A torn meniscus in knee is a common cause of knee pain affecting active sportspeople and the elderly. Previously, we would treat a torn meniscus with keyhole surgery. However, recent evidence suggests that most torn meniscus settles with physical therapy. So, how should you treat a torn meniscus?
What is the meniscus?
The meniscus is c-shaped cartilage that sits in the knee joint. There are two menisci – one on the inside (medial meniscus) and one on the outside (lateral meniscus). The primary function of the meniscus is to act as a shock absorber and provide stability. So a tear can lead to pain and a feeling of locking or giving way.
Causes of a torn meniscus in the knee
Some cases of cartilage tear arise from an acute injury. For example, a sudden twist during sports such as football, skiing, or rugby can lead to a meniscal tear. However, some cases have no history of acute injury. As we age, the meniscus becomes weaker and prone to injury.
How do you know if the meniscus is torn?
Overall, diagnosing a meniscal tear requires a clinical assessment and imaging.
Generally, symptoms related to a meniscal tear include:
- Pain on the knee’s inside (medial meniscal tear) or outside (lateral meniscal tear). Sometimes, pain can move to the back of the knee.
- Swelling located below and above the kneecap,
- A feeling of instability also called giving way
- Catching or clicking sensation of the knee,
- An inability to fully bend or straighten your knee
- A lump inside or outside of the knee secondary to a meniscal cyst. Generally, cysts form from a meniscal tear.
Your doctor will examine your knee to confirm a diagnosis and rule out other knee injuries. Examples of other injuries include anterior cruciate ligament injury or medial collateral ligament injury. Again, an expert in knee injuries can rule out these conditions.
Often, imaging is needed in the assessment of a meniscal tear. A standing X-ray is vital to see if you have arthritis in the knee. Generally, an MRI scan is also used to diagnose a meniscal tear.
Meniscus or cartilage tear: what is the difference?
Often, there is confusion between a meniscus tear and a cartilage tear. People often use them interchangeably, causing some confusion.
The knee joint contains two types of cartilage. One type is articular cartilage, forming a smooth surface covering the bone ends. On the other hand, the menisci are a different type of cartilage that sits between the bones and acts as a shock absorber.
Articular cartilage injuries are often described as thinning, a flap, or a defect. Injuries to the cartilage can produce symptoms similar to a meniscal tear.
Treatment of a torn meniscus in knee
Overall, we treat most meniscal tears with conservative therapy. Generally, this rule applies to degenerative tears, or tears that occur without trauma (such as a knee twist)
Usually, initial treatment consists of ice (ice pack 10-15 mins every 2-3 hours), knee joint compression (using a compressive bandage), and anti-inflammatory tablets such as ibuprofen.
Next, we refer you to a physiotherapist to return you to sport or full function. Physical therapy should improve the knee’s range of motion, strength, and balance. Treatment should also focus on building power and control in the hip and pelvis.
Some doctors try a cortisone injection into the knee if you get stuck. We perform injections into the knee joint or directly surrounding the meniscal tear. Recently, some doctors have been using platelet-rich plasma or PRP injections into the cartilage tear to help heal cartilage.
But don’t all meniscal tears need surgery?
Actually no. If we perform MRI scans on people with no knee pain, many will have a meniscal tear. And a surgeon would not recommend surgery in these cases. So, the presence of a tear on the scan should not be the reason to have surgery.
In general, evidence would support physiotherapy. For example, in a recent study, people with partial meniscal tears were split into two groups. One group had surgery, while the other group had physiotherapy. There was no difference between groups in knee pain or function at three months and two years.
Moreover, a recent review collecting all high-level evidence for meniscal surgery suggests that keyhole surgery provides a small benefit compared to physiotherapy. However, the benefit only occurs in those people with no underlying arthritis. Generally, you should avoid surgery if you have co-existing knee arthritis. Removing part of the meniscus in knee arthritis may accelerate the wear and tear and lead to earlier knee replacement. For example, a recent study found that keyhole surgery for degenerative meniscal tears increases the risk of arthritis progression and the need for knee replacement surgery by 300%.
So best to stay away from keyhole surgery if you can.
However, some cases need surgery. Some of these cases include:
- Persistent pain that does not settle within 24 weeks of exercise therapy
- Gross swelling of the knee limiting the range of motion
- Mechanical symptoms such as the feeling of instability, giving way or locking
- Traumatic tears occur with an acute knee twist, especially in younger people. In particular, traumatic lateral meniscal tears need closer attention. Overall, we think that vertical or horizontal tears near the edge of the joint have better healing potential with sutures.
- Meniscal root tear: Meniscal roots anchor the meniscus to the tibia. An injury to the posterior meniscal root requires urgent surgical review to prevent further damage to the meniscus and articular cartilage. A recent study found that repair of the meniscal root was associated with less progression to arthritis than non-operative treatment or meniscal removal.
Athletes with a torn meniscus: Do we treat it differently?
Generally, we believe that young athletes with a torn meniscus need surgery early. However, new findings question this thinking. Young athletes with meniscal tears were randomised into immediate surgery or physiotherapy. After 12 months, there was no difference between groups for pain or return to sport. Also, only one in four athletes who had physiotherapy eventually required surgery. So, even for young athletes, we should consider a trial of physiotherapy in almost all cases.
Treatment for cartilage loss in the knee
Generally, a cartilage injury such as a fissure, flap, or defect is treated conservatively, similar to early arthritis.
Usually, we only consider surgery in young people with a single defect traditionally related to trauma. Options include microfracture or autologous chondrocyte implantation. Unfortunately, these options are only used in small numbers of people and require a long recovery.
Other common questions related to a torn meniscus in the knee:
Can a meniscal tear heal on its own?
When meniscus tears, bleeding and inflammation ensue. Sometimes, the meniscal tear can scar up and heal. Generally, healing potential is better on the periphery of the meniscus, where the blood supply is better.
Can I walk with a torn meniscus?
It depends on the severity of the symptoms. But yes, most people with meniscal tears can walk for fitness.
Does knee keyhole surgery increase the risk of arthritis progression?
Possibly yes. A recent study found that keyhole surgery for a degenerative meniscal tear increases the risk of knee replacement by at least three times. So it could be that removing the meniscus is not healthy for the joint.
Final word for Sportdoctorlondon on a torn meniscus in knee
Meniscal tears are a common cause of knee pain. Generally, we recommend a trial of therapy followed by injection if needed for degenerative tears. Often, we perform injections into the knee joint and around the meniscal tear. Finally, surgery is only for traumatic tears or when conservative management fails.
I loved when you mentioned that if we perform MRI scans in people with no knee pain, a significant number will have a meniscal tear. My child told me yesterday that he is suffering from back pain every time he bends. My wife and I decided to bring him to the best Pediatric Physiotherapy in town.
Hello-
I’m in my 60’s, female, in decent shape. I walk over four miles a day for exercise. I have arthritis in my knees, but it has been well-managed. I have some herniated discs, facet issues and scoliosis. The other night, I was rolling over in bed and my knee locked up. I couldn’t bend it more, not extend it. I couldn’t even lie down because every movement hurt. I don’t know if it clicked or popped when this happened, because I was asleep. After 30-45 minutes of kneading my IT band area and knee itself, it settled down. Now, however, that knee is unstable and I have fairly strong pain behind my knee and on the outside of my knee. I have difficulty with steps and can barely sit down or stand up if I do not have arms on the chair or a table on which to lean. If I bend my knee as fully as possible, it feels swollen and painful, but I can’t see any noticeable swelling just looking at it. I have been icing and also using infrared light band on it. No real improvement. What do you think it COULD be and how long to I continue self-care before seeing my ortho?
Hi, sorry to hear about your problems. I suspect you may have a torn meniscus. I’d continue to ice. If you can take NSAIDS such as Aleve or ibuprofen, then I’d suggest taking this medication for 1-2 weeks.
https://sportdoctorlondon.com/how-long-does-it-take-for-ibuprofen-to-work/
If no improvement, then I’d see your orthopedic doctor.
Lorenzo
Two years into my knee journey. Felt pop during plyometric workout. Iced, ibuprofen, rest. No resolution, saw primary. Of course nothing snowed on standard X-ray (waste of time). Given knee brace and exercises. Three months later chronic mild to medium pain finally referred to PT. Continue with brace, PT and ibuprofen. Tore calf from over compensating from knee pain at 6 months into journey. After calf mostly healed got cortisone injection that dulled but didn’t completely relieve pain. Just dwelt with chronic pain and limiting workouts which sucks. Now no specific event but pain is intensified, new bump on inside and excruciating pain not relieved by ANY OTC meds, ice, cryotherapy, infrared light therapy for the last 9 months. Pain wakes me nightly and I can no longer do the runs and lifting workouts I would like. Constant clicking in knee (meniscus?) pain on inside like meniscus pain, pain around MCL, pain to soft touch of fingers, hard lump the size of maybe half a golf ball on medial part of knee. Suggestions?
Hi I suspect you have a degenerative meniscal tear +/- meniscal cyst: see this blog for hints on how to treat it:
https://sportdoctorlondon.com/lump-on-the-side-of-knee/
Lorenzo
Missed a step and badly bruised and swollen.
Have been icing it since this occurred.
Can walk but have been home.
It is somewhat better.Am I doing the right thing?
Hi Harriet, It’s important to keep icing the knee and applying a compression bandage. If the pain does not improve, you should see your doctor.
LM
Hi, I am a dancer and was performing with knee pads on, doing floor tricks (front split) and I went to shift weight to get up, so my left knee was
On the ground (with a very cushioned knee pad) and the weight of my body shifted from right over to the left side and I heard or felt a pop (as I was leaning to the left so it was the inside of my left
Knee). It didn’t swell. But I did have a hard time with some buckling as I left the venue. It’s been 8 weeks of ice and ibuprofen (I haven’t tried a brace yet or wrapping). I’ve still been dancing but the pain has gotten worse on the inside of
The leg/knee and I feel it most when I am sitting in chairs or sleeping and first wake
Up, it’s really painful until I bend and straighten it a few times. I can straighten it fully, feels tender to the touch like a bruise, But it’s fine if I’m moving or walking. I want to be able to do my dancing/gymnastics again where I do flips and land on my knee pads (which is why this seems silly I got hurt just shifting from right to left)
so just want to make sure I’m healing correctly. Any advice is greatly appreciated and I have the moment it happened on film if needed. Thank you for your help!
You need to see a doctor and get further investigations – such as X-ray or MRI – to clarify your injury and decide on the best way forward to manage it.
Hi doctor, I was diagnosed with a medial meniscus root tear today. I have a golf trip booked in a week, can I go ahead and play without further damage? I will be using golf buggies and will get a knee brace to limit walking and support it. What’s your advice?
Hi Jon, These root tears are tricky. You need to speak to your doctor. Treatment depends on your age, your symptoms, and other injuries in the knee joint.
LM
Hi Doctor,
I’m 30 years with 5ft 9inches 200lbs, hit gym and play soccer weekly 3-4 times to stay active. I fell bad while playing soccer. My knee got inward and hit the ground and been a month by now. First 2 days it was difficult for the knee movment and walk much.
Now, I’m to walk and have good knee mobility. I’m following RICE and having ibupforen for inflamation but no results. However, i figured that semimembranosus muscles or tendons deeply has a pain and been swollen from a month. The swelling is still there. There is a acute pain and bit lose joing near MCL.
Is this swelling is common, if yes how long does it take or what I’ve to do?
May I get back to sport or hit gym again. Please suggest
Based on your description, I think you’ve sustained significant damage to your knee – perhaps a meniscal tear +/- anterior cruciate ligament tear. I would suggest you see a doctor and consider an MRI scan to confirm the diagnosis.