Condition Basics

What is a meniscus tear?

A meniscus tear is a common knee injury. The meniscus is a rubbery, C-shaped disc that cushions your knee. Each knee has two menisci (plural of meniscus)—one at the outer edge of the knee and one at the inner edge. They keep your knee steady by balancing your weight across the knee. A torn meniscus can prevent your knee from working right.

What causes it?

A meniscus tear is usually caused by twisting or turning quickly, often with your foot planted while your knee is bent. Meniscus tears can occur when you lift something heavy or play sports. As you get older, your meniscus gets worn. This can make it tear more easily.

What are the symptoms?

Symptoms of a meniscus tear depend on the size of the tear. Small tears may cause a little swelling and some pain. Larger tears usually cause more pain, swelling, and stiffness. The knee may catch, pop, or lock. It may be hard to walk.

How is it diagnosed?

Your doctor will ask questions about your knee and what you were doing when it started to hurt. He or she will look at both knees and check for tenderness and range of motion and see how stable your knee is. You may also have X-rays or an MRI.

How is a meniscus tear treated?

Treatment may include resting your knee, using ice on it, wrapping it with an elastic bandage, and propping it up on pillows. It may also include physiotherapy and surgery. Your treatment depends on the type of tear, where it is, and how serious it is. It also depends on your age and how active you are.

Symptoms

Symptoms of a meniscus tear depend on the size and location of the tear.

With small tears, you may have minor pain at the time of the injury. Slight swelling often develops slowly over several days. Many times people can walk with only a little pain.

In a typical moderate tear, you feel pain at the side or in the centre of the knee. Often, you are still able to walk. Swelling usually increases slowly and may make the knee feel stiff and limit bending. There is often sharp pain when you twist or squat.

Larger tears usually cause more pain, immediate swelling, and stiffness. The knee may catch, pop, or lock. You may not be able to straighten your knee. It can also feel unstable or give out without warning.

What Happens

What happens when you have a meniscus tear depends on the size of the tear and its location on the meniscus.

• With a small tear, the pain and swelling usually go away in a few weeks after the injury. The pain may come back if you bend or twist your knee. The tear may heal on its own with rest and some physiotherapy.
• With a moderate tear, the swelling slowly gets worse over a few days after the injury. Your symptoms may go away in a couple of weeks, but they may come back if you twist or overuse your knee. The pain may come and go for years if the tear isn't treated.
• A large tear can make your knee swell and become stiff right after the injury or within a few days. Without treatment, you may have long-term pain, or your pain may get worse. You also may not have full use of your knee.

How the location and type of tear affect healing

Where a meniscus tear occurs is one of the most important things that affects healing. Tears at the outer edge (red zone) tend to heal well because there is a good blood supply. The inner area (white zone) lacks a good blood supply and therefore does not heal well.

The type of tear often determines whether a tear can be repaired. Longitudinal tears are often repairable. Radial tears may be repairable depending on where they are located. Oblique (flap) tears and another type called horizontal tears are generally not repairable.

When to Call

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Examinations and Tests

Your doctor will ask about past injuries and what you were doing when your knee started to hurt. A physical examination will help your doctor find out if a torn meniscus is the cause of your pain. Your doctor will look at both knees and check for tenderness and range of motion and see how stable your knee is.

You may have tests such as X-rays to check the bones of the knee or an MRI, which can give a clear picture of where a tear is and how serious it is. The doctor may order the MRI if the diagnosis is not clear. You may need to meet with an orthopedic surgeon.

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Treatment Overview

Your choices for treating a torn meniscus are:

• Treatment without surgery. This includes resting, using ice, wrapping the knee in an elastic bandage, propping it up on pillows, and doing physiotherapy. This treatment choice may include wearing a temporary knee brace.
• Surgery to sew the tear together.
• Surgery to remove the torn section of the meniscus.
• Surgery to remove the entire meniscus.

There are many things to think about when deciding how to treat a torn meniscus. These things include where the tear is and how serious it is, your pain level, your age and activity level, your doctor's preference, and when the injury happened. The decision about whether to have surgery depends on the kinds of symptoms you have and how bad they are, not just on how big the tear is. You may have a large tear but still decide not to have it repaired.

Meniscus repair is more successful if:

• You are younger. Experts think people younger than about age 40 do best.^{footnote 1}
• Your knee has good stability from the ligaments.
• The tear is in the outer edge of the meniscus.
• The repair is done within the first few weeks after the injury.

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Self-Care

If you have a new meniscus tear or a flare-up of severe pain from a tear, you can take these steps to reduce pain and swelling:

• Rest and reduce your activity. Avoid motions or positions that cause discomfort. Follow your doctor's directions for using crutches or a knee brace, if suggested.
• Put ice or a cold pack on your knee for 10 to 20 minutes at a time. Try to do this every 1 to 2 hours for the next 3 days (when you are awake) or until the swelling goes down. Put a thin cloth between the ice and your skin.
• Wrap the knee with an elastic bandage, such as an Ace wrap, to help decrease swelling.
• Prop up the sore leg on a pillow when you ice your knee or anytime you sit or lie down during the next 3 days. Try to keep your leg above the level of your heart. This will help reduce swelling.
• Ask your doctor if you can take NSAIDs, such as ibuprofen or naproxen, to relieve pain and reduce swelling. Be safe with medicines. Read and follow all instructions on the label.
• Follow your doctor's instructions for resting and caring for your knee.

If you have ongoing pain from a meniscus tear, you can work with your doctor to plan a rehabilitation (rehab) program that helps you regain as much strength and flexibility in your knee as possible. Your rehab program probably will include physiotherapy and home exercises.

• A program of physiotherapy and home exercises can help your knee heal and help you return to your activities.
• Building strength and flexibility in your knee and legs may help prevent future degeneration in your knee.

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Surgery

When you have a meniscus tear, you may need surgery to repair it. Your choices are:

• Surgery to sew the tear together.
• Surgery to remove the torn section of the meniscus.
• Surgery to remove the entire meniscus.

Whenever possible, meniscus surgery is done using arthroscopy, rather than through a large cut in the knee.

Your doctor will likely suggest the treatment that he or she thinks will work best for you. This is based on where the tear is, the pattern of the tear, and how big it is.

Your pain level, your age, your health, and your activity level may also affect your treatment options.

Extent and success of meniscus repair

It's best to keep as much of the meniscus as possible. If the meniscus can be repaired successfully, repairing it reduces the chance of knee joint degeneration compared with removing all or part of the meniscus.

Meniscus repair is more successful if:

• You are younger. Experts think people younger than about age 40 do best.
• Your knee has good stability from the ligaments.
• The tear is in the outer edge of the meniscus.
• The repair is done within the first few weeks after the injury.^{footnote 2}

Meniscal repair may prevent degenerative changes in the knee joint. Many doctors believe that a successful meniscus repair lowers the risk of early-onset arthritis, because it reduces the stress put on the knee joint.

Other surgery option

Meniscal transplant is an experimental treatment for meniscal tears. It might be a good option for a meniscus that is already weakened or scarred due to previous injury or treatment. In this surgery, a piece of meniscus cartilage from a donor (allograft) is transplanted into the knee.

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