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 1/3 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 1/3 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.
Shubham chawla says
Hello Sir,
Greetings from India. I am a 27 year old male.
I feel pain in my left knee whenever I sit cross-legged. My MRI reports confirmed that i have complex tear of medial meniscus. So I consulted a orthopedist, he suggested me to get surgery. But it’s already been 3 months and I am doing some exercises to avoid surgery.
Initially i had knee locking but now as I am not sitting in cross-legged position so locking is not happening. My orthopedist told me either get surgery or do not sit in cross-legged position throughout my life but I am not satisfied with this theory as there are circumstances where i have to sit cross-legged. Moreover my orthopedist said that if i don’t get it treated well, this would turn in to knee arthritis. But as you have mentioned above that Meniscus surgery also increases the risk of arthritis.
Now, i am confused what should I do. Please respond at the earliest.
Yours thankfully
Shubham Chawla
Howard J. Luks, MD says
treating a meniscus tear by taking out the torn part will increase your risk of arthritis. Most complex tears do not require surgery, especially if the knee is feeling better. We typically do not restrict activities. If your pain does not improve with physio you can consider surgery, but try to find a surgeon who repairs the meniscus with sutures.
Tracy says
About 4 wks ago I fell on asphalt on my left knee while carrying a heavy box, had immediate severe pain and swelling, applied ice immediately.Limped rest of day. Pain has lessened significantly and swelling gone except when on feet a lot , climbing and descending stairs, or kneeling than swelling returns. X-ray taken, nothing showed, Dr. In E.R. thought possible ligament problem, lateral and area below(not under) my knee cap. I have had no MRI, can’t afford to have. Still get pain and some weakness with climbing and descending stairs, and pain with kneeling. Not sure if I should start P.T. or continue waiting till further improvement, etc. Have not used crutches at all. Thank you. Tracy
Tracy says
About 4 wks ago I fell on asphalt on my left knee while carrying a heavy box, had immediate severe pain and swelling, applied ice immediately.Limped rest of day. Pain has lessened significantly and swelling gone except when on feet a lot , climbing and descending stairs, or kneeling than swelling returns. X-ray taken, nothing showed, Dr. In E.R. thought possible ligament problem, lateral and area below(not under) my knee cap. I have had no MRI, can’t afford to have. Still get pain and some weakness with climbing and descending stairs, and pain with kneeling. Not sure if I should start P.T. or continue waiting till further improvement, etc. Have not used crutches at all. I have not received a reply. Please do. Thank you. Tracy
Russell says
Hello Dr. Luks,
Great article. I’m glad I found it. I’m a 55 year old extremely active male in excellent shape. I mountain bike, run (both trail and street), hike, and go to the gym most days where I will ride the recumbent bike, lift weights, yoga, lots of stretching, etc. I also do a lot of lunges.
Anyway, I’m really not sure how the problem began but my right knee started to get stiff and swollen a few weeks ago. There’s not really any pain to speak of just some discomfort, swelling and stiffness. I haven’t run since but I continue to bike and exercise (no lunges, just wall sits). Symptoms have gotten only a bit better.
I got an MRI last week and my doc said if the problems persist to consider surgery. Would rather not. I’m including my MRI results and hoping you can tell me what it all means in English and what you think my best bet is going forward. Thx a million! Russell
CLINICAL INFORMATION: Pain in right knee. Stiffness and swelling. History of prior surgery on this
knee. [FYI – I had meniscus surgery on this knee approx. 12 years ago – that injury was painful and the knee was as big as a basketball then.]
At 1.5 Tesla, multiple series were obtained without contrast and comparison made with a Western
Connecticut health network MRI from 2007.
There is an appearance consistent with minor partial medial meniscectomy with resection of portions of the posterior horn and body. There is a different configuration to the signal in a small portion of the body with vertical signal that was not evident previously consistent with a small recurrent tear. The free edge of the resected posterior horn is irregular. The lateral meniscus is intact as are the cruciate and collateral ligaments and patellar and quadriceps tendons.
There is a small joint effusion, but no popliteal cyst. There are tiny areas of superficial fissuring of
cartilage in the medial and lateral facets of the patella. There is mild thinning and irregularity of medial trochlear articular cartilage. Lateral tibiofemoral articular cartilage is preserved but there is mild to moderate thinning and irregularity of medial tibiofemoral articular cartilage.
IMPRESSION:
Postoperative medial meniscus in the right knee with minor recurrent tearing in portions of the posterior horn and body.
Patellofemoral and medial tibiofemoral chondromalacia.
Small joint effusion.
Howard J. Luks, MD says
Hi Russell …
That MRI doesn’t reveal anything to be worried about. Considering you had meniscus surgery a while back the arthritic changes are very mild (mild to moderate thinning of medial ….). This is an MRI and a knee that is saying you should not operate on me. Chronic, small meniscus tears rarely cause swelling. Swelling is a sign of inflammation from mild arthritis. If we are really active those knees will swell on occasion. At this point, just consider it to be part of the human experience.
This situation often takes many months for the swelling to recede. You should stay active. You may find that short, SLOW runs help the knee feel better.
Surgery would more than likely make your issue worse… it will not improve that swelling since it is not due to the “minor” meniscus issues.
Keep active, let this go for a few more months.
Good luck
Russell says
Dr Luks,
What a relief! After reading your article I became skeptical of meniscus surgery so I’m glad you responded so quickly.
One (hopefully) last question regarding the MRI results: It states “Patellofemoral and medial tibiofemoral chondromalacia”, which a quick google search tells me is runners knee. Unless it’s my imagination it seems most of my discomfort is in the front especially near the kneecap (the left knee has a little of that feeling as well).
So, did I read that correctly and is there any advice you can give regarding that?
Thx yet again!
Russell
Damian McCleod says
Hi Dr. Luks, I just wanted to say thank you for sharing this thorough breakdown of treatment options, and tear explanations; it’s also nice to see a surgeon actively recommending non-invasive methods like physical therapy first.
As a practitioner, I may be biased here, but I would also recommend acupuncture. This study shows that it slightly better therapeutic effect than physical therapy in the treatment of knee osteoarthritis.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040698/
Great information on your site, thanks again.
Damian