One of the most common knee injuries, a torn meniscus typically occurs from twisting or rotating the knee.
The meniscus is frequently known as the shock absorber of the knee. There are two menisci — one that is medial (U-shaped) and located on the inner side of the knee joint, and one that is lateral (S-shaped) and located on the outside of the knee joint. They both stabilize the knee and are attached to the shinbone (tibia).
What are the symptoms of a torn meniscus?
Meniscus tears can vastly differ — some are severe, while others may be barely noticeable. When you tear your meniscus, the knee will generally swell depending on your age and activity level, as well as the location of the tear. If the tear is in an area that has a lot of blood supply, then it tends to swell more; if it’s in an area with poor blood supply, then it tends to swell a bit less.
In addition to swelling and pain, other symptoms of a torn meniscus include:
- Clicking or popping
- A feeling of fullness
- Limited range of motion and stiffness
- Feeling of your knee giving way or being locked in place
When the knee continues to bother you and you can’t progress through your normal routine, it’s time to seek medical care.
What causes a torn meniscus?
The meniscus can get trapped or pinched if the knee is twisted, bent or straightened unexpectedly or aggressively. As a result of that meniscus being pinched, a tear can develop. Kneeling, squatting, lifting something heavy, or other forms of hyperflexion and hyperextension can also lead to a torn meniscus.
Risk factors for a torn meniscus include:
- Sports: Athletes participating in contact sports, such as football, or sports that involve pivoting, such as basketball or tennis, are at a greater risk.
- Age: Older adults may tear a meniscus with little or no trauma due to degenerative changes in the knee.
- Gender: According to a study published in the Journal of Orthopaedic & Sports Physical Therapy, men are at a significantly greater risk for meniscal tears than women.
- Occupation: That same study found that people who have jobs that require kneeling or squatting for more than one hour per day are at a greater risk for degenerative meniscal tears. In addition, having to sit, stand, walk or drive for long periods of time were found to increase risk.
- Weight: Obesity increases wear-and-tear on the knees, which can put you at greater risk.
- Smoking: Smokers tend to lose collagen in their cartilage, which puts them at greater risk for a meniscal tear.
How is a torn meniscus diagnosed?
When first diagnosing a torn meniscus, your doctor will take a history and physical exam. The doctor will look for swelling, loss of motion, pain with certain twisting maneuvers, and tenderness on the joint line.
Then, they will order imaging tests. While X-rays will not reveal anything related to the cartilage, they may be used to rule out other problems. An MRI is the best imaging test to confirm a torn meniscus, as it shows hard and soft tissues within the knee. An MRI can determine the severity of the tear and what treatment is warranted.
According to a 2018 article published in EFORT Open Reviews, when diagnosing and classifying a meniscus tear, the tear depth, pattern, length, location, and quality of the meniscal tissue are all taken into account. However, they are typically classified, at least initially, by the location. Meniscal tears most commonly occur on the medial side.
There are two types of meniscus tears:
- Traumatic tear: Traumatic meniscal tears occur from sudden twisting or rotating, and are more common in active people from ages 10-45. They are usually radial or vertical in the meniscus, and can produce a moveable fragment that may catch in the knee, which typically requires surgical treatment.
- Degenerative tear: Degenerative meniscal tears occur as part of the aging process, and therefore are common for people 45+ years of age. They are usually horizontal in the meniscus and are less likely to produce symptoms of catching or locking than traumatic tears.
What is the treatment for a torn meniscus?
Treatment for a torn meniscus depends on the severity of the tear, as well as its location. Specifically, there are two zones that have been classified in the meniscus — the red-red vascular zone in the periphery and the white-white avascular zone centrally. Recommended treatment can depend on which zone the tear is in; for example, tears in the white zone are unlikely to heal on their own, according to the World Journal of Orthopedics.
According to Dr. Vladimir Alexander, Founding Partner of Alexander Orthopaedics, “If the tear is very small, or if the tear is small and in an area of good blood supply, it can be treated with rehabilitation to allow the meniscal tear to heal.”
Here are some other non-surgical ways to treat a torn meniscus:
The standard method of “RICE” works as an initial treatment for a torn meniscus. Avoid twisting, rotating, pivoting and other activities that can aggravate the knee.
Using a cold pack can reduce swelling and pain, as well as keeping the knee elevated.
In addition to RICE, pain relievers can help ease knee pain, including anti-inflammatory and analgesic medications.
Exercise and therapy
Certain exercises, such as strengthening the quadriceps with static cycling, have been shown to help medial meniscus tears, according to the World Journal of Orthopedics. Working with an experienced physical therapist will ensure that you find the right exercises and treatment plan to heal, rather than further damage, your torn meniscus.
According to Dr. Alexander, “While you can live with a torn meniscus, it will change your quality of life, which is why most people choose to have surgical treatment.” If the tear is large or in an area with poor blood supply, then a partial meniscectomy (a partial removal of the torn piece of meniscus) will typically be performed. A meniscectomy can be partial or total; however, the total meniscectomy is almost never performed.
A partial meniscectomy can be performed open or arthroscopically. The EFORT Open Review states that the partial meniscectomy is usually performed arthroscopically, as this procedure can be performed quickly and with better short-term results. However, this treatment should still be used only if pain and symptoms persist for several months.
In younger patients or in patients where the torn meniscus is in an area of good blood supply, Dr. Alexander recommends an arthroscopic meniscal repair instead of a partial removal. The World Journal of Orthopedics states that meniscal repair has “grown in popularity and boasts excellent long-term results.”
Can a torn meniscus heal on its own?
Some meniscal cartilage tears can heal on their own. Dr. Alexander says, “The ones that heal on their own are the ones that are small or in the region of good blood supply. If you have a meniscal tear that is large or outside the zone of good blood supply, it will generally not heal on its own.”
Instead, according to Dr. Alexander, this meniscal tear creates a third-body wear phenomenon in the knee, like a grain of sand in a ball bearing. This will wear out the healthy cartilage on the end of the femur or on the top of the tibia — two surfaces around the knee that are supposed to move smoothly and synchronously.
As a result of that wear, the knee will degenerate prematurely and a knee replacement will be required before it would have been otherwise had they not had the torn meniscus.
What exercises can you do with a torn meniscus?
The activity one can perform with a torn meniscus is different for everyone, and depends on the individual’s comfort level and the severity of their injury. Some people can walk, sit, sleep and stand without pain, while others may find that their torn meniscus prevents them from participating in their usual daily activities. Even going up and down stairs or getting into a car can produce pain in a knee with a torn meniscus.
Walking on a torn meniscus, along with other low-impact exercising, can help keep the cartilage in the knee lubricated, which helps with a torn meniscus. However, participating in sports and activities that involve twisting and rotating motions should be avoided.
What is the torn meniscus recovery process?
Treating your torn meniscus starts by speaking with your doctor. At Alexander Orthopaedics, we create a personalized treatment plan for each patient, from diagnosis to rehabilitation. We’re your partner on the road to recovery.