What is a meniscus tear?
A meniscus tear is a common knee injury that occurs when one of the two menisci in the knee joint gets damaged. The menisci are C-shaped pieces of cartilage structures inside your knees between the femur (thigh bone) and tibia (shin bone) — these pieces of cartilage function as shock absorbers for the knee, cushioning our bones and knee joint.
As per the diagram of the left knee above, there are two menisci in each knee and both of them are susceptible to tears.
Medial meniscus tear
Affects the inner side of the knee
Lateral meniscus tear
Affects the outer side of the knee
Meniscus tears can vary in size, location, and shape. The type of tear can be classified based on several factors and can be catergorised into the common types of tears below:
Based on tear location:
Radial tear
A tear that extends from the inner rim of the meniscus outward.
Horizontal tear
A tear that runs parallel to the ground, splitting the meniscus into two halves.
Vertical (Longitudinal) tear
A tear that runs along the length of the meniscus, often in the direction of the curve.
Complex tear
A combination of multiple tear types, often resulting in a fragmented or irregularly shaped tear.
Bucket handle tear
A type of longitudinal tear where a portion of the meniscus is displaced, creating a handle-like appearance.
Based on tear severity:
Partial tear
Only a portion of the meniscus is torn, and the rest remains intact.
Complete tear
The tear goes all the way through the meniscus, often causing a significant disruption in its function.
What are the symptoms of a meniscus tear?
Pain:
Typically located along the joint line of the knee, either on the inner (medial) or outer (lateral) side, depending on which meniscus is torn. Pain may worsen with certain movements, such as knee twists, squatting, or deep knee bending.
Swelling:
Swelling can develop within a couple of hours after the injury, especially if there is bleeding within the joint (hemarthrosis). Swelling may persist, or worsen, with continued activity.
Stiffness:
A feeling of tightness or difficulty fully extending or flexing the knee. Points to a decrease in knee mobility and limited range of movement.
linked to issues like a locked knee where it feels "stuck" in certain positions, particularly so in cases of more severe tears or if torn portions of the meniscus move into the joint.
Knee instability:
Some people report a feeling of instability or a sensation that the knee might give way. This is more likely to occur with larger or more complicated tears that affect the joint's function.
Clicking or popping sensation:
A torn meniscus may cause a clicking, popping, or catching sensation in the knee as the torn cartilage moves within the joint.
Locked knee:
In cases where a piece of the meniscus detaches, it may get caught in the joint, causing the knee to "lock" and restrict movement.
Suffering from multiple of the common symptoms above? Suspect that you might have a torn meniscus? Request an appointment with our knee specialists at Thomson Medical for an accurate diagnosis of your condition and a personalised treatment plan.
What causes a meniscus tear?
Meniscal tears often occur in people with higher activity levels such as people who participate in contact sports where excessive pressure and strain are placed on the knee joint. Additionally, as we age, our meniscus gets worn down and weakens, leading to it getting thinner, compromising its ability to absorb shockwaves, causing knee pain when excessive pressure is placed on the injured knee. Below are some common causes of a torn meniscus:
Trauma or acute injury
Twisting or rotating motions: A sudden pivot or twist, especially while the foot is planted on the ground, can cause a meniscus tear. This is particularly common in sports like football, basketball, or skiing.
Direct impact: A direct blow to the knee, such as during a tackle or a fall, can also cause a tear.
Degenerative changes
As we age, the meniscus loses its flexibility over time and becomes weaker. Tears can occur even with relatively low-impact movements, such as squatting or getting up from a chair. This type of tear is more common in older adults.
Conditions like arthritis further accelerate cartilage breakdown, contributing to meniscal degeneration and an increased risk of tears. Degenerative tears are often linked to general wear and tear of the cartilage and joint over time, leading to thinning and weakening of the meniscus.
Combination of injury and degeneration
In some cases, a person may have a degenerated meniscus due to a previous meniscal injury. Thus, even a minor twist or strain can cause it to tear.
What are the risk factors for a meniscus tear?
Several of the below risk factors can increase the risk for meniscus tear. Understanding these risk factors below can help you take proactive measures to lower your risk of injury and help you better protect your knees.
Age:
The natural aging process leads to wear and tear of the knee joint, making the meniscus more susceptible to injury even from minor stress.
Osteoarthritis:
Osteoarthritis is a degenerative joint condition that results in the thinning and weakening of cartilage, including the meniscus, increasing the risk for meniscus tear.
Participation in high-impact sports:
Impact activities that require sudden stops, jumps, or twisting motions (e.g., basketball, soccer, football), as well as contact sports, can lead to acute meniscus tears.
Previous knee injuries:
A history of knee injuries such as a previous meniscus injury, may weaken the joint and surrounding structures, making future injuries more likely.
Obesity:
Carrying excess weight places additional stress on the knee joints, contributing to a higher risk of meniscus tears.
Weak muscles:
Weakness in the leg muscles that support the knee, including the quadriceps, hamstrings, and core, can lead to instability and a greater chance of injury.
Lack of proper warm-up or conditioning:
Failing to warm up adequately before physical activity can increase the likelihood of knee injuries, including meniscus tears.
Want to know more about how to mitigate the above risk factors? Request an appointment with our physical therapists and specialists today.
Diagnosis of meniscus tears
Medical history and physical examination
Your doctor will usually ask you about your everyday movements and history of knee problems such as previous or additional knee injuries.
The doctor will then proceed to physical tests to aid in their evaluation of knee cartilage and knee function. Common tests include:
McMurray test: The knee is rotated while the leg is bent, checking for pain or a clicking sound that suggests a tear.
Apley’s compression test: The knee is compressed while it is rotated to check for pain or discomfort.
Joint line tenderness: Pressing along the knee’s joint line to identify pain, which often indicates a meniscus tear.
X-ray
Based on the doctor's assessment of your condition, you may be required to undergo an X-ray to give the doctor a better sense of your situation.
The X-ray is useful in helping the orthopaedic surgeon rule out other problems, such as fractures or arthritis, but it doesn't show soft tissues like cartilage.
MRI
MRI offers detailed, high-resolution images of the knee's soft tissues, including the meniscus, cartilage, ligaments, and tendons. This enables doctors to accurately identify not only the presence of a tear but also its precise location, size, and severity.
MRI can detect other knee problems such as anterior cruciate ligament (ACL) injuries, bone fractures, arthritis, or joint inflammation, providing a comprehensive assessment of knee health.
Nonsurgical treatment for meniscus tears
For minor tears or in cases where surgery is not recommended, conservative treatment may be sufficient:
RICE principle
Rest: Avoid activities that place stress on the knee, especially twisting or pivoting movements.
Ice: Apply an ice pack for 15-20 minutes every few hours to reduce pain and swelling.
Compression: Use an elastic bandage or knee brace to support the knee and reduce swelling.
Elevation: Raise the knee to reduce swelling, especially during the first 48 hours after the injury.
Physical therapy: Focus on strengthening the muscles around the knee (quadriceps, hamstrings) to improve joint stability and prevent further injury.
Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help manage pain and inflammation.
Surgical treatment for meniscus tears
Surgery may be necessary for more severe or persistent meniscus tears, especially if non-surgical methods don’t relieve symptoms. Surgical options include:
Meniscectomy (Partial meniscus removal)
Involves removing the torn portion of the meniscus.
This is often performed if the tear is in an area that cannot heal or if the damage is extensive.
Recovery is generally faster than a meniscus repair, but it may lead to an increased risk of osteoarthritis in the long term due to loss of cartilage.
Meniscus repair
In some cases, particularly with tears in the outer portion of the meniscus (where blood supply is better), the meniscus can be stitched back together.
Recovery is longer than a meniscectomy, as the meniscus needs time to heal.
Following the rehabilitation plan and attending physical therapy sessions are important in recovering from a meniscus tear surgery.
Meniscus transplantation
For patients with a severely damaged knee meniscus or those who have had multiple surgeries, a meniscus transplant (using a donor meniscus tissue) may be considered.
Arthroscopy
Arthroscopy is a minimally invasive procedure which uses a small camera (arthroscope) and specialised instruments inserted through tiny incisions to diagnose and treat meniscus tears, reducing trauma to surrounding tissues.
It allows surgeons to both assess the extent of damage and perform procedures like meniscectomy, meniscus repair, or even cartilage smoothing during the same session.
With smaller incisions, arthroscopy typically results in less pain, lower risk of infection, and quicker recovery compared to open surgery.
Knee specialists
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FAQ
How common are meniscus tears?
Meniscus tears are one of the most common knee injuries, especially among athletes and older adults. They can occur due to sudden twisting movements during sports or gradual wear and tear as part of the ageing process.
How do I know if I tore my meniscus?
Signs of a torn meniscus include knee pain, swelling, stiffness, and difficulty fully straightening or bending the knee. Some people may also feel a popping sensation at the time of injury or experience the knee locking or giving way.
Can you still walk with a torn meniscus?
Yes, many people can still walk with a torn meniscus, particularly if the tear is small. However, activities that involve twisting or bending the knee may worsen pain and swelling, so medical evaluation and treatment are recommended.
Who might tear a meniscus?
Athletes who engage in activities involving sudden twisting, pivoting, or heavy impact.
Older adults as the meniscus becomes more fragile with age.
People with poor knee alignment or those who have had previous knee injuries are also at higher risk.
Overweight people and people with weak leg muscles.
How long is the meniscus tear recovery time?
Non-surgical recovery: Typically takes a few weeks to a few months, depending on the severity of the tear and the treatment approach. Physical therapy is important to regain strength, flexibility, and knee function.
Post-surgical recovery:
Meniscectomy: Recovery is generally faster, with many people returning to normal activities in 4-6 weeks.
Meniscus repair: Recovery can take 3-6 months, and patients are usually advised to avoid high-impact or twisting activities during the healing process.
How can I prevent a meniscus tear?
Strengthening the muscles around the knee: This can help stabilise the joint and prevent injury.
Stretching: Maintaining flexibility in the knee joint and surrounding muscles.
Proper warm-up and cool-down: Before and after physical activities.
Using proper techniques: When playing sports (especially when performing high-impact activities or sports), ensuring good technique can reduce the risk of injury.
Wearing proper footwear: This is to ensure good support and alignment of the knee during physical activity.
Can a meniscus tear heal on its own?
Some small, mild tears (especially those on the outer edge of the meniscus) can heal with rest, ice, and physical therapy, as the outer part of the meniscus has a better blood supply. However, larger or more complex tears often require surgical intervention to heal properly.
Can physical therapy help with a meniscus tear?
Yes, physical therapy is often recommended, both before and after surgery, to:
Strengthen the muscles around the knee to provide support.
Improve the range of motion and flexibility.
Reduce pain and swelling.
Improve function and prevent further injury.
Does bad knee pain mean that I've torn my meniscus?
Not necessarily. While a torn meniscus can cause knee pain, other conditions like ligament injuries, arthritis, tendonitis, or bursitis can also lead to knee discomfort. If the pain is severe, accompanied by swelling, locking, or difficulty moving the knee, it’s best to consult a doctor for proper evaluation and diagnosis.
What activities can I do with a meniscus tear?
Activity restrictions depend on the severity of the tear and the treatment approach. For mild tears, physical therapy and low-impact exercises like swimming or cycling may be recommended. Higher-impact activities like running or jumping may need to be avoided until healing is complete. For those who have had surgery, doctors typically recommend avoiding high-impact sports (e.g., running, jumping, or pivoting) until full recovery is achieved. Generally, the timeline for returning to sports is around 3-6 months, depending on the type of surgery and individual recovery progress.
What are the risks of untreated meniscus tears?
If left untreated, a meniscus tear can lead to:
Chronic pain and discomfort.
Instability in the knee, leading to difficulty with activities.
Further damage to the knee joint, including cartilage wear, which can eventually lead to osteoarthritis.
What is the difference between a meniscus tear and an ACL injury?
A meniscus tear involves damage to the cartilage in the knee joint, while an ACL injury refers to a tear in the anterior cruciate ligament (ACL), a key ligament that stabilizes the knee. Both injuries can cause similar symptoms, such as pain, swelling, and instability, but the ACL is a ligament and the meniscus is cartilage. ACL injuries are more likely to require surgical repair, while meniscus tears may or may not need surgery depending on the severity. Learn more about ACL tears and injuries here.
Can a meniscus tear lead to arthritis?
Yes, particularly if part of the meniscus is removed (through meniscectomy) or if a tear is left untreated. The meniscus plays a key role in absorbing shock and distributing force in the knee joint. Without a fully functioning meniscus, there is increased wear on the joint, which can lead to osteoarthritis over time.
The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist by requesting an appointment with Thomson Medical today.
For more information, contact us:
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