Treating a Knee Meniscus Tear: Surgery vs. Physical Therapy

A torn meniscus in the knee is a common cause of knee pain in active people and older adults. We used to treat most tears with keyhole surgery. But recent evidence shows that most settle with physiotherapy — so how should a torn meniscus be treated?

What is the meniscus?

The meniscus is a c-shaped cartilage in the knee joint. There are two — one on the inside (medial meniscus) and one on the outside (lateral meniscus). Their job is to absorb shock and provide stability, so a tear can cause pain, and a feeling of locking or giving way.

Causes of a torn meniscus 

Some tears follow an acute injury — a sudden twist during football, skiing, or rugby. Others happen without any injury at all: as we age, the meniscus weakens and becomes prone to tearing during everyday movements. This distinction between traumatic and degenerative tears matters, because it shapes the treatment.

How do you know if the meniscus is torn?

Diagnosing a meniscal tear needs a clinical assessment and imaging. Typical symptoms include:

• Pain on the inside (medial tear) or outside (lateral tear) of the knee, which can sometimes move to the back of the knee

• Swelling above and below the kneecap

• A feeling of instability, or giving way

• Catching or clicking of the knee

• An inability to fully bend or straighten the knee

• A lump at the side of the knee from a meniscal cyst, which usually forms from a tear

Your doctor examines the knee to confirm the diagnosis and rule out other injuries, such as an anterior cruciate ligament or medial collateral ligament injury. Imaging helps: a standing X-ray shows whether there’s arthritis, and MRI is used to diagnose the tear itself.

Meniscus or cartilage tear: what’s the difference?

These terms are often used interchangeably, which confuses. The knee contains two types of cartilage: articular cartilage, the smooth surface covering the bone ends, and the menisci, which sit between the bones as shock absorbers. Articular cartilage injuries are described as thinning, a flap, or a defect — and they can produce symptoms similar to a meniscal tear.

Treatment of a torn meniscus

We treat most meniscal tears without surgery — particularly degenerative tears, and tears that occur without trauma.

Initial treatment is ice (10–15 minutes every 2–3 hours), compression with a bandage, and anti-inflammatory tablets such as ibuprofen. We then refer you to a physiotherapist to restore range of motion, strength, and balance, and to build control in the hip and pelvis.

If progress stalls, a cortisone or PRP injection close to the meniscal tear can help — placed accurately under ultrasound rather than simply into the joint.

But don’t all meniscal tears need surgery?

No — and this is where the evidence has changed. If you scan people with no knee pain at all, many have a meniscal tear. So a tear on a scan is not, by itself, a reason for surgery.

The evidence supports physiotherapy. In one study, people with partial meniscal tears were split into surgery or physiotherapy groups, and there was no difference in pain or function at three months or two years. A review of all the high-level evidence found that keyhole surgery offers only a small benefit over physiotherapy — and only in people without arthritis.

This matters, because removing part of the meniscus in an arthritic knee can accelerate the wear. One study found that keyhole surgery for degenerative tears increased the risk of arthritis progression and the need for knee replacement. So it’s best to avoid keyhole surgery where possible.

When surgery is needed

Some cases do need surgery, including:

• Persistent pain that doesn’t settle within 24 weeks of exercise therapy

• Gross swelling limiting the range of motion

• Mechanical symptoms — instability, giving way, or true locking

• Traumatic tears from an acute twist, especially in younger people. Vertical or horizontal tears near the edge of the joint have better healing potential and are more suitable for repair with sutures.

• A meniscal root tear — the root anchors the meniscus to the tibia, and a posterior root injury needs urgent surgical review. Repairing the root reduces progression to arthritis compared with removal or non-operative treatment.

Athletes with a torn meniscus: do we treat it differently?

We used to believe young athletes needed early surgery. New findings question that. When young athletes with meniscal tears were randomised to immediate surgery or physiotherapy, there was no difference in pain or return to sport at 12 months — and only one in four of the physiotherapy group eventually needed surgery. So even for young athletes, a trial of physiotherapy is worthwhile in almost all cases.

Frequently asked questions about a torn meniscus in the knee

Can a meniscal tear heal on its own?

Sometimes. When the meniscus tears, bleeding and inflammation can allow it to scar and heal — but only where the blood supply is good, at the outer edge. Tears in the inner two-thirds, where there’s little blood supply, don’t heal on their own, though they often become painless with rehabilitation.

Can I walk with a torn meniscus?

Usually, yes. It depends on the severity of your symptoms, but most people with a meniscal tear can walk for fitness. Sharp locking or the knee giving way is a reason to be assessed before continuing.

Does knee keyhole surgery increase the risk of arthritis?

Possibly. A study found that keyhole surgery for a degenerative meniscal tear increased the risk of later knee replacement. Removing meniscal tissue reduces the knee’s natural cushioning, which may be why — and it’s a key reason we avoid surgery for degenerative tears.

How long does a torn meniscus take to settle?

Degenerative tears often settle over a few months of rehabilitation. We generally give exercise therapy a proper trial — up to around 24 weeks — before considering surgery, unless there’s a locked knee or a root tear that needs earlier attention.

What is a meniscal root tear, and why does it matter?

The meniscal root is where the meniscus anchors to the shin bone. If the root tears, the whole meniscus stops working as a shock absorber — as though it had been removed. This accelerates arthritis, so a posterior root tear is one of the few meniscal injuries that warrants prompt surgical review.

Final word from Sport Doctor London about a torn meniscus in the knee

Meniscal tears are a common cause of knee pain. For degenerative tears, we recommend a trial of physiotherapy, followed by an injection if needed, and often perform injections into the joint and around the tear. Surgery is reserved for traumatic tears, root tears, and cases where conservative treatment fails.

If you have knee pain, swelling, or locking, Dr Masci can assess you in London, arrange the right imaging, and guide your treatment. Contact the team here or call +44 (0) 203 488 0350.

Related conditions:

• Meniscus injections
• Meniscal cyst (lump on the side of the knee)
• Discoid meniscus
• Baker’s cyst
• Knee injections for arthritis
• Pain behind the knee