One of the most common knee injuries is a meniscus tear, which typically occurs from twisting or over-rotating the knee.
The meniscus is the cartilage that protects the surface of two bones where they meet (the joint). It functions as a cushion, and is sometimes described as the “shock absorber” of the knee.
There are two menisci that protect the joint where your upper and lower leg bones meet (your femur and your tibia). One is medial — on the inner side of the knee — and is U-shaped. The other is lateral — on the outside of the knee — and is S-shaped. Together, they cushion and stabilize the knee joint.
What are the symptoms of a torn meniscus?
Meniscus tears can vastly differ — some are severe, while others are barely noticeable. When you tear your meniscus, the knee will usually swell. The degree of swelling depends on your age and activity level, as well as the location of the tear itself. Increased blood flow to the area means a greater likelihood of swelling.
In addition to swelling, other symptoms of a torn meniscus include:
- Pain around the knee
- Clicking or popping
- A feeling of fullness
- Limited range of motion and stiffness
- Feeling of your knee giving way
- Knee feeling locked in place
When your knee continues to cause discomfort and interferes with daily life, it’s time to seek medical care.
What causes a torn meniscus?
Either meniscus can get trapped or pinched if the knee is twisted, bent, or straightened unexpectedly or aggressively. A severe pinch can lead to a tear in the cartilage itself. 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 like football, or sports that involve pivoting, like 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.
- Sex: According to a study published in the Journal of Orthopaedic & Sports Physical Therapy, male bodies are at a significantly greater risk for meniscal tears than female bodies.
- Occupation: The same study found that people are at a greater risk for degenerative meniscus tears if they are required to kneel or squat for more than one hour per day. Prolonged sitting, standing, walking or driving were also found to increase risk.
- Weight: Obesity usually increases pressure on the knees, which can increase the risk of tears.
- Smoking: Smokers tend to lose collagen in their cartilage at a greater rate than non-smokers, reducing the elasticity of their joints and making the meniscus more susceptible to tearing.
How is a torn meniscus diagnosed?
When first diagnosing a torn meniscus, your doctor will take an oral history and perform a physical exam. The doctor will look for swelling, loss of motion, pain when twisting the body, and tenderness on the joint line.
Then, they will probably order imaging tests. While X-rays will not reveal damage 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 both hard and soft tissues in the knee. An MRI can determine the severity of the tear and what treatment, if any, is needed.
Meniscal tears are typically described and classified by their location. They are most commonly found on the medial (outside) of the knee joint.
According to a 2018 article by the European Federation of National Associations of Orthopaedics, fully diagnosing and classifying a meniscus tear requires assessing the tear’s depth, pattern, length, location, and the quality of the meniscal tissue.
Types of Meniscus Tears
- Traumatic: these meniscal tears result from sudden twisting or rotating, and are more common in active people between 10 and 45 years old. They can align vertically or horizontally, and can produce a moveable or detached fragment that catches or locks the knee. This typically requires surgical treatment.
- Degenerative: these meniscal tears occur as part of the aging process, and are common for people 45+ years of age. They are usually horizontal tears and are less likely to produce the knee-catching or locking symptoms associated with traumatic tears.
What is the treatment for a meniscus tear?
Treatment for a torn meniscus depends on the severity of the tear, as well as its location. Specifically, there are two zones used to classify tears: the red vascular zone on the periphery of the meniscus and the white avascular zone toward the center. 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 Orthopaedic Associates, “If the tear is very small, or 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:
Rest. Ice. Compression. Elevation.
The “R.I.C.E.” healing method can work as an initial treatment for a torn meniscus. You should avoid twisting, rotating, pivoting, and any activities that could aggravate the knee. Keeping the knee elevated and using a cold pack can reduce swelling and pain.
In addition to R.I.C.E., common pain relievers can help ease knee pain, particularly anti-inflammatory and analgesic medications.
Exercise and Therapy
Exercises like static cycling (which strengthens the quadriceps) have been shown to help medial meniscus tears. An experienced physical therapist can ensure that you use exercises that heal, not further damage, your already 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 (removal of the torn piece of meniscus) is typically performed. A meniscectomy can be partial (removal of the damaged area) or total (removal of the entire meniscus); however, a total meniscectomy is rarely necessary.
A partial meniscectomy can be performed as an open surgery (with a scalpel) or arthroscopically (with a small tube). A partial meniscectomy is usually performed arthroscopically, as this procedure can be performed quickly and with better short-term results.
Usually, a meniscectomy is only necessary if pain or other 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. 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, a large 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 the tibia — which need to move smoothly and synchronously.
As a result of that wear, the knee will degenerate prematurely and a knee replacement could be required.
What exercises can you do with a torn meniscus?
Comfortable and appropriate physical activity with any injury depends on the individual’s comfort level and the severity of their injury. Some people with a meniscus tear can walk, sit, sleep, and stand without any pain. Others may find that their torn meniscus prevents them from participating in their usual daily activities like going up and down stairs or getting in and out of vehicles.
Walking on a torn meniscus, along with other low-impact exercise, can help keep the cartilage in the knee lubricated, which helps keep the meniscus flexible and supports faster healing. However, participating in sports and activities that involve twisting and rotating the leg should be avoided.
What is the recovery process for a meniscus tear?
Treating a torn meniscus starts by speaking with your doctor. At Alexander Orthopaedic, we create a personalized treatment plan for each patient, including each step from diagnosis to rehabilitation. We’re your partner on the road to recovery from your meniscus tear and other sports injuries.
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Our team is highly-qualified and ready to treat your meniscus tear. We’re known as a leading authority in orthopedic care and, with many outpatient services available, we’re a convenient choice for both professional and amateur athletes.