Knee Meniscal Tears
What is a knee meniscal tear?
The meniscus is cartilage (connective tissue) between the two bones that make up the knee. Each knee has two menisci, one on the outer side and one on the inner side of the knee joint.
The meniscus can tear from an injury (acute tears) or from wear-and-tear on the knee over time (degenerative tears). A torn meniscus is very common but it can be hard to diagnose and treat.
How do you know if you have a torn meniscus in your knee?
A recent study showed that a large number of patients have MRIs that show meniscus tears even if they have absolutely no knee pain! Overuse of MRI can lead to overtreatment, drive up the cost of insurance, and cause unnecessary anxiety and concern. —Dr. Benjamin Schwartz
Usually people feel “mechanical symptoms” first. This includes feeling like your knee is catching, locking, or giving way. Sometimes, these are signs of other knee problems, such as arthritis or knee cap issues, but the catching and locking are more likely to be from a tear. A torn meniscus also causes sharp pain when you twist at the knee or bend it deeply.
Sometimes your knee might swell (water on the knee) if the tear irritates the knee lining (synovium). Some people feel like their leg isn’t stable or they don’t trust it enough to stand or walk on.
Symptoms can be mild such as an occasional catching sensation or slight swelling or can be more severe including difficulty putting weight on the leg and a lot of swelling.
- Catching or popping sensation in the knee
- Feeling that the knee is locked in place when you try to move it
- Buckling of the leg
- Sharp pain (especially when you twist the knee)
Other symptoms you may have
- Swelling of the knee
- A feeling of instability (not trusting the knee)
Most meniscus tears can be treated at home at first. Stop doing any exercise or activity that makes you twist, pivot, or bend the knee deeply. That includes sports and moving heavy objects. Follow the R.I.C.E. protocol to rest, ice, compress, and elevate the knee. Take over-the-counter nonsteroidal antiinflammatory drugs (NSAIDs) regularly if the pain hurts too much.
If your symptoms don’t get better after 3 to 6 weeks or if the pain is severe and you can’t put weight on the leg or move the knee without pain, call your doctor. They may refer you to a bone specialist (orthopedic surgeon).
The meniscus does not have a good blood supply which means that most tears in the meniscus do not heal themselves. However, that does not mean all meniscus tears require surgery. In fact, the pain from most tears improves with treatment.
There’s one type of tear called a “locked bucket handle tear” that requires surgery. Here, the torn piece of meniscus can get trapped between the bones. This makes it impossible to straighten the knee. This usually happens after a specific injury. You’ll probably need surgery. If you injure your knee and you can’t straighten it, contact your medical provider. You will likely be referred to an orthopedic surgeon.
Knee meniscal tear treatments
Almost every patient who develops arthritis also has meniscal tears. A meniscus tear is like driving over a nail and having a flat tire. The rest of the car is fine and patching the tire fixes the problem. Arthritis is like totalling the car. Sure the tires might be flat, but fixing them isn’t going to make the car run again—you need a new car! —Dr. Schwartz
The best way to treat a meniscus tear depends on how bad your symptoms are. And whether the tear is from an injury or from wear-and-tear. Most tears can be treated at home with the following approaches:
Rest, Ice, Compression, and Elevation (R.I.C.E.) is usually the first step in treatment. It’s best used in the first 24 to 72 hours after symptoms begin. But you can keep using R.I.C.E. until the pain and swelling are better.
- Rest means not doing any activity that requires a lot of effort. Walking is fine if your pain isn’t too bad.
- Ice the knee for 20 to 30 minutes, 3 to 4 times a day. This helps lower pain and swelling.
- Compress the area by wrapping the knee with an ACE wrap.
- Elevation means keeping the knee above your heart level to reduce swelling.
Stop doing any activities that hurt your knee.
- No twisting or pivoting motions.
- No deep bending of the knee (squatting, lifting).
- Once your symptoms are better, you can slowly start doing these things again.
Take over-the-counter pain relievers (NSAIDS)
- NSAIDs like ibuprofen (Motrin, Advil) or naproxen (Aleve) can help. You have to take them regularly to get any benefit. Take ibuprofen 3 times a day or naproxen twice a day for at least 2 to 3 weeks. If they don’t make the pain better, or only work for a few days, talk to your doctor about a prescription NSAID.
Wear a knee brace. This can help support the joint. And help address the pain, locking, and knee giving way. Most off-the-shelf braces from a pharmacy work well.
If the pain doesn’t get better in 3 to 6 weeks, see your primary care doctor or an orthopedic surgeon. They might recommend:
- Physical therapy to help stretch and strengthen the leg muscles supporting the knee.
- Corticosteroid (“cortisone”) injections. These can relieve severe pain or pain that hasn’t gotten better over time. It also reduces inflammation and swelling inside the joint.
- MRI test. These tests are only needed if the pain has lasted more than 6 weeks or the doctor is worried about a locked meniscus tear. MRIs tend to be overused in the evaluation of meniscus tears.
Surgery for meniscus tears is only recommended for locked tears, tears that fail to respond to at least 6 weeks of nonsurgical treatment, and large tears from an injury in young patients.
There is a lot of controversy about surgery for degenerative (wear-and-tear) meniscal tears. Some studies have shown that these tears do equally as well with physical therapy and cortisone injections as they do with surgery.
It is not recommended to do knee surgery for knees that have arthritis and meniscus tears as this has not been shown to improve pain and may actually further aggravate the knee.
If surgery is warranted, the surgeon will either fix the tear or remove the damaged meniscus entirely. Only certain types of tears can be repaired, usually in younger patients. That’s because the meniscus has a poor blood supply, limiting its ability to heal. The blood supply becomes worse with age. Your surgeon will make this decision at the time of surgery.
This is when a few small cuts are made at the front of the knee. Small tools are used to fix or take out the torn tissue.
- If the meniscus is repaired, it can take 6 to 12 weeks to heal from surgery. You probably won't be allowed to put your full weight on the leg and will need crutches. You might need physical therapy to regain strength and range of motion.
- The surgeon might remove the damaged meniscus instead of fixing it. After this surgery, you can usually put full weight on the leg right away. But crutches might feel better for the first 3 weeks. You might need physical therapy.
It can be frustrating to deal with several weeks of lingering discomfort and many of us are looking for a quick fix to get back to normal. But there is increasing evidence that meniscus tears do just as well without surgery as they do with surgery. —Dr. Schwartz
If you treat your meniscus tear without surgery, your doctor will want to see you to see how the treatments are working.
If you continue to have pain, an MRI may be ordered. If you have surgery, follow up is usually within 1 to 3 weeks to remove stitches, check your progress, and determine if you need physical therapy.
Knee meniscal tear causes
The meniscus is cartilage that acts as a shock absorber between the two leg bones. Over time or with sudden injury, the meniscus can tear. Factors that can increase your risk include:
- Doing sports, especially if you have to twist or pivot (e.g., football, skiing, volleyball).
- Deep knee bending or getting up from a crouched position. This can grind the meniscus between the knee bones.
- Older age. The meniscus becomes more brittle with age.
- Knee arthritis.
- Calcium deposits in the meniscus (also called chondrocalcinosis or pseudogout).
Strengthening your leg muscles (especially the quadricep and hamstring) can help lower the chances you’ll tear a meniscus. This is especially helpful if you play a sport that requires twisting or pivoting.