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.
Steve
Hi Dr. Luks,
First, thank you very much for keeping this thread going; I think it’s a great resources for folks. Now for my question :) I have a complex meniscus tear in my left knee. I can walk for short distances, around a mile, but then my knee begins to hurt after a while. In fact, these days it’s almost always sore. My injury happened about 6 months ago from painting my curb for 40 minutes while standing on my knees, without padding. My Orthopedic surgeon wants to cutout the torn portion of my meniscus and told me I will lose 1/6 of it. I also spoke with another doctor about doing a stem cell treatment. But it’s $6k out of pocket without any guarantees (although the Doctor told me he’s had an 85% success rate with “pain reduction”). Also, the doctor proposing stem cell treatment hasn’t done any MRI follow ups to show that the meniscus was actually repaired. So I’m concerned about the efficacy of the treatment. Meniscus surgery seems to be the way to go, but I’m concerned about the increased chance of arthritis. Maybe I should shop around for a cheaper stem cell treatment? Perhaps it’s worth rolling the dice on it if there is a chance I can save my meniscus? Another idea is to hold out for a few more years to see if some of the current stem cell studies bear fruit. Although, it’s a long time to wait, and I’m concerned if I do nothing things will only get worse for me.
Thanks,
Steve
Howard J. Luks, MD
Most meniscus tears do not require surgery… and those patients return to a very active lifestyle.
If your tear does require surgery for whatever reason then an attempt at a repair and not cutting it out is the way to go. Over the years we have learned that we can successfully repair many tears once deemed unrepairable.
Stem cells at this time are a waste of money. They do not lead to regeneration. Some people might feel better, but those numbers are never greater than a positive response to a placebo. Save your money.
Good Luck …
Pei W.C.
Hai, I’m Pei, 45 yrs old this year, I have injured my right knee below is my MRI report, I have been rested for almost 6 week, I would like to ask if my knee injury like this will it heal by resting? Tq.
Tear of the posterior horn of the medial meniscus. Lateral miniscus is intact. The anterior and posterior cruciate ligaments are intact.
Bony contusion/oedema in the corresponding surfaces of the medial femoral condyle and medial tibial plateau focal high signal noted in the midpole of the patella posteriorly. Minimal fluid in this prepatellar bursa, patellofemoral and tibiafemoral joint spaces. The quadriceps tendon and infrapatellar tendon are intact.
Sprain of the miniscus capsular junction of the posterior horn of the medial miniscus and sprain of the mid portion of the medial collateral ligament. The lateral collateral ligament is intact.
Impression :
Tear of the posterior horn of the medial meniscus. Sprain of the meniscal capsular junction of the posterior horn of the medial meniscus and the mid portion of the medial collateral ligament.
Bony contusion / oedema in the corresponding surfaces of the medial femoral condyle and medial tibial plateau. Focal high signal noted in the midpole of the patella posteriorly.
*I didn’t walk, I have been resting at home almost 5 weeks and plan to walk next week, I can feel my knee is no more pain but still worried, do I need operation if pain starts bck? Tq.
narendra
Hi Doctor
i have very active lifestyle with regular Gyming and Running. July-17 i started having knee pains and my leg started to feel stiff and had issues with my moment. i ignored it for sometime but then every time i did legs or started running i had pain and stiffness in my right Knee. I visited Doctor and they recomended me MRI. My MRI results :
1. Tear Anterior horn lateral meniscus involving the anterior meniscal root and associated with anterolateral parameniscal cyst.
2. peripheral the posterior horn of the lateral meniscus.
3. Mild(Grade 1) sprain of the ACL for the clinical correlation.
4. Bone bruise of the distal femur.
5.Minimal Synovial effusion of the knee joint.
Aprpeciate if you can suggest the possible way to over come the issue.
Best Regards
Narendra Sidhnani
Narendra Sidhnani
Mira
Hi,
I’m a 27 year old female. The onset of my knee pain was insidious over the last 6 months, to the point where I could not walk even short distances. I’ve had physical therapy for 2 months, and am now able to walk longer distances but seem to have plateaued and haven’t made any further gains for the last month. I still can’t walk as much as I need to for my job without pain and swelling. MRI results were somewhat inconclusive (below) – particularly because it describes a possible tear on the lateral meniscus, but my pain has been consistently centered over the medial joint line and medial femoral condyle. I’m wondering about the likelihood that this will improve conservatively vs require surgery (which, as a Medicaid patient, is proving quite difficult to even get a consult for). Thanks for any input you may have!
*MRI RESULTS: Vertically oriented fluid signal at the junction of the meniscofemoral ligament and posterior horn of the lateral meniscus is felt to be related to anatomical variant with large meniscofemoral ligament. However, this could possibly represent a healing tear in this region as well.
Howard J. Luks, MD
Hi. It is not unusual for an MRI to show certain things that may not be the source of your pain. Not all causes of pain are clear on an MRI. Without a clear diagnosis, usually brought forth by a good examination, it is hard to say if surgery is needed. There are many hospital employed physicians and clinics that accept Medicaid patients. It depends on the region of the country you are in.
Diane Sterling
Approximately one month ago, while slowly walking, I felt something snap in my knee which turned out to be a tear (actually two tears) in my meniscus that resulted in my knee giving out totally and my being unable to walk or stand on it for several hours. After getting an MRI, it confirmed this and then I saw an Orthopaedic group who suggested I needed surgery to correct it. Since the incident happened I resumed normal work activities within a few days with some pain and now just have very little pain. I’m scheduled for surgery in 5 days on 2/9 but am having serious doubts now about proceeding with this. My research is showing consistently what I see in your article here….that the surgery may not have as good of a success rate for totally erasing pain and restoring function than simple PT would and could actually do more damage by hastening the probability of arthritis and then a total knee replacement. Please tell me it’s not just concerns about the surgery….would I be making the right decision to cancel the surgery and just try PT first?
Howard J. Luks, MD
Your research is accurate… the vast majority of meniscus tears do not require surgery.
Good Luck