceptable, but pain that builds up day after day suggests the programme needs adjusting. Cycling and swimming are often well tolerated while you recover. Keep your physiotherapist and doctor informed about catching or locking, as these may change the plan.
What does recovery involve?
Recovery after conservative care is gradual over weeks. After trimming, many people return to daily activities within a few weeks. After repair, weight-bearing and bending may be restricted for some weeks to protect the stitches, and return to sport takes several months. These are typical ranges that vary. Risks of surgery include infection, stiffness, blood clots, failure of a repair and, over the longer term, arthritis.
When should you seek help?
See a specialist if your knee keeps catching, swelling or giving way, or if pain does not settle after a few weeks of sensible care.
When to seek urgent care: attend the nearest emergency department if the knee is locked and you cannot straighten it, if you cannot bear weight after injury, or if the knee becomes hot and swollen with fever.
Discuss your situation with Dr. Karnav Panchal for an assessment of meniscus tears.
Common questions
Does every meniscus tear need surgery?
No. Many tears, especially degenerative ones, improve with physiotherapy and activity changes. Surgery is considered for specific situations such as locking or repairable tears.
Can a torn meniscus heal by itself?
Tears in the outer part of the meniscus, which has a better blood supply, may heal. Tears in the inner part are less likely to heal but may still become less painful.
Is it safe to keep walking with a meniscus tear?
Walking is usually fine within comfort. Avoid deep squatting and twisting until you have been assessed, and seek help if the knee locks.
Related treatment page: Meniscus Tears. To talk about your own symptoms, request a consultation.