The meniscus is a C-shaped piece of cartilage in your knee that acts as a cushion and shock absorber for the knee. Tearing your meniscus is a common knee injury that can result from acute trauma—usually a sports accident—or from degenerative wear and tear as you age.
If you have symptoms of a torn meniscus, you should speak to a sports medicine specialist because many meniscus tears require surgery to heal correctly. After a doctor diagnoses your meniscus injury, they can tell you what kind of tear you have, what part of the meniscus is torn, and what your treatment options are. Request an appointment to learn how we at Mass General Brigham can help.
During your appointment, your doctor will ask about how you injured yourself and what symptoms you're experiencing. They'll evaluate your meniscus tear symptoms in a physical exam, looking for instability, discomfort, and any limits on your range of motion.
One type of physical exam your doctor may perform is called the McMurray Test. You'll lie on your back while the doctor supports your foot with one hand and feels your knee with the other. They'll bend your leg to 90 degrees, rotate the lower leg to various angles, and then extend the leg again. Your doctor will feel and listen for irregularities and ask you if you feel any pain during the test.
The McMurray Test is useful because your doctor can perform it immediately, in their office, without any special tools or preparation. However, some studies show that it only identifies a meniscal tear about 61% of the time. That means it's a helpful first step, but may not provide enough information for your doctor to be sure you have a meniscal tear.
To diagnose a torn meniscus conclusively, your doctor will perform imaging tests like a knee X-ray (to rule out other knee problems) or an MRI scan. The MRI can show the inside of the knee in great detail, including soft tissues like the meniscus, so the doctor can see where the meniscus tear is and how severe it is.
There are many kinds of meniscus tears. Your treatment plan will depend on which type you have and its severity.
A few types of minor meniscus tears can heal on their own with nonsurgical treatments, but most meniscus tears require surgery. That’s because most of the meniscus—about 2/3—doesn't have a blood supply, so red blood cells can't repair it effectively.
Often, modern meniscus surgery is performed with a minimally invasive technique called arthroscopy. In an arthroscopic procedure, the surgeon makes a few small incisions around the knee and then uses a tiny camera and small, remote-controlled surgical tools to perform the operation with much less trauma to the knee.
Two types of meniscus surgery are performed this way: meniscal repair and meniscectomy. In a meniscal repair, the orthopedic surgeon will sew the meniscus back together, allowing the tissue to heal over time. If the meniscus can't be repaired, the surgeon will perform a meniscectomy, removing part or all of the meniscus, depending on the extent of the damage.
Preserving as much of the meniscus as possible is the preferred approach for active and younger patients, since they will continue to put more stress on the knee over time.
In patients with degenerative meniscal tears—often older patients—the knee may show other signs of osteoarthritis. A surgeon may recommend a total knee replacement when this is the case, as the procedure is one of the best options for alleviating chronic pain from osteoarthritis.
Some people who have suffered a meniscus injury or tear may develop osteoarthritis of the knee because they don't have enough cushioning in the area, even if they have undergone meniscus tear surgery. If this arthritis progresses, patients who had arthroscopic meniscus surgery may still need a total knee replacement as they get older.
A meniscus transplant is a comparatively rare procedure, but it can help younger patients who have issues after a meniscectomy. To be a candidate for this operation, you need to be experiencing persistent pain or other problems due to a compromised meniscus, but have a knee joint that is in otherwise good condition. If you meet these requirements, your healthcare provider may recommend this approach if a suitable donor meniscus can be found.
When your meniscus tear is small and contained to the "red zone"—the part of the meniscus with good blood supply—it may be able to heal without surgery. If your meniscus can heal on its own, your doctor will recommend nonsurgical meniscus tear therapies that can help. Common therapies include:
Recovery from meniscus surgery depends on the type and severity of the tear, as well as the procedure used to treat it. In general, meniscectomies take less time to recover from than meniscal repairs. With a meniscectomy, you can expect to return to full activity in 4-6 weeks. Meniscal repairs can take as much as six months to recover fully, due to the time it takes for the sewn meniscus to grow back together.
With both procedures, you should start physical therapy soon after your operation to regain range of motion.
A knee replacement has a different recovery process from meniscus surgeries. Read more about total knee replacement.
Meniscectomies—the operation that removes the damaged meniscus or a part of it—have the shortest recovery time, but can have lasting complications like chronic pain or faster joint deterioration and arthritis development in the knee. Meniscal repairs are slower to heal, but often have better outcomes when they're successful.
Almost all meniscus injuries heal slowly because of limited blood flow to the meniscus.
In some cases, yes. However, it depends on the type, location, and severity of the tear. For many meniscus tears, surgical treatment is the only option.
Wearing a knee brace or compression sleeve can help give your knee some stability as the tear heals. If you have meniscus surgery, you'll probably wear a more structured knee brace for several weeks after the operation to keep your knee still while the initial healing takes place.
Cortisone can help reduce pain and inflammation after a meniscus injury, but it won't make your meniscus heal any faster.
Depending on the severity of the tear and your symptoms, you may feel well enough to train. However, many sports and exercises require you to perform motions—like twisting and squatting—that risk making the tear worse. It's better to take it easy until the tear has healed or been repaired surgically. Ask your doctor about the activities you have in mind, and they can guide your return to sport.
Physical therapy is an important part of any rehabilitation plan. If you have surgery, your doctor will refer you to a physical therapist who can help you regain strength and range of motion after the operation. If you don't need surgery, a physical therapist can still help deal with symptoms like limited range of motion or joint pain. As the tear heals, you'll be better prepared to return to activity if you've been following a physical therapy program. Degenerative meniscal tears, in particular, may benefit from physical therapy even if the patient doesn't receive surgical treatment.
