Meniscus Tear

The menisci are two C-shaped pads of cartilage that sit between the thigh bone and the shin bone, helping to absorb load and stabilise the knee. A tear can follow a sudden twist, or develop gradually as the meniscus changes over time. It’s one of the most common knee problems seen in sport and in adults over forty, and the best treatment depends on the type of tear and how it’s affecting you.

Understanding meniscus tears

There are two broad patterns:

• Traumatic tears: usually happen when the knee twists or is struck, often in sport, and are more common in younger people. They can cause swelling, pain and sometimes locking
• Degenerative tears: develop gradually with age and repeated load, often with little or no clear injury. They’re extremely common on scans, including in people with no knee pain

Meniscus problems also commonly occur alongside early osteoarthritis, which is part of why scans and symptoms don’t always line up. See our knee pain page for other causes of knee pain.

Symptoms we commonly see

• Pain along the inner or outer side of the knee, often with twisting or deep bending
• Swelling that develops over a day or so
• Catching, clicking or a sense of the knee giving way
• Sometimes a true locked knee, where it won’t fully straighten
• Difficulty with squatting, pivoting or kneeling

Our evidence-based approach

A randomised trial in middle-aged adults with degenerative meniscal tears found that supervised exercise therapy gave outcomes comparable to arthroscopic partial meniscectomy at two years, and systematic reviews and clinical guidelines have since recommended against arthroscopic surgery for most people with degenerative knee disease. Our approach includes:

1. Assessment to work out the type of tear, whether there’s a true mechanical block, and what else in the knee is involved
2. Education and load management, so you can stay active while symptoms settle
3. Progressive strengthening of the quadriceps, hamstrings, hip and calf, which gives the knee more stability and reduces load through the joint
4. Balance and control work, restoring confidence in the knee
5. A graded return to squatting, running, and sport, with testing of strength on both sides
6. Timely referral for a surgical opinion where it’s warranted, such as a locked knee or a traumatic tear in an athlete
7. Pre- and post-operative rehab if surgery is the right path

What to expect: recovery timeline

• Degenerative tears: many people improve over eight to twelve weeks of consistent strengthening, with ongoing exercise to keep the benefits
• Traumatic tears managed without surgery: typically need several weeks to a few months of structured rehab, depending on the tear and your sport
• After surgery: recovery depends on the procedure and your surgeon’s protocol, usually a few months for a trimmed meniscus and longer after a repair

When to seek help urgently

Seek prompt assessment if your knee is locked and won’t straighten, gives way repeatedly, swells quickly after a twisting injury, or is hot, red and swollen. Also seek help if you can’t put weight on the leg after an injury.

References

• Kise NJ, et al. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ. 2016;354:i3740.
• Thorlund JB, et al. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ. 2015;350:h2747.
• Siemieniuk RAC, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ. 2017;357:j1982.