Meniscus Tear

The menisci are two C-shaped cartilage cushions between the femur and the tibia. They spread load and protect the joint surface. Losing meniscal tissue raises the load on the cartilage, which is why preserving it matters.

Two different problems with the same name

This distinction determines the entire treatment plan:

Traumatic tear. A specific injury, usually a twisting movement, typically in a younger and otherwise healthy knee. Presents with localised pain, swelling over a day or two, and often catching or locking.

Degenerate tear. Part of the general wear of an ageing knee. Frequently found on MRI in knees with osteoarthritis, often without a specific injury, and often not the cause of the pain.

Treating a degenerate tear as though it were a traumatic one is the single most common error in this area, and it produces disappointed patients whose knee is unchanged after surgery. See knee osteoarthritis if arthritis is also present.

How it is assessed

Examination localises the tenderness and tests for mechanical symptoms. X-rays, weight-bearing, assess whether arthritis is present, which is essential context. MRI shows the tear and its pattern, and is most useful when the plan may involve surgery.

An MRI report of a meniscal tear on its own is not an indication for surgery.

Treatment

Where the knee is locked or repeatedly catching, arthroscopic surgery is usually appropriate and should not be delayed indefinitely.

Where the tear is traumatic and repairable, repair preserves the meniscus and the joint surface it protects, at the cost of a considerably longer and more restricted recovery.

Where the tear is degenerate and the knee is arthritic, structured strengthening, load management and weight reduction where relevant are the appropriate first line. Evidence does not support arthroscopic surgery for this pattern.

The arthroscopy page covers what the operation involves and the important difference between repair and trimming.

What to ask

1. Is my tear traumatic or degenerate?
2. Do my X-rays show arthritis as well?
3. Is the tear repairable, and what happens if it turns out not to be?
4. What specific symptom is surgery expected to fix?
5. What would happen if I did strengthening for three months first?

Common questions

Do I need surgery for a torn meniscus?

It depends which kind of tear it is. A traumatic tear in a younger knee causing locking or catching often benefits from arthroscopic repair or trimming. A degenerate tear found on MRI in an arthritic knee is usually better managed with strengthening and load management, because operating on the tear frequently does not change the pain. The distinction matters more than the word tear.

What does a locked knee mean?

A knee that cannot be fully straightened because a torn fragment of meniscus is physically blocking movement. This is one of the clearer indications for arthroscopic surgery and it should be assessed promptly rather than waited out.

Is a repair better than trimming it out?

Preserving the meniscus is better for the long-term health of the joint, because the meniscus protects the cartilage surface. But not every tear is repairable: it depends on the pattern, the location, the blood supply and your age. A repair also requires a much longer and more restricted recovery. Ask which is planned and what the fallback is.

Can it heal without surgery?

Tears in the outer part of the meniscus have a blood supply and can heal. Tears in the inner two thirds largely do not. Many tears, whether they heal or not, become asymptomatic with strengthening and time, which is why non-surgical management is often tried first when the knee is not locked.

Related reading

Knee Arthroscopy

Keyhole knee surgery: what it can and cannot fix, why it is no longer recommended for most arthritic knees, and when it remains the right operation.

Knee Osteoarthritis

What knee osteoarthritis is, how it is assessed and graded, what actually helps at each stage, and when a joint replacement becomes the sensible option.