Meniscal Tear

A meniscal tear is one of the most common knee injuries, especially among athletes and older adults. The meniscus is a C-shaped piece of cartilage located in the knee joint, acting as a cushion between the femur (thigh bone) and tibia (shin bone) (1). Each knee has two menisci: the medial meniscus, located on the inside, and the lateral meniscus, located on the outside. These cartilaginous structures play a crucial role in stabilizing the knee and distributing body weight across the joint. A tear in the meniscus can compromise knee function and lead to pain, swelling, and limited mobility (1).

Meniscal tears can occur during physical activities that involve sudden twisting, squatting, or turning motions, especially while bearing weight. They are also common in older adults due to degenerative changes in the knee (1). Proper diagnosis and timely treatment are essential for recovery and preventing long-term joint complications.

Symptoms

The symptoms of a meniscal tear can vary depending on the severity and location of the tear. Common signs include (1):

• Pain in the knee, especially along the joint line
• Swelling that may appear immediately or develop over a few days
• A popping sensation during the injury
• Stiffness and difficulty straightening the knee fully
• Locking or catching of the knee joint
• A feeling that the knee is giving way

In acute cases, symptoms may appear suddenly during or after an activity. In chronic or degenerative tears, symptoms might develop gradually and worsen over time.

Causes

Meniscal tears can result from various causes, which are broadly categorized into traumatic and degenerative origins

• Traumatic Tears: Often occur in young individuals or athletes during activities that involve twisting, pivoting, or sudden changes in direction. These tears typically result from sports such as football, basketball, or skiing (1).
• Degenerative Tears: Common in older adults, these tears result from age-related wear and tear of the meniscal cartilage. As the meniscus weakens with age, even a minor movement or squatting motion can cause a tear.
• Combined Injuries: Meniscal tears can occur along with other knee injuries such as anterior cruciate ligament (ACL) tears.

Risk Factors

Several factors can increase the risk of a meniscal tear, including:

• Age: Individuals over 40 are more prone to degenerative tears (2).
• Athletic Activity: Participation in contact sports or activities with abrupt knee movements raises the risk.
• Previous Knee Injuries: A history of ligament injuries, particularly ACL tears, increases susceptibility.
• Occupational Hazards: Jobs that require squatting, kneeling, or heavy lifting can put stress on the meniscus.
• Poor Conditioning: Weak thigh muscles and poor flexibility may lead to instability and increase injury risk.
• Obesity: Excess body weight puts additional strain on the knee joint.

Diagnosis

A meniscal tear is typically diagnosed through a combination of medical history, physical examination, and imaging studies (2).

• Physical Exam: A healthcare provider will examine the knee for tenderness, range of motion, and specific maneuvers such as the McMurray test to detect a tear.
• Imaging
  • X-rays: Though they do not show cartilage, they help rule out other causes of knee pain like fractures or arthritis.
  • MRI (Magnetic Resonance Imaging): The most effective imaging tool to visualize soft tissues including the meniscus, allowing accurate identification of the tear’s location and severity (2).

In some cases, arthroscopy, a minimally invasive procedure, may be used for both diagnosis and treatment.

Treatment Options

The treatment for a meniscal tear depends on various factors such as the size and location of the tear, patient age, activity level, and overall knee health. Treatment can be conservative or surgical (2).

Conservative (Non-Surgical) Treatment

• Rest: Avoid activities that aggravate the pain.
• Ice: Applying ice helps reduce swelling.
• Compression and Elevation: Helps manage inflammation.
• Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can relieve pain and reduce swelling.
• Physical Therapy: Strengthening exercises for the quadriceps and hamstrings can improve knee stability.

Surgical Treatment

• Arthroscopic Surgery: A common option involving small incisions and a camera to either trim (meniscectomy) or repair the torn meniscus (3).
• Meniscal Repair: Suitable for tears in the vascular (outer) part of the meniscus, where blood supply supports healing.
• Meniscectomy: Involves removing the damaged portion if repair isn’t feasible.

Recovery from surgery can take several weeks to months, depending on the type of surgery and patient compliance with rehabilitation protocols (3).

Living With or Prevention

Living with a meniscal tear, particularly if it’s untreated or degenerative, can be challenging. Long-term complications can include chronic pain, instability, or early-onset osteoarthritis. Adopting preventive strategies and lifestyle modifications is key (3).

Prevention Tips

• Strength Training: Strengthening the muscles around the knee, especially the quadriceps and hamstrings, helps protect the joint.
• Flexibility Exercises: Stretching can enhance range of motion and reduce the likelihood of injury.
• Proper Technique: Learning correct sports and exercise techniques can help minimize injury risks.
• Use of Knee Braces: During high-risk activities, a brace may provide added stability.
• Weight Management: Maintaining a healthy weight reduces pressure on the knee joints.

Living With a Tear

For those with minor or degenerative tears managed conservatively, maintaining a regular low-impact exercise regimen (like swimming or cycling), adhering to physical therapy, and avoiding excessive knee strain are essential. Regular follow-ups with a healthcare provider can help monitor the condition and make timely adjustments to the treatment plan (3).

References

1. Banovetz MT, Roethke LC, Rodriguez AN, LaPrade RF. Meniscal Root Tears: A Decade of Research on their Relevant Anatomy, Biomechanics, Diagnosis, and Treatment. Arch Bone Jt Surg. 2022 May;10(5):366-380. doi: 10.22038/ABJS.2021.60054.2958. PMID: 35755791; PMCID: PMC9194705.
2. Zhang S, Chen G, Li R, Yang C, Zheng J, Wang C, Lu J, Zhang Z, Shang X, Zhang H, Wang W, Li W, Huang J, Zhang Y, Wang J, Wang Y, Zheng X, Chen S, Li J, Hua Y. Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine. Orthop J Sports Med. 2022 Dec 9;10(12):23259671221138082. doi: 10.1177/23259671221138082. PMID: 36532151; PMCID: PMC9747892.
3. Screpis D, Qordja F, De Berardinis L, Piovan G, Magnanelli S, Amarossi A, Gigante AP, Zorzi C. Saving the Meniscus: A Retrospective Observational Study of the Incidence, Treatment, and Failure Rate of the Main Meniscal Tear Types at 24-Month Follow-Up. J Clin Med. 2025 May 12;14(10):3350. doi: 10.3390/jcm14103350. PMID: 40429345; PMCID: PMC12111877.