Meniscal Tear: Symptoms, Diagnosis & Treatment
The meniscus is a crescent-shaped pad of fibrocartilage inside each knee. Every knee has a medial (inner) and lateral (outer) meniscus. Together they act as shock absorbers, improve joint stability, and help distribute load across the knee.
Meniscal tears can occur with a twisting injury (sport or mis-step). In older adults, tears often develop through degenerative wear and tear.
Diagnosis is based on history, examination, and often MRI to define tear type and location.
Most tears do not require surgery. Many settle with physiotherapy and activity modification. When a tear causes mechanical symptoms such as painful catching, clicking or locking, a knee arthroscopy may be recommended to repair the tear or trim unstable fragments.
Common Symptoms & Causes
- Sharp pain with twisting/squatting; tenderness along the joint line
- Swelling (can be delayed hours after injury)
- Mechanical symptoms: catching, clicking, locking, giving way
- Causes: sports pivot injury; kneeling/squatting strain; age-related degeneration
How We Diagnose a Meniscal Tear
- Clinical assessment: joint line tenderness, pain with squat/twist, effusion
- MRI: defines tear type (e.g., longitudinal, radial, flap, bucket handle), location (red-red, red-white, white-white zones), and associated injuries
- X-ray: rules out arthritis or fracture in older patients
Treatment Options
Non-operative care (first-line for many)
- Activity modification & relative rest; avoid deep twisting/squats initially
- Physiotherapy: swelling control, range of motion, quadriceps/hip strength, gait retraining
- Analgesia/anti-inflammatories as advised by your GP
- Image-guided injection (selected cases) to settle synovitis and enable rehab
When surgery is considered
- Mechanical symptoms (locking, frequent catching)
- Repairable tear in a vascular zone (especially in younger/active patients)
- Failed high-quality non-operative care
Meniscal Repair vs Trimming (Partial Meniscectomy)
| Aspect | Meniscal Repair | Meniscal Trim (Partial Meniscectomy) |
|---|---|---|
| Best for | Peripheral, longitudinal or root tears in vascular zones; acute tears; younger/active patients | Complex, degenerative, flap/radial tears not suitable for repair |
| Goal | Preserve meniscal tissue to protect joint in the long term | Remove unstable fragments to relieve mechanical symptoms |
| Recovery | Usually slower; protected weight-bearing & ROM limits early on (surgeon-specific) | Typically faster; weight-bearing as tolerated; rapid ROM restoration |
| Long-term | Better joint preservation when healing occurs | Small increase in OA risk with larger tissue loss; aim to trim conservatively |
We prioritise repair when possible. Preserving healthy meniscus helps protect cartilage. If a tear is not repairable, we trim as little as necessary to stop catching/locking.
Recovery & Follow-up
- Non-operative: most patients improve over weeks with targeted physiotherapy.
- After trim: many return to desk work in 3–7 days; gradual sport in 3–6 weeks as comfort/strength allow.
- After repair: bracing and activity restrictions early on; return to running often 3 months+, pivot/contact sports later (surgeon-guided).
Risks (uncommon): infection, DVT, stiffness, persistent mechanical symptoms (particularly if there is underlying arthritis). Your surgeon will discuss your individual risk profile.
Meniscal Tear – FAQs
Do all meniscal tears need surgery?
No. Many degenerative or stable tears settle with physiotherapy, load management and time.
How do I know if my tear needs repair?
Repair is considered for repairable patterns in vascular zones, especially with locking or persistent mechanical symptoms. MRI and arthroscopic assessment confirm suitability.
Can I run again after a meniscal tear?
Often yes. Timing depends on treatment type, symptoms, strength and control. Your clinician will guide a graded return-to-run program.
Further Reading
- Managing atraumatic meniscal tears in middle-aged patients. J Fam Pract. 2017.
- Meniscal tears: pathophysiology and management. World J Orthop.
