A meniscus tear is a
common knee injury. The meniscus is a rubbery, C-shaped disc that cushions your
knee. Each knee has two menisci (plural of meniscus)—one at the outer edge of
the knee and one at the inner edge. The menisci keep your knee steady by
balancing your weight across the knee. A torn meniscus can prevent your knee
from working right.
A meniscus tear is
usually caused by twisting or turning quickly, often with the foot planted
while the knee is bent. Meniscus tears can occur when you lift something heavy or
play sports. As you get older, your meniscus gets worn. This can make it tear
There are three types of
meniscus tears. Each has its own set of symptoms.
minor tear, you may have slight pain and swelling. This
usually goes away in 2 or 3 weeks.
A moderate tear can cause pain at the side or center of your
knee. Swelling slowly gets worse over 2 or 3 days. This may make your knee feel
stiff and limit how you can bend your knee, but walking is usually possible.
You might feel a sharp pain when you twist your knee or squat. These symptoms
may go away in 1 or 2 weeks but can come back if you twist or overuse your knee.
The pain may come and go for years if the tear isn't treated.
severe tears, pieces of the torn meniscus can move into
the joint space. This can make your knee catch, pop, or lock. You may not be
able to straighten it. Your knee may feel "wobbly" or give way without warning.
It may swell and become stiff right after the injury or within 2 or 3
If you are older and your meniscus is worn, you may not know
what you did to cause the tear. You may only remember feeling pain after you
got up from a squatting position, for example. Pain and slight swelling are
often the only symptoms.
Your doctor will
ask about past injuries and what you were doing when your knee started to hurt.
A physical exam will help your doctor find out if a torn meniscus is the cause
of your pain. Your doctor will look at both knees and check for tenderness,
range of motion, and how stable your knee is. X-rays
are also usually done.
You may need to meet with an
orthopedic surgeon for more testing. These tests may
MRI, which can give a clear picture of where a tear is
and how serious it is.
How your doctor treats your
meniscus tear depends on several things, such as the type of tear, where it is,
and how serious it is. Your age and how active you are may also affect your
Treatment may include:
Learning about meniscus tears:
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Symptoms of a
meniscus tear depend on the size and location of the
tear and whether other knee injuries occurred along with it. Pain can also be due to swelling and injury to
With small tears, you
may have minimal pain at the time of the injury. Slight swelling often develops
gradually over several days. Many times you can walk with only minimal pain,
although pain increases with squatting, lifting, or rising from a seated
position. These symptoms usually go away in 2 to 3 weeks although pain may
recur with bending or twisting.
In a typical moderate tear, you feel pain at the side or in the center of
the knee, depending on where the tear is. Often, you are still able to walk.
Swelling usually increases gradually over 2 to 3 days and may make the knee
feel stiff and limit bending. There is often sharp pain when twisting or
squatting. Symptoms may diminish in 1 to 2 weeks but recur with activities that
involve twisting or from overuse. The pain may come and go over a period of
years if left untreated.
usually cause more pain and immediate swelling and stiffness. Swelling can
develop over 2 to 3 days. Pieces of the torn meniscus can float into the joint
space. This can make the knee catch, pop, or lock. You may not be able to
straighten your knee. The knee can also feel "wobbly" or unstable, or give way
without warning. If other injuries occurred with the meniscus tear, especially
torn ligaments, you may have increased pain, swelling, a feeling that the knee
is unstable, and difficulty walking.
Older people whose menisci
are worn may not be able to identify a specific event that caused a tear, or
they may recall symptoms developing after a minor incident such as rising from
a squatting position. Pain and minimal swelling are often the only
Pain at the inside of the knee can mean there is a tear to
the medial meniscus. Pain at the outer side of the affected knee can mean there is a
tear to the lateral meniscus.
During an examination for a possible
meniscus tear, your doctor will ask you about
past injuries and what you were doing when your knee started to hurt. He or
she will do an
exam of both knees to evaluate tenderness,
range of motion, and knee stability. An X-ray is usually done to evaluate the
knee bones if there is swelling, if there is pain at a certain place (point tenderness), or if you cannot put weight on your leg.
Your knee may be too painful or swollen for a full
exam. In this case, your doctor may withdraw fluid from your joint and inject a
numbing medicine (local anesthetic) into the joint. This
might relieve your pain enough that you can have an exam. Or the exam may be
postponed for a week while you care for your knee at home with rest, ice,
compression, and elevation.
doctor or an emergency room doctor may refer you to an
orthopedist for a more complete examination. An
orthopedist may order a
magnetic resonance imaging (MRI) if the diagnosis is
uncertain. An MRI typically gives a good picture of the location and extent of
meniscus tear and also provides images of the
An orthopedist may recommend
arthroscopy, a procedure used to examine and repair
the inside of the knee joint by inserting a thin tube (arthroscope) containing
a camera with light through a small incision near the knee joint. With
arthroscopy, the orthopedist can directly view and possibly treat the meniscus
and other parts of the knee.
There are many things to consider
when deciding how to treat your
torn meniscus, including the extent and location of
the tear, your pain level, your age and activity level, your doctor's
preference, and when the injury occurred. Your treatment choices are:
Whenever possible, meniscus surgery is done using
arthroscopy, rather than through a large cut in the
The location (zone) of the tear is one of the most
important things that helps determine treatment.
Also, the pattern of the tear may determine whether a tear
can be repaired. Longitudinal tears are often repairable. Radial tears may be
repairable depending on where they are located. Horizontal and flap (oblique)
tears are generally not repairable.
It is preferable to preserve as much of
the meniscus as possible. If the meniscus can be repaired successfully, saving
the injured meniscus by doing a meniscal repair reduces the occurrence of knee
joint degeneration compared with partial or total removal (meniscectomy).
Meniscus repair is more successful in younger people (experts think people
younger than about 40 years old do best), in knees that have good stability from the
ligaments, if the tear is in the red zone, and if the repair is done within the
first few weeks after the injury (acute).1
Meniscal repair may prevent degenerative changes in the knee joint. Many
doctors believe that a successful meniscus repair lowers the risk of
early-onset arthritis, because it reduces the stress put on the knee
Orthopedists most often perform meniscus surgery with
arthroscopy, a procedure used both to examine and then
to treat the inside of a joint by inserting a thin tube (arthroscope)
containing a camera and a light through small incisions near the joint.
Surgical instruments are inserted through other small incisions near the joint.
Some tears require open knee surgery.
Rehabilitation (rehab) varies depending on the injury, the type of
surgery, your orthopedic surgeon's preference, and your age, health status, and
activities. Time periods vary, but in general meniscus
surgery is usually followed by a period of rest, walking, and selected
exercises. After you have full range of motion without pain and your knee
strength is back to normal, you can return to your previous activity
For some exercises you can do at home (with your doctor's
Other knee injuries, most commonly to the anterior cruciate
ligament (ACL) and/or the medial collateral ligament, may occur
at the same time as a meniscus tear. In these cases, the treatment plan is
different. Typically, your orthopedist will treat your torn meniscus, if
needed, at the same time that ACL surgery is done. In this case, the ACL
rehab plan is followed.
Meniscal transplant is an experimental treatment
for meniscal tears. It might be a good option for a meniscus that is already
weakened or scarred due to previous injury or treatment. In this surgical
procedure, a piece of meniscus cartilage from a donor (allograft) is
transplanted into the knee.
To be eligible for meniscal
transplantation, a person:
If you have recently injured your knee,
follow these first-aid steps to reduce pain and swelling:
If the tear is minor and your symptoms go away, your doctor
may recommend a set of exercises to build up your quadriceps and hamstring
muscles and increase your flexibility. It's important to follow your
doctor's guidance to avoid a new or repeat injury.
Your recovery time after surgery will depend on many things, including the injury and the type of surgery you have.
The American Academy of Orthopaedic Surgeons (AAOS)
provides information and education to raise the public's awareness of
musculoskeletal conditions, with an emphasis on preventive measures. The AAOS
website contains information on orthopedic conditions and treatments, injury
prevention, and wellness and exercise.
The American College of Sports Medicine (ACSM) provides general
information and publications about exercise and sports medicine.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases (NIAMS) is a governmental institute that serves the public
and health professionals by providing information, locating other information
sources, and participating in a national federal database of health
information. NIAMS supports research into the causes, treatment, and prevention
of arthritis and musculoskeletal and skin diseases and supports the training of
scientists to carry out this research.
The NIAMS website provides
health information referrals to the NIAMS Clearinghouse, which has information
packages about diseases.
CitationsMcMahon PJ, Kaplan LD (2006). Sports medicine. In HB Skinner, ed., Current Diagnosis and Treatment in Orthopedics, 4th ed., pp. 163–220. New York: McGraw-Hill.Other Works ConsultedAmerican College of Radiology (2011). ACR Appropriateness Criteria: Acute Trauma to the Knee. Available online: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonMusculoskeletalImaging/AcuteTraumatotheKNEEDoc2.aspx.Paxton ES, et al. (2011). Meniscal repair versus partial meniscectomy: A systematic review comparing reoperation rates and clinical outcomes. Arthroscopy, 27(9): 1275–1288.
September 10, 2012
William H. Blahd, Jr., MD, FACEP - Emergency Medicine & Patrick J. McMahon, MD - Orthopedic Surgery
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