Meniscus tear

The menisci are the two wedges of cartilage that sit between the thigh bone and the shin bone, spreading load across the joint. Tears fall into two broad groups: a sudden tear in a twisting injury, and a degenerative tear that develops gradually with wear, often without any clear injury at all. The two present differently and are managed differently, so the assessment is as much about which kind of tear this is as about where it sits.

Symptoms

  • Pain along the line of the joint, on the inner or the outer side of the knee.
  • Swelling that builds over the day or two after the injury rather than immediately.
  • Catching, clicking or a sense of the knee giving way, particularly on twisting or squatting.
  • Difficulty fully straightening or bending the knee — a knee that locks and will not straighten needs prompt assessment.
How meniscus tears happen

A traumatic tear usually follows a twist on a loaded, bent knee — a turn on a planted foot, a deep squat, a tackle — and is often felt at a particular moment. These tears are common alongside an anterior cruciate ligament injury, where the same movement injures both. A degenerative lesion is different: the tissue weakens gradually with age and repeated loading, and a tear can appear with no injury at all, or after something as slight as standing up from a squat. Degenerative lesions are common findings on scans of knees that have never hurt, which is why they are interpreted alongside the examination rather than on their own.

How it is assessed

Assessment begins with how the problem started and what the knee has done since, followed by an examination of both knees so the affected side can be compared with the other. Imaging is used where it would change what is done, rather than as a matter of routine.

In clinic

The examination looks for tenderness along the joint line, for pain reproduced by rotating the loaded knee, and for any block to full straightening. No single test is conclusive — joint line tenderness and rotation tests each miss a proportion of tears, and their accuracy varies with who performs them — so they are taken together with the history and with how the knee behaves under load.

Imaging

MRI is the usual imaging test and identifies most tears, showing the pattern, the position, and whether the meniscus has displaced out of the joint. It is read against the examination rather than in place of it: tears are found on scans of knees with no symptoms, and a scan reporting a tear does not by itself establish that the tear is what is causing the trouble.

Stage and severity

Tears are described by the pattern of damage and by whether other structures in the knee are affected.

Tear pattern
Longitudinal, bucket-handle, radial, flap, horizontal, or a tear at the root where the meniscus anchors to the bone. The pattern largely determines whether a tear can be repaired, and a displaced bucket-handle tear blocking movement is treated as urgent.
Extent of the tear
How long the tear is, how far it reaches towards the outer rim, and whether the meniscus has moved out of the joint. The outer part of the meniscus has a blood supply and can heal; the inner part largely does not.
With other injuries
A tear alongside an anterior cruciate ligament injury, cartilage damage, or established osteoarthritis. Each of these changes what a repair is likely to achieve and what the knee needs overall.
Associated injuries

Meniscal tears occur alongside anterior cruciate ligament injuries often enough that finding one prompts a careful look for the other. Damage to the cartilage surfaces is frequently present, particularly with degenerative lesions. A tear at the root of the meniscus behaves like losing the meniscus altogether — the ring of tissue can no longer spread load, it displaces out of the joint, and cartilage loss can follow quickly — which is why root tears are looked for specifically rather than treated as one pattern among others. Which of these is present is usually what determines whether repair is worthwhile.

Treatment options

The two options below are set out side by side. Which applies depends on the findings, the structures involved and what you need to return to.

Non-surgical care

What it involves
Activity modification, a progressive exercise programme for the quadriceps, hamstrings and hip, and pain relief where it is needed. Time matters in its own right: many tears settle as the surrounding irritation subsides.
Typical course
Supervised exercise over roughly three months, reviewed on symptoms and function rather than on repeat imaging.
Considerations
The first-line treatment for a degenerative meniscal lesion. Randomised trials in middle-aged and older patients have found no clinically meaningful advantage for arthroscopic partial meniscectomy over exercise therapy, including at ten years, and guidance now recommends against arthroscopy for degenerative knee disease in nearly all cases.
Follow-up
Reviewed after a course of exercise, with surgery considered if symptoms persist and the findings account for them.

Surgical treatment

What it involves
Arthroscopy to repair the tear with sutures where it can be repaired, or to trim the torn portion where it cannot. Preserving meniscal tissue is the aim wherever the tear allows it.
Typical course
A repair is protected for several weeks, with limits on weight-bearing and deep bending, and return to sport is measured in months. A trim allows a faster return, at the cost of the tissue removed.
Considerations
Indicated for a locked knee from a displaced tear, for repairable traumatic tears — including root tears, and including some patterns once considered irreparable — and for persistent symptoms that the findings explain. Long-term outcomes are worse after removing meniscal tissue than after preserving it, which is why repair is attempted where it is feasible.
Follow-up
Reviewed through the protected phase and again before return to sport or to heavy work.

What recovery involves

Recovery depends on which treatment is used. The stages below apply to meniscal repair, and the timings are typical rather than fixed — progress is judged on what the knee can do at each stage.

  1. Protection

    The first two weeks

    Settle swelling, restore straightening, and keep within the limits set for weight-bearing and bending while the repair holds.

  2. Restoring movement

    Weeks 2 to 6

    Regain full bending as restrictions are lifted, and rebuild quadriceps strength without loading the repair through deep flexion.

  3. Strength and load

    Weeks 6 to 16

    Progressive strengthening, and a return to full weight-bearing activity, squatting and stationary cycling.

  4. Return to sport

    From around four to six months

    Running, then pivoting and contact, once strength is close to symmetrical and the knee is comfortable under load.

Page information

Reviewed by
Dr Lai Kah Weng
Version
1.0
Review date
September 2026
Next review
September 2027

References

  1. Kopf S, Beaufils P, Hirschmann MT, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2020;28(4):1177–1194.
  2. Beaufils P, Becker R, Kopf S, et al. Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):335–346.
  3. Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ. 2015;350:h2747.
  4. van de Graaf VA, Noorduyn JCA, Willigenburg NW, et al. Effect of early surgery vs physical therapy on knee function among patients with nonobstructive meniscal tears: the ESCAPE randomized clinical trial. JAMA. 2018;320(13):1328–1337.

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