Meniscus tears are a very common injury. Since many people over 50 will have one and many more over 70 will have one it is normal to wonder if a meniscus tear can heal without surgery.
Yes, some meniscus tears can heal on their own. Perhaps even more important, even if a meniscus tear doesn’t heal, many tears will stop hurting if treated without surgery. It is just as important to understand that many meniscus tears do not require surgery. What? Really? Yes… most meniscal tears are degenerative and will not require surgery.
Over the last 5 years, there have been many scientific studies showing that the pain from a degenerative meniscus tear has the same chance of going away with surgery or physical therapy. Other papers show that your risk of needing a knee replacement increase if you have surgery to remove the torn pieces. Some of you are under the misconception that having surgery now will prevent knee arthritis. That is simply not true. A more recent study on meniscus tears showed that surgery had the same result as sham surgery. That means that some people were put under anesthesia, had two little cuts made in their skin, but the meniscus was not treated. Those people had the same chance of feeling better as those who had the actual surgery.
So, to recap:
Surgery increases your risk of needing a knee replacement. Physical therapy has been shown to often have the same effect as surgery. Sham surgery usually works just as well as the actual surgery. Surgery is one heck of a placebo.
Yes, some tears will not heal. Some tears will continue to hurt. Surgery may become a reasonable option for some people. But meniscus surgery should not be near as common as it is today.
Some tears, particularly those in athletes or meniscus tears that occurred due to trauma will require surgery. Most acute meniscus tears should be sutured or repaired. Healing after a meniscus repair is becoming more successful with better techniques. Many tears were deemed non-repairable decades ago. Many of those tears can now be repaired with a reasonable chance of success.
The meniscus is a “C”-shaped cartilage disk in the knee. There are two menisci within each knee. A normal meniscus serves a very important role as a shock absorber and as a stabilizer. When a meniscus tears, it can lead to pain, instability, locking and it can lead to osteoarthritis over the long term. Staying active and staying in the game is important … so getting a meniscus tear to heal may be very important to you.
Whether or not a meniscus tear can be fixed, and whether or not a meniscus tear might heal depends on the type of tear and the cause of the tear.
As a surgeon, I look at the cause of your meniscus tear and the type of meniscus tear you have. Once I know what type of tear you have I can determine if your meniscus tear will heal on it own, or if it might require surgery to help it heal.
There are different types of meniscus tears:
There are different causes of meniscus tears.
Acute injuries can cause meniscus tears (longitudinal, peripheral, bucket-handle and radial tears) …
but most meniscal tears (complex, degenerative, and horizontal cleavage) are caused by degeneration and wear and tear.
Healing of a Meniscus Injury
The meniscus serves a very important function. Therefore, now more than ever, we try to focus on meniscus preservation or healing. That means our goal is to try and fix or suture your tear so that it will heal. Be careful, occasionally a surgeon might tell you they will “fix” your meniscus … but they are actually intent on cutting the torn portion out. Be sure to clarify this with them before considering which surgeon should repair your meniscus tear. I should also state that we are not talking about treating highly degenerative or worn out tears in people in their 7th and 8th decades. Those tears are not repairable and most usually do not need to be operated on. Most people with degenerative tears will do very well with a compression sleeve and physical therapy and moderate exercise.
Can my meniscus tear be repaired?
Over the past few years, a lot of research has focused on the healing potential of certain tears we once thought would not heal. We know that the peripheral ⅓ of a meniscus has a blood supply adequate enough to bring healing nutrients to the area of the tear. Therefore, it was always assumed that only tears within the outer ⅓ of a meniscus would heal once they were sutured or stitched back together. Recent research has shown that tears with little blood supply are still capable of healing after they have been sutured together. Horizontal cleavage tears were once considered a degenerative tear not capable of healing. This paper and others show that horizontal cleavage tears can be repaired, with a reasonable chance of success. Radial tears of the meniscus were also considered not repairable, and most surgeons would simply cut out the torn portion, leaving you at risk for developing osteoarthritis. This paper shows that we are now capable of fixing radial tears of the meniscus, again with a reasonable chance of healing.
Can Meniscus Tears Heal Without Surgery?
When you first started reading this you were likely reading to see if your tear could heal on its own — without the need for surgery. In a very small group of people that can happen. Meniscus tears that heal themselves tend to be traumatic tears which occur at the same time you tear your Anterior Cruciate Ligament or ACL. Otherwise, most tears do not heal unless they are sutured back together.
Bottom Line: The meniscus serves a very important function within our knee. When a meniscus tears, it will not serve to protect your knee from developing osteoarthritis. Many tears are now repairable with modern techniques. If these repairs are successful at restoring the integrity of the meniscus, then you may not go on to suffer the consequences of an arthritic knee.
Repairs are generally reserved for acute, traumatic tears in children and young adults. Surgery for degenerative meniscus tears in adult knees with osteoarthritis is rarely required. Although your degenerative tear will not heal spontaneously, physical therapy and other non-surgical measures are usually effective at minimizing pain and maximizing function as effectively as surgery.
David Sokolowski
Dr. Luks,
I was, until a few weeks ago, a very active 56 year-old male. I started experiencing pain in my right knee one year ago and was subsequently diagnosed with a meniscal tear following an MRI. I decided to put off surgery and go with cortisone injections. These helped immensely but didn’t last. Now, having actively participated in sports throughout the past year, the pain and swelling and stiffness have returned and are much worse. So, I recently had another MRI done. Here are the summarized results:
1. There is complex tearing and deformity of the posterior horn of the medial meniscus.
2. Areas of tearing and deformity of the posterior one third of the lateral meniscus are present.
3. Residua of chronic healed medial collateral ligament sprain.
4. Small knee joint effusion.
I’ve been to two separate orthopedic surgeons, and they both recommend surgery to remove (not repair) part of the meniscus. I’m very apprehensive about this surgery and am wondering if there’s anyway to rehab (somewhat) without it. What do you think?
Howard J. Luks, MD
HI David…
It’s a very difficult problem. Folks our age who have meniscus surgery, especially involving the lateral meniscus do not do very well for very long. There are a number of us who try to never take out a portion of the lateral meniscus because that “compartment” in the knee becomes very cranky after surgery and tends to degenerate quite rapidly. Medial side tears might do a bit better, but also cause arthrosis over time.
I imagine they also found some chondromalacia or arthritic changes too?? Most of these tears can be managed non-operatively… but ultimately the decision is between you and your surgeon. I can not tell you which way to go with this. Just make sure that your docs understand your expectations and make sure they believe you will be able to achieve them after surgery. Sometimes having a cranky, stiff knee is part of being active after 50 ? :-(
Lastly. the data on horizontal tears, especially on the medial side show that they may heal after surgery. We have been fixing these for a while in the right individual. Perhaps you can find someone who is at least willing to consider repairing them if you chose to go ahead with surgery.
Again… this is a very tough problem… and tough decision making. There is no clear answer here. Other than the fact that the research is starting to favor non-surgical management.
Deepa
Dear Dr Howard, I hope you can guide me and possibly re-assure me about Arthoscopic left knee surgery that I have been advised to do by a reputed Orthopaedic surgeon here in Melbourne, Australia. I am a female aged 47y who had a recent car accident and both my knees were bruised and injured (i also have mild-moderate osteo-arthritis on both knees), however no broken bones or bleeding etc but I have discomfort and pain/ stiffness when walking on left knee which was not there before and which worries me as I have 2 young kids at home to look after. The pain becomes worse when shopping or walking for more than an hour.
The results of the left knee MRI revealed:
1. Severe medial knee joint and early patellofemoral joint ostearthritis, 2. Narked degenrative thinning through the body of the medial mensicus with an associated complex tear 3. Degenerative change with a horizontal tear through the body of the lateral meniscus 4. Moderate knee joint effusion 5. A partly ruptured bakers cyst 6. mild prepattelar bursitis.
Please advise if the key hole surgery would work or if it is a sham for my condition, I am especially concerned as you said that research shows arthritis progression can be fast after a surgery like this. I am fairly young and this is of great anxiety for me. Please help settle me at ease.
Howard J. Luks, MD
Given that you have severe knee osteoarthritic changes it is highly unlikely that you will respond well to keyhole surgery.
After a car accident it is best to give physio and time quite a few months before making decisions like this. But given the changes in your knee– your first surgery might not be keyhole… it could be a replacement. Best to continue with non-surgical treatment for now.
Good luck !
Seema
Hello Dr. Howard,
Greetings!!
I am 42 years old. I have a partial tear in the medial patellofemoral ligament, a horizontal tear in the body of the medial meniscus and grade 1 signal in the body of the lateral meniscus. There is a mild sprain in the ACL. My injury happened 6 weeks back.
I am undergoing PT since last three weeks, and I feel my pain is little better, and knee bending is improving. My question is: If someone faces these type of tears, they lose the ability to run, cycling even after full recovery. Is there ae chances of reoccurring. What are the further precautions you would like to suggest to avoid these risks?
I have dreams of running a marathon; it is going to be impossible now?
Regards,
Seema
Howard J. Luks, MD
You have a good chance of recovering in a number of months ( can be 4-6 months). Keep up with you exercises and stretches.
David Detherow
I am 48 year old active make. I tore my meniscus 13 weeks ago no surgery. I still have problems with swelling of the knee after jogging or running. How long should swelling persist down the road?
Howard J. Luks, MD
HI David… I often finds that the swelling associated with physical activity subsides within a number of months. But even if the swelling persists, is it worse to deal with that or assume the risks (accelerated osteoarthritis, surgical risks, etc) of surgery?
Harry
Hi Dr. Luks, thank you for the insight in this article and it is awesome of you to answer so many peoples questions. I would greatly appreciate if you could give me any insight into my situation. I am 35 yr old male, I hurt my knee practicing Brazilian Jiu Jitsu. I haven’t had it evaluated because I have no medical insurance. From my research I believe I may have injured my meniscus to some degree. My lower leg was pulled inward and my outer knee made a loud pop. It did not hurt at all, so I continued training that night. The next day it did hurt and was stiff, but not extreme, never swelled. Slightly hurt to the touch on outer knee, and most pain is sometimes upon rotation or pivoting. This was 10 days ago. It dosen’t hurt now at rest, but sharp pain sometimes upon pivots or rotation, as if I could injure it further. My dilemma is 1. no insurance, and 2. I feel I really need to get back to Jiu Jitsu, it has completely changed my overall health and life recently and if I don’t have that I may not be able to stay committed to the same level of health, fitness, and relief of stress. I think id rather have arthritis, just don’t want to totally injure my knee to for sure not be able to train. I’ve ordered a pretty good knee brace and intend to return to training next week. I am extremely inflexible and that may have led to the injury, id like to work on that through yoga and continuing Jiu Jitsu. Can you provide any insight, thoughts, or recommendations? Thank you so much!!