Meniscus Tear

What is the meniscus?

The menisci are two crescent-shaped fibrocartilage structures between the femur and the tibia, one on the medial (inner) and one on the lateral (outer) side of the knee. They act as “shock absorbers”, distributing load over a larger surface, stabilising the joint and contributing to the lubrication and nutrition of the articular cartilage.

Thanks to the menisci, the loads on the knee are distributed evenly, protecting the cartilage from premature wear. This is why preserving the meniscus — whenever possible — matters so much: its extensive removal is associated with an increased risk of early osteoarthritis.

The role of the meniscus in knee function

To understand the significance of a tear, it is worth looking more closely at the role of the meniscus. Without the menisci, the loads on the knee would be concentrated on small, focal areas of the cartilage, causing rapid wear. The menisci “spread” these loads over a larger surface, drastically reducing the pressure per unit of area.

Beyond this “shock absorber” role, the menisci also contribute to the stability of the joint and to the lubrication and nutrition of the cartilage. In other words, they are multifunctional structures and by no means “expendable”. It is precisely this understanding that has radically changed the modern approach: from the older tendency towards ready removal to today’s philosophy of maximum possible preservation.

Causes and types of tear

Depending on the cause, meniscus tears fall into two main categories:

• Traumatic tear: It usually occurs in younger, active people, as the result of a sudden twisting movement of the knee with the foot planted on the ground — a classic sports injury. It often coexists with other injuries, such as an anterior cruciate ligament tear.
• Degenerative tear: It appears at older ages, as a result of the gradual wear and “ageing” of the fibrocartilage tissue. Here, the tear can be caused even by a simple, everyday movement, such as deep squatting.

Tears are also classified according to their shape (longitudinal, radial, “bucket-handle”, flap, etc.) and their location. Location is particularly important: the outer part of the meniscus has a good blood supply and the capacity to heal, whereas the inner part is avascular and does not heal — a decisive factor in the choice of treatment.

Clinical presentation – Symptoms

The symptoms of a meniscus tear vary depending on the type and extent of the damage. The most common are:

• Pain in the knee, often localised to the medial or lateral side, depending on which meniscus is affected.
• Swelling (oedema) of the knee, which usually develops gradually over hours.
• Mechanical symptoms: a feeling of “locking” or “blocking” of the knee, or a sensation that “something is catching” inside the joint.
• Difficulty fully straightening or bending the knee.
• A feeling of instability or that the knee “gives way”.

In degenerative tears, the symptoms may be milder and more diffuse, whereas in traumatic tears there is often a clear link with a specific episode.

Diagnosis

The diagnosis of a meniscus tear is based on a combination of history, clinical examination and imaging. The orthopedic surgeon assesses the mechanism of injury and performs special clinical tests that reproduce the symptoms and put pressure on the meniscus.

MRI is the investigation of choice, as it accurately shows the tear — its type, location and extent — as well as any associated damage to the ligaments or cartilage. X-rays, although they do not show the menisci (which are soft tissue), help to exclude other bone pathology or arthritis.

Treatment

The treatment of a meniscus tear is individualised according to the type and location of the tear, the patient’s age and activity level, and the presence of associated injuries.

Conservative treatment

In some cases — particularly small, stable or degenerative tears without marked mechanical symptoms — treatment can be conservative. It includes relative rest, activity modification, anti-inflammatory medication and, above all, targeted physiotherapy to strengthen the muscles that stabilise the knee. Many degenerative tears respond satisfactorily to conservative treatment.

Surgical treatment (arthroscopic)

When the tear causes persistent symptoms or mechanical problems (locking), or does not respond to conservative treatment, arthroscopic treatment is indicated. The operation is performed through small incisions and the surgeon chooses one of two main approaches:

• Meniscal repair: The preferred option whenever feasible, particularly in younger patients and in tears of the vascular peripheral zone. The meniscus is sutured and preserved, protecting the knee in the long term.
• Partial meniscectomy: When repair is not feasible, only the damaged part of the meniscus is removed, preserving as much healthy tissue as possible.

Modern surgery clearly leans towards preserving the meniscus, as its extensive removal accelerates wear of the cartilage.

Recovery

The recovery time and the rehabilitation programme depend directly on the type of procedure. After a partial meniscectomy, recovery is rapid, with a return to everyday activities within a few weeks. After a meniscal repair, rehabilitation is more cautious and prolonged: weight-bearing and knee flexion are restricted for several weeks, so that the meniscus can heal in the correct position.

In every case, the physiotherapy programme focuses on reducing swelling, regaining range of motion, muscle strengthening and a gradual return to activities. Following the instructions is decisive, particularly after a repair.

Why preserving the meniscus matters

The meniscus is not an “expendable” tissue. Its role in distributing load and protecting the cartilage is fundamental. The older practice of extensive removal of the meniscus (total meniscectomy) has been abandoned, as it was shown to lead to accelerated wear and early osteoarthritis.

This is why the modern philosophy is maximum possible preservation: repair where it is feasible, and the most limited removal possible where it is not. This approach protects the knee for the future and is one of the reasons why the surgeon’s experience matters.

Prevention of meniscus tears

Although it is not always possible to prevent a traumatic tear, certain measures reduce the risk, particularly in athletes:

• Strengthening of the muscles that stabilise the knee (quadriceps, hamstrings, gluteal muscles)
• Improving flexibility and balance
• Correct technique in turns, landings and changes of direction
• An adequate warm-up before exercise
• Avoiding a sudden increase in the intensity of activity
• For degenerative tears, maintaining a healthy body weight and regular, gentle exercise

These measures protect the knee as a whole and also reduce the risk of other injuries.

What happens if it is left untreated

A symptomatic meniscus tear that is left untreated can cause problems beyond the immediate pain. The unstable, damaged part of the meniscus can “catch” in the joint, causing repeated episodes of locking and, above all, gradually wearing the adjacent articular cartilage.

Over time, this chronic damage can accelerate the onset of osteoarthritis in the corresponding compartment of the knee. For this reason, a symptomatic tear — particularly one with mechanical symptoms — should not be ignored, but should be assessed promptly by a specialist orthopedic surgeon.

Considerations by age

A meniscus tear is treated differently depending on the patient’s age and profile. In younger, active patients, the tear is usually traumatic, the meniscus is as a rule healthy, and the priority is to preserve it by repair — both to protect the knee and to allow a return to a high level of activity.

In older patients, tears are often degenerative and coexist with early arthritis. Here, the approach is more conservative: many such tears respond to physiotherapy and activity modification, while arthroscopy is reserved for cases with clear mechanical symptoms. Recognising these differences is important for the right treatment decision, so as to avoid both unnecessary operations and delay where surgery is truly necessary.

Cost of treating a meniscus tear

The cost depends on the type of treatment (conservative or arthroscopic), the type of procedure (repair or partial meniscectomy), the materials that may be used, the hospital and the class of room, as well as the patient’s insurance cover. In most cases, private insurance policies and insurance funds cover a significant part of the expense.

Precise information is given on an individual basis, after the clinical assessment. The practice is at your disposal for any relevant information.

More on the factors that determine the cost and on cover by insurance funds: Cost of surgery.

The role of physiotherapy in rehabilitation

Whether treatment is conservative or surgical, physiotherapy plays a decisive role. In conservative treatment, it aims to strengthen the muscles that stabilise the knee and to reduce the strain on the meniscus. After arthroscopy, the programme is adapted to the type of procedure.

After a meniscal repair in particular, physiotherapy requires special care: weight-bearing and the range of flexion are restricted in the early stages, to protect the repair and allow the meniscus to heal in the correct position. Faithful adherence to the programme is particularly important here, as a hasty return to activity can jeopardise healing.

Frequently asked questions

Does a meniscus tear heal on its own?

It depends on the location. Tears in the vascular peripheral zone of the meniscus have the capacity to heal (particularly with repair), whereas tears in the avascular inner part do not heal on their own.

Is surgery always needed?

No. Small, stable or degenerative tears without marked mechanical symptoms are often treated conservatively. Surgery is indicated when there are persistent symptoms or locking of the knee.

Repair or removal of the meniscus?

Whenever feasible, repair is preferred, as it preserves the meniscus and protects the knee in the long term. Partial meniscectomy is performed only when repair is not possible, removing as little as possible.

How long does recovery take?

After a partial meniscectomy, a few weeks. After a repair, rehabilitation is more prolonged and cautious, so that the meniscus can heal.

Can a meniscus tear lead to arthritis?

Extensive removal of the meniscus is associated with an increased risk of early arthritis. This is why the modern approach emphasises preserving as much of the meniscus as possible.

Is the cost covered by insurance?

In most cases, private insurance policies and insurance funds cover part or all of the expense. The practice can give you detailed information.

How often does it coexist with other injuries?

Traumatic meniscus tears often coexist with other injuries, particularly a tear of the anterior cruciate ligament. This is why MRI, which “maps” all the structures of the knee, is important before any treatment decision.

Can I walk with a meniscus tear?

Many patients can walk, particularly with degenerative tears. However, mechanical symptoms (locking) or severe pain can make walking considerably more difficult and need to be assessed.

What are “mechanical symptoms”?

They are the feeling of “locking” or “blocking” of the knee, as well as the sensation that “something is catching” inside the joint. They are caused by the unstable part of the meniscus getting in the way of movement and are a strong indication for surgical treatment.

How quickly should a meniscus tear be treated?

As a rule, it is not an emergency. However, a symptomatic tear — particularly one with locking — should not be ignored, so as to avoid secondary damage to the cartilage.