Meniscus Tear

What is a meniscus tear?

The meniscus is a shock-absorbing cartilage in the middle of your knee. There are two menisci – one on the inside (“medial”) and another on the outside of the knee (“lateral”).

Patients with meniscus tears will complain of pain on either side of the knee. Sometimes there is associated swelling of the knee. Twisting or squatting can cause increased pain. Occasionally, if there is a large meniscus tear, a patient can complain that their knee locks, that is, it gets stuck in a certain position then needs to be “wiggled” to get it back into place.

The meniscus can be torn in two main ways.

  1. Traumatic tear – Twisting injuries to the knee can cause meniscus tears. This can happen during sports or even while doing things around the house or office. Road accidents are another common way of injuring the meniscus.

  2. Degenerative tear – As you age, so do your menisci. They “wear out” and can tear with minimal trauma. Often people don’t remember what caused the tear at all!

How are meniscus tears diagnosed?

Meniscus tears are typically diagnosed through a combination of: medical history and physical exam, imaging tests, and arthroscopy

Medical history and physical exam

The orthopaedic surgeon will ask about the patient's symptoms, activity level, and any injury that may have caused the tear. A physical exam can reveal signs of a meniscus tear like joint swelling, tenderness, reduced range of motion, and locks or catching in the joint.

Imaging tests

Common imaging tests used to detect meniscus tears include:

  • X-rays: Can show signs of arthritis and cartilage loss but often do not show meniscal tears directly.

  • MRI scan: The most accurate imaging test for detecting meniscal tears. An MRI clearly shows the meniscus and any tears or damage.

  • CT scan or arthrogram: Alternative imaging options that can reveal meniscus abnormalities.

Arthroscopy

If imaging tests indicate a probable meniscus tear but the diagnosis is still unclear, the orthopaedic doctor may recommend arthroscopy. This involves inserting a tiny camera into the knee joint to inspect the meniscus directly. Arthroscopy can also be used for minimally invasive repair of some meniscal tears.

Diagnosing meniscus tears accurately is important to determine the best treatment. Conservative options may be recommended for minor tears while surgery is often needed for complex, displaced tears to repair the damage and relieve symptoms.

Meniscus Tear Treatment

Fortunately, there are effective treatment options for meniscus tears based on the location and severity of the damage:

For minor, non-displaced tears in active individuals, initial therapy may involve rest, icing the knee, compression and over-the-counter anti-inflammatory medication. Physical therapy can also be utilised, which focuses on strengthening and stretching exercises to support the meniscus. If symptoms improve, surgery may be avoided.

For torn pieces of meniscus that cannot heal, surgical removal (partial or complete meniscectomy) can relieve pain and allow a return to normal activities. This is recommended for bucket-handle or longitudinal tears that do not respond to conservative care. While meniscus removal can help relieve symptoms, it increases the risk of osteoarthritis over time.

For young, active patients with stable, vertical meniscus tears, surgical repair may be a good option. This involves stitching or reattaching the torn tissue to preserve as much of the meniscus as possible. The repair can restore function and decrease osteoarthritis risk compared to meniscectomy. The orthopaedic doctor will assess the condition of the meniscus to see if it is suitable for repair, as some tears are irreparable.

The goal of treatment is to relieve pain, improve knee function and mobility, and prevent osteoarthritis progression. Your orthopaedic doctor will be able to recommend the option that offers the highest likelihood of success based on the type, location and extent of your meniscus tear.

Recovery from surgery typically requires months of dedicated physical therapy to regain strength and range of motion in the joint. With proper treatment and rehabilitation, most patients are able to return to their regular activities following a meniscus tear.

Suspect a meniscus tear? Consult our knee specialist Dr Sean Leo for a thorough assessment and get a personalised treatment plan for your condition.