Your knee bears the greatest forces of all of your joints, withstanding up to seven times your body weight through daily activity alone. Consequently, it needs shock absorbers to protect it from impact. This comes in the form of two C-shaped discs of cartilage that sit inside your knee joint between the bottom end of your thighbone (femur) and the top end of your shinbone (tibia). These are called menisci and act as cushions, with one meniscus on the inner side of your knee joint (medial meniscus) and one on the outer side of your knee joint (lateral meniscus). However, these menisci can tear.
Your menisci can tear in different ways. To identify the type of meniscal tear you have, your doctor will need to assess your knee, and you may need to have an MRI scan. The type, size and position of your meniscus tear will determine your treatment.
Falls, twisting injuries and impacts to your knee can all result in a meniscus tear, which is why tears are more common in runners, people who play contact sports such as rugby, and people who ski, which involves a lot of twisting. However, it isn’t just high-impact activities that can lead to meniscal tears.
Everyday tasks, such as kneeling, bending to pick up something or standing up from a crouched position can also cause meniscal tears. This is especially true as you get older as the menisci become less rubbery with age, and in those who lead a more sedentary lifestyle as the knee joint weakens.
Your meniscus doesn’t have a blood supply. This means boosting blood supply to the region by pushing your knee’s range of motion won’t help stabilise or heal a meniscus tear. Instead, resisted flexion of your knee past 90 degrees will increase the pressure on your meniscus by threefold, which can cause further damage.
In cases where surgery is not needed, your meniscal tear will likely always be there, but this doesn’t mean you need to endure pain or discomfort. Following a dedicated treatment pathway to properly rehabilitate your knee joint can help you return to your usual activities without pain.
Knowing the signs to look out for can ensure you seek appropriate treatment for your meniscal tear.
You will likely notice something has gone awry with your knee at the moment your meniscus tears. You may feel a pop, clicking or the sensation of a tear. You may also notice that your knee becomes swollen over the next few days.
After the initial sensation of the tear occurring, at rest, your meniscal tear shouldn’t cause you any pain. This is because your menisci are not supplied by nerves. However, any movement that tugs at the tear will trigger inflammation in your knee joint, which does cause pain. Pain is often sharp and easily pinpointed.
This means you may have days where your meniscal tear causes no pain and other days when you perform an awkward movement that tugs your tear and causes your pain to flare up. Pain is often worse at night, when you may unintentionally bend your knee and twist, triggering inflammation as the tear catches.
Severe meniscal tears can become displaced and wedged improperly inside your knee joint. This can cause your knee to lock up, preventing you from fully extending your knee.
In most cases, resting your knee, elevating it and applying ice packs will reduce the inflammation around your torn meniscus, which is what causes your pain. You can also take over-the-counter painkillers and anti-inflammatory drugs, such as paracetamol and ibuprofen, respectively. Once your pain settles, you can slowly return to your usual activities.
It’s also important to build up the strength in your knee to improve its stability, particularly by strengthening your quadriceps muscles. This will help prevent your tear from catching and causing painful inflammation.
If you are a runner, you can try switching to cycling for a period of time to help take the weight off your knees while simultaneously strengthening the muscles around your knees. Swimming can also help strengthen your knee joints, but avoid breaststroke as this involves twisting movements, and instead perform the front crawl.
If your symptoms don’t improve with home remedies and muscle-strengthening exercises, you may need physiotherapy. Your physiotherapist will provide specific exercises that focus on strengthening the muscles around your knees.
Your doctor may also recommend a steroid injection into your knee to reduce inflammation and subsequently ease your pain so you can perform more knee-strengthening exercises with your physiotherapist.
If home remedies, physiotherapy and steroid injections aren’t enough to improve your symptoms, you may need surgery.
Today, most meniscal tears can be treated with a type of keyhole surgery called knee arthroscopy. This is a minimally invasive procedure that doesn’t need large cuts to be made and is usually a day case procedure.
If you have a small tear on the edge of your meniscus, the tear can often be trimmed off, leaving the healthy meniscus behind. In most cases, you will be able to fully bear weight on your knee and walk on the same day as your surgery, often without crutches. Recovery is, therefore, very quick.
If you have a large tear, surgery will focus on repairing your meniscus to preserve it. As the meniscus is a very delicate tissue, it will need to be protected after surgery. You may, therefore, need to wear a knee brace and use crutches for around six weeks. You will be able to bend your knee to a certain degree while wearing your knee brace but will need more time for the biology of your knee to return to normal.
In cases where surgery is not needed, the meniscal tear itself does not usually heal. However, home remedies to reduce inflammation and exercises to strengthen the muscles around your knee can prevent the tear from catching and causing symptoms. In these cases, it can take four to six months to build up the strength of your muscles and for any inflammation to settle.
If you have a small tear that is treated with surgery, you can usually return to all of your usual activities in a few weeks.
If you have a large tear that is treated with surgery, you will usually need around six weeks before you can return to low-impact activities and around six months before you can return to high-impact activities, such as football and tennis.
With all meniscal tears, once you’ve had one tear, you are at increased risk of a tear in the future. However, with proper treatment, you can ultimately return to your usual activities safely and comfortably.
Mr Khalid Al-Dadah is a Consultant Specialist Knee Surgeon at Spire St Anthony's Hospital and the South West London Elective Orthopaedic Centre, the largest joint replacement centre in Europe. He provides expertise across the full range of knee pathologies, from sports knee injuries, such as meniscal tears and ligament ruptures, to the complete repertoire of knee replacement surgery, including partial, total and revision knee replacements. He is also an Honorary Clinical Lecturer at Imperial College London and a Fellow of the Higher Education Academy.
If you're concerned about symptoms you're experiencing or require further information on the subject, talk to a GP or see an expert consultant at your local Spire hospital.
Need help with appointments, quotes or general information?Enquire online
View our consultants to find the specialist that's right for you.Find a specialist