Runners often develop knee pain.  If given enough time, or perhaps cross training and physical therapy that pain will often subside.  When a runner sees an Orthopedic Surgeon they may be referred for an MRI.  Virtually no one over 40 has a “normal” knee MRI.  Upwards of 30-35% of runners over 50 have meniscus tears. Runners might be inclined to jump for surgical options thinking they might be able to get back to running sooner. That’s not the best strategy if you wish to continue running for years to come. So an MRI of a runner’s knee with pain might show a meniscus tear.  Does that mean that the meniscus is the cause of pain? Does that mean that the runner needs surgery? Can they continue running?

Running is a great exercise. Runners are a unique breed of athlete to treat.  Running is meditative and enables us to relax, as we hit our goal of exercising a few days per week. If we cannot run because of a meniscus tear or knee pain we will be very upset.   As you can imagine this blog receives hundreds of private comments each month.  The following questions appeared three times recently in slightly different formats… The questions centered around running and meniscus tears.

  1. Can I continue to run with a meniscus tear?
  2. Can I make a meniscus tear worse if I run?
  3. Will meniscus surgery help me run better?

As you know, we have two menisci in each knee, we discuss what a meniscus is here.  Most meniscus tears, especially in runners tend to occur along the posterior horn of the medial meniscus.  These tears tend to be degenerative, possibly (but not proven to be) associated with a long running career.

Runners and meniscus tears?

running and meniscus tearMeniscus tears can present in two different ways in runners.  Whether or not you can run depends on which group you are in.

Group 1: Most runners find out that they have a medial meniscus tear because they head to an Orthopedic Surgeons office when their knee hurts after a run.  Most runners do not recall any one particular injury- that’s why we call these degenerative tears.  This group of runners with a meniscus tear are able to run.  They have varying amounts of pain after the run, or during the run, especially if they run on a cantered road, or a trail. This group is most concerned with making the tear worse if they continue to run.  They wonder if they can continue to run despite having a meniscus tear.

Group 2: Sometimes a runner presents with pain on the inner side of the knee or the back of the knee.  The pain is severe enough that they can not run, squat, pivot or twist.  These runners are concerned because they are not able to run.  Because runners are so committed, and often “need to” run, they may overreact and choose the wrong treatment option.

What is causing the pain? Often times when these degenerative tears initiate or occur the knee pain will be more severe for a few weeks. Yes, a few weeks… perhaps even a month or two.  The pain is usually due to a synovitis (inflammation) which will often settle down over time.  Here’s where many runners get into trouble.  They rush into a docs office, they get an MRI and surgery is scheduled before they give the pain a chance to improve on its own.  A meniscus does not have nerves in it.  The tear doesn’t hurt.  The inflammation because of the tear leads to pain.  It may take 4-8 weeks for that inflammation to settle down. And yes, the inflammation can settle down without having surgery on the tear.

Having part of your meniscus removed – torn or not – as a runner could end a long running career.  Surgery for a meniscus tear in a runner might help for a short while, but the loss of meniscus might initiate an arthritic process causing more degeneration within the knee.  Runners in general have a lower incidence of arthritis than a non-runner — but not if part of the meniscus is removed.

Can I run with a meniscus tear?

meniscus tear in a runnerFirst off… many if not most meniscus tears do not require surgery. Surgery will not prevent arthritis from occurring.  Many runners get back on the road, even elite runners, with a degenerative meniscus tear.  If you have a mild ache during the run, or a mildly sore knee after a run then you can often continue running.  There is very little risk that running will worsen the tear.  You may wish to wear a compression sleeve during the run. Compression sleeves have been proven to improve knee pain and improve a sense of knee stability.   If you run on a cantered road, perhaps change the direction you run.  If you run single track trails perhaps run on carriage trails.  Those little changes can make a big difference.  Surgery for a meniscus tear in a runner should be considered only if:

  • the pain continues and is severe enough that you can not run.
  • your pain did not improve with appropriate physical therapy – yes it works.
  • a compression sleeve does not improve your symptoms
  • you waited at least 6-8 weeks for your knee to recover on its own.
  • you have no evidence of moderate or severe osteoarthritis.

Meniscus surgery in a runner.

If you are a runner and the pain you have from a meniscus tear is keeping you from doing what you love then there is a chance that surgery might be the right option for you.  As long as you do not have confounding issues such as osteoarthritis then you might feel great after an arthroscopy for your meniscus tear.  But remember, there is a chance that you will not feel great. The decision making variables here are key to ensure best chance of success.  Understand the principles of shared decision making before signing the dotted line. Perhaps consider seeing an Orthopedic Surgeon who is also a runner.  Being an active trail/endurance runner gives me a much greater appreciation of just how important running is in your life!

When can I run after meniscus tear surgery?

Runners start to whither if we can not run.  I am one of you! I get it! But rushing back out onto the road is a recipe for a disaster if you return to running too soon.  When a part of the meniscus is removed, the physics of how the knee works and the stress that certain parts of the knee are subject to changes significantly.  You must allow for the knee to recover and get used to its new environment.  That might mean returning to running at 4 weeks, or it might mean 6-8 weeks depending on the appearance of the other structures in your knee at the time of surgery.  If you head back out on the road and your knee swells significantly then your knee is telling you that it is not ready.  Do your exercises and wait a few more weeks.  Plan on slowly adding your miles back.  Plan on slowly adding to your pace.  Do not plan on intense interval, track or hill work for at least 3 months after meniscus surgery.  Think long term… we are trying to prevent secondary damage to your knee and give you a longer running career.

Disclaimer:  this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.

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About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

44 comments on “Can I make a meniscus tear worse if I run on it?

  • Thank you for the great article. I’m dealing with a big question right now and perhaps you would be kind enough to lend you opinion. I’m a 59-year-old marathon runner and triathlete that has a medial meniscus tear in my left knee. While training for the Boston Marathon last year my left knee really started hurting. It would hurt at the beginning of the runs, but after warming up I was able to lessen the pain and complete the workouts. I was able to complete Boston (Bucket list item). However, the pain both during workouts and afterward got so bad I eventually couldn’t run anymore. An MRI revealed severe bone marrow edema and contusions in my knee, along with the meniscus tear. While forced to take several months off from running I was at least able to continue bicycling and swimming (which both increased in mileage, since no running to deal with, and they didn’t bother my knee). Now that the bone bruising has completely healed up I’ve been slowly running again for the past few months. I’ll be turning 60 next year and want to complete at least one full Ironman Triathlon (another bucket list item). I currently have no knee pain from the bruising issue, but do have the slight pain from the meniscus. Knowing that with the meniscus tear, full blown marathon training will eventually bring back the bruising, I’m planning to do as minimal running as I can get away with in preparation for the race (along with continued increases in cycling and swimming). My targeted race is at the end of July and I plan to pick up my running mileage in March. Right now (December), I’m just running a couple of miles 2-3 days a week, so I don’t lose everything and have to start from scratch. Basically, my question is: Since my meniscus isn’t causing any locking/catching in my knee, and since surgery wouldn’t be able to repair the cushioning between the two bones, I’m inclined to continue with my plan to compete in the Ironman in July. Would surgery at this time (soon, with time to recover before the heavy training) be beneficial in any way, or should I continue on my current course? Or am I crazy to be doing this? Thank you for any insight you can provide.

    • Hey there :)
      A few years later since you posted about your bone bruising but I have that same situation. What happened with you??
      Surgeon wants to do a subchondroplasty procedure for bone edema. and NOT touch my meniscus tear. Is there a better solution?
      Please advise- someone :)

      • Depends on how severe the arthritis is, how long the edema has been present and what your symptoms are. Often times, a knee will be found to have a 1) A degenerative meniscus tear, 2) bone marrow edema (inflammation) and 3) Osteoarthritis. Many of these knees will calm down over a few months without any surgery… some may do well with a subchondroplasty- but only if the arthritis is mild or moderate. If there is significant swelling in the knee itself then a subchondroplasty may not work well.

  • My doctor told me that meniscus tears do not heal and if I don’t have the surgery that I will get arthritis in it and it will wear it down to the bone. Does this sound right?

    • Not entirely accurate…
      1. Some meniscus tears do heal.
      2. Most do not.
      3 Most meniscus tears are due to degeneration/ aging and activity.
      4 Most degenerative meniscus tears do not need surgery.
      5. Recent scientific studies show that xrays after meniscus surgery might actually look worse due to progression of osteoarthritis.
      The decision to have meniscus surgery is mostly yours… it is almost always a quality of life decision. Many patients do very well without meniscus surgery after a course of physical therapy. Some also find that a compression sleeve works if there is a ache that remains in the knee.

  • I injured my medial meniscus during a 9 mile run which I hadn’t worked up to. I had severe knee pain which prompted an MRI with the diagnosis of “medial meniscus defect.” There’s a white half-moon shaped feature in the non-vascular portion of my right meniscus, with no evidence of displacement or a tear. Anyways, the pain has gradually lessened and mobility returned over a whole YEAR. Many times I’ve wanted to throw up my hands and surrender to surgery bUT I know it’s not the best long term choice. I’d encourage anyone to stick out the pain and the PT, even when you think no progress is being made and you just want the pain to go away. Don’t operate unless you have to. It’s been tough accepting the fact I just can’t jump off the couch and do a ten miler whenever I want. Do the PT, strengthen all the supporting muscle groups to protect your knee, and consider your recovery as the ultimate marathon of PATIENCE!

  • I am a pickleballer who slipped on a poorly maintained wood floor 11 months ago landing on the outer side of my knee. I hopped right up and experienced very minor pain at that site ( probably a “1” on the pain scale). This minor pain did not hinder my activities in any way and I continued to play as usual. I never experienced any swelling or discoloration. As the months went by the minor pain remained but never got worse. I started some self PT strengthening exercises (leg lifts) and balance exercises while guarding aginst any further twisting, heavy lifting etc. Three months ago my knee started feeling less stable so I started wearing a Velcro type wrap around brace. This helped a lot but I’ve started experiencing increased pain on some days while on other days not so much. I continue to play pickleball albeit with less vigor. Getting up from a sitting position to a standing position seems to cause me the most pain. I’ve start using my arms on the armrests to push up. Other wise I’m an active, healthy 67 year old retired nurse. Am I doing all I can do in the way of self rehab? I’m scheduled for an MRI in a month but surgery is not going to be my treatment of choice . Any thoughts or suggestions would be greatly appreciated.

  • I have only recently developed the pain associated with a meniscus tear – should I be resting to allow for healing or can I keep training? Hoping for a reply!

    • It depends… if it is a chronic degenerative tear that you aggravated then there is little risk in running if the pain is minimal too. If on the other hand this was a traumatic tear (slip, fall, accident, twist, etc) then a few weeks rest, PT and a slower return to running is usually best course of action.

    • Madison
      I would advise stopping running / any sport which pounds your knee and get an MRI scan.

      I did about 250 miles on my knee with a menisical tear (without knowing what it was for quite some time). The tear got worse to the point I could not run at all.
      My mensical repair subsequently failed and I’ve just had another surgery where they removed 50 per cent of my meniscus :(.
      Until you get a diagnosis please stop

  • Thanks for this article, Doctor!

    I’ve never actually got to running, but I really really like the idea of it and would love to finally start doing it.
    I’m 30 years old, 6′ 3″, 220 lbs (hence the idea of running, haha) and received a knee injury two years ago. It’s a radial tear, and it bugs me ever since – sometimes I twist my leg and it gets really tiresome to walk around, sometimes even walking around brings heat feeling into my bad knee. I used chondroitin glucosamine msm mix prescribed by my doctor, but it doesn’t seem to change anything. I tried to run, just a bit, in a gym – felt all right, but my knee was hurting a bit and a bit inflamed afterwards. When it gets really bad I use ibuprofen gel, which actually helps a lot to remove pain and inflammation. Whenever I stretch my leg from a bent position – it ALWAYS gives an audible grinding/popping sound, every single time!

    Now, according to my doctor, I should actually do the surgery, but I’ve read a hundred reports and studies showing that in my case (as in many other cases) it’s not guaranteed that my knee we’ll be as good as before. My buddy had almost the same issue and couldn’t run after surgery at all (or so he says).

    The question is: I’m willing to run, but I’m not sure if I won’t make things worse and beyond repair by doing so. Should I take any precautions (like going on a diet and losing some nice amount of weight before I start running)?

  • Hello,
    Thank you for your nice article. It helped me understand more of my knee pain. I wasn’t sure if it was meniscus but I am now certain it is. My inside of my left knee and the back of my knee hurts. I can walk but not run much. The most difficult is standing up after sitting down. I also have pain going up and down the stairs. I am a 46 year old woman. I have run several marathons including Boston in 2016 and have been training for a marathon recently. After about 2 months of training, I started feeling some pain. I would forget the pain while running but would feel it after and the next few days. I kept on running through the pain until it got worse in the last 2 weeks. I haven’t run in 2weeks and I still have the pain. I have been icing it at least 2 times a day. It has been helping but I still have the pain.
    My marathon is in 5 days(Chicago 2017). Will cortisone shots help temporarily just to run the marathon?
    Thank you for your help!

    • HI ! As a fellow runner I know how depressing this can be !!!!
      If you have pain at rest and pain with just walking then you should be examined to be sure this is not a stress reaction or stress fracture. A typical runner’s degenerative meniscus tear doesn’t typically hurt all the time.

      Good Luck !!

  • Hi,
    Thank you for the informative article. I am 36 years old and I love being active. I was not able to participate in Spartan this year because of pain in my knee. An MRI revealed that I have a meniscus tear in my knee and my doctor thinks I need surgery. I am not entirely sure. I was hoping you could point me in the right direction. This is what my MRI reports stated: TECHNIQUE: MRI KNEE RIGHT WO CONTRAST SAG PD FS, SAG PD, AX PD FS, COR PD FS,
    COR T1

    REPORT: Increased T2 signal is present in the periphery of the anterior horn of the lateral meniscus. A linear horizontal area of abnormal signal is also seen extending towards the inferior surface. However, definite extension to the
    inferior surface or apex is not identified. The posterior horn of the lateral meniscus is intact. The patient appears to have an incomplete discoid lateral meniscus. The medial meniscus is intact. Mild extrusion is present. No abnormal
    signal is seen suspicious for tear.

    There is moderate chondromalacia in the medial compartment. Mild reactive and subcortical cystic changes are present in the medial femoral condyle. Mild chondral malacia is also present in the patellofemoral compartment.

    A small knee joint effusion is noted. A small fluid collection is present adjacent to the tibiofibular joint. The ACL, PCL, MCL, LCL, quadriceps and patellar tendons are intact.

    • The arthritis (chondromalacia) and the stress reaction to the arthritis (reactive sub-cortical cystic changes) seem to be a more likely cause of your pain. I can not comment on specific treatments in this format… but arthroscopic surgery alone not likely to improve pain with these changes present.

  • I am a 47 yr old female who loves running. I believe it is what keeps me sane. 2 weeks after my last marathon in May I was got our of my chair and my knee buckled. Didn’t think much of it at the time but an hour later my knee swelled up like a balloon. I stopped running for a few days. After the swelling went down I went for a 5km run with minimal discomfort. Swelling and pain returned after the run. Dr took X-rays which were unremarkable. Tried physio for 2 months with little to no improvement. Stairs continue to be an issue as well as sleeping. My knee wakes me up every night I turn over in bed. Had MRI done last week(4 months after chair incident). Mri indicated radial tear, moderate sized bakers cyst and knee effusion. Please help me return to the sport I love. Would surgery even be an option? Would a radial tear heal on its own? Is a bakers cyst reason for concern? My family dr has referred me to a specialist but I can’t get an appointment for 2 months.

    • HI … As a fellow sanity runner I understand your pain.
      Radial tears can be more symptomatic than other types of tears.
      Some are degenerative, some are not. A Bakers cysts is just a collection of fluid.

      Many radial tears are repairable. Removing the torn piece is not a great treatment option.

      Good luck

      • Wow! Fast response. Thank you!! One more quick question. If one were to attempt running (taking ibuprofen for swelling, Tylenol for pain), is it wise? Or would a radial tear continue to tear? As a fellow runner you understand how cagey we get when we can’t hit the trails. Once again ,thank you.

      • Taking NSAIDs before exercise is not a great idea.
        Running on a radial tear should not cause it to become larger…. Other activities can make a meniscus tear larger — activities such as squatting, pivoting, twisting.
        good luck !!

  • Fantastic article Dr. Luks. I have a question about my own condition. My history is thus: I’m a 51 yo male, competitive age group cyclist and recreational runner. I had my left medial meniscus trimmed around 20 years ago and the right one done two years ago. I began running again (after many years of not running) a year or so ago and just fell in love with it- my wife even says it keeps me sane :-) Fast forward to 6 weeks ago when, a few days after a longish run (7), I felt the familiar “pop” in my left knee followed by pain and swelling. I haven’t run since, and have only been riding the rollers indoors but the internal swelling comes and goes. I finally went to the ortho last week and he ordered an MRI that indicated a horn type tear and some very mild degeneration of the hard cartilage on the femur. He said the tear was non-repairable and advised surgery to trim the meniscus (again). I’m loathe to do that again as removing more of it seems counter intuitive to me. I did see a PT that I know and we ran through a series of exercises meant to show whether I had any muscular imbalance in my legs. He said between the cycling, running and gym work that I do that everything looked good to him.

    So, I guess my main question is, knowing my history but not diagnosing me, would you advise against returning to running altogether? I would love to return to it but I also don’t want to do further damage. Heck, I’d be happy to just get on the treadmill at this point!

    Thanks for your input.

    • Nothing wrong with trying to return to running and see how the knee handles it…. I would however complete the PT and conditioning and wait approx 2 months after the tear occurred. I know many runners who have successfully returned to the trails with a known meniscus tear.
      Saadly, the arthritis in the knee will progress slowly regardless of what you do.

      Good Luck

      • Thanks Dr. Luks! I managed about a half mile on the treadmill a few days ago. So far so good but I’ll continue to ease into it slowly. Am also doing band work and stretching as ordered by the PT.

        I must say one of the biggest disappointments in this whole ordeal is that I have not been able to run in the cities I travel to. It is so enjoyable to get out early in the morning in a new city and experience it from the sidewalk.

        Best to you in the New Year.

  • Great article and exactly what I have been looking for since because being recommended a knee Arthroscopy operation to “tidy up” a knee with MRI revealing a lateral meniscus tear and 1 cm of missing cartillage (non meniscus). This followed a couple of months of very conservative running following feeling a tweak in the knee getting out of the car, ending with overdoing it a bit and getting severe swelling in the knee lasting 8 days and incapacitating me for a couple of days.

    I am very reluctant to have an op yet so it was great to read your article. The knee swelling has mostly gone and I am thinking that a period of time cross training and doing relevant knee strengthening exercises is the best course of action for me. ……. would you agree? Ps 50 year old 20 years of running 4 times a week.

  • Hello Dr. Howard. Thanks for writing these articles – really useful when people like us are looking for answers. I am 34 yrs old female, not exactly a runner but i started running back in Dec 2017 which only lasted for 2-3 months , after that I started experiencing some discomfort in my right knee. It was negligible at the time and would only come if I ran. That was Feb-Mar 2018. I tried running in between , but my PT advised not to so I gave up and took to morning walk and swimming. This was Apr- May 2018. During this time, the pain increased to last only during the activity but mostly ok on resting. But I was worried. I went to the first ortho doc , got 2 MRIs done (1 said curvilinear grade 2 signal seen in posterior horn of medial meniscus, the 2nd MRI said ” linear myxoid intrasubstance degeneration in posterior horn of medial meniscus without overt tear, also focal grade 2 chondral lesion at anteromedial femoral condyle with grade 1 changes elsewhere, most other articular cartilage intact’. First doc said wait out 6-8 weeks, gets synvisc injections and then arthroscopy if no improvement.Went to second doctor, didnt recommend surgery. Went to 3rd doc – he said unless your knee locks (it doesn’t thankfully), he said exercise and wait and watch. The thing is I have now waited out 2-3 months since June. I started strengthening exercises properly in late July. The situation is almost the same. Some better days, some not so good. I can walk around in the house but my walking endurance is 10-15 min after which it starts hurting. The pain intensity varies overall – sometimes no pain on resting, sometimes soreness on medial side, sometimes it hurts like 5/10, no pattern really and at times it goes to lateral side as well (example – I tried cycling today in 2 months for 10 min). The thing is now this issue has started in my left leg too! But it’s not as bad. I do get stiffness as well sometimes, heaviness in legs, ROM in right knee is 80 % but I can not kneel, squat as they really hurt. So, long story short – I am unable to go back to any activity and would like to atleast commence my walks and swim sessions. Please can you advice and how long does it take for PT to really work and suggest if PT is the way to go. I don’t want to go for surgery!! Thanks

  • I’ve been reading along and watching your you tube postings relating to meniscus tears. I was recently dx’d with bakers cyst and MRI shows medial meniscus tear. The Ortho recommends surgery to “clip” the tear and remove the cyst. I’m 56 and run average of 10 miles/ week along with alternate cardio/weight training on opposite running days. My knee is slightly swollen at times and not painful to point where it prohibits me at this point from excersizing. The cyst causes an “ache” more than pain. I’m not 100% certain I want recommended surgery and now after watching your videos and reading your opinions – tend to feel mine might also be more degenitive arthritis type injury.

    If I continue with my current excersize program do you feel the tear may worsen given my age/arthritis? The Ortho surgeon advises that the meniscus will not heal itself as there is no blood flow to tear to promote healing. Thank you

    • It’s true.. meniscus tears have no blood supply. That is why they tend to fray and degenerate as we age. They do not have the ability to heal themselves very well. Many runners are able to run with meniscus tears and have no pain or very little pain. Arthroscopic Surgery like you are considering is not a great answer for a degenerative tear in a middle age runner who doesn’t have terrible pain. Once a portion of the meniscus is removed during the surgery it is very likely that your arthritis will advance more rapidly. When a patient is contemplating surgery for a meniscus tear, in an arthritic knee, the research supports non- surgical management. In addition, the decision is a quality of life decision. That means that the decision is yours and should be based on the effect that the tear is having on your quality of life now. There is always a small chance that the tear will worsen. But that should not guide your decision. Arthritis is always a chronic progressive process… it will worsen slowly over time. Surgery now will NOT stop the arthritis from worsening, and might in fact speed up the rate at which you arthritis worsens.

      Good luck in your decision making. Don’t rush this decision.

  • Good Morning! I am grateful I found this site. I am a 57 year old marathon runner. I have previously had a medial meniscus repair on the right knee and a menisectomy on the left about 11 years ago. A couple of months ago just 2 miles into my run I felt a pop and I had to walk back home. The pain was terrible for a couple of days then fine and I was able to run. Long story short my knee continued to swell and I had pain getting up from sitting which comes and goes. I finally got a MRI with a dx of a Complex tear posterior horn with radial sided vertical and flap components associated with some extrusion of medial meniscal material in the medial recess. Doctor says it is non repairable and recommends smoothing it out so it won’t tear further. The odd thing is I can run without pain but its the swelling and clicking that bother me. I have full mobility. I am hesitant to have more meniscus removed but the doctor is worried about the tear ripping further. I would really appreciate advice! Thank you!

    • These flap tears can be annoying. The problem with these radial tears is they compromise the integrity of the entire meniscus from a functional perspective. These tears usually occur at the “root” of the meniscus. Some of these root tears are repairable, some are not. There’s no rush to make a decsision. If the flap remains bothersome you can have it trimmed back, but… unfortunately, these knees may develop arthritis fairly soon after radial tears. The only thing that might limit that would be if a repair was successful.

  • Thanks for the wonderful articles. I’m a 50 year competitive marathon runner – I’ve completed 114 marathons and love running (my PR is 2:37). In March I had an MRI and was diagnosed with a tear posterior horn medial meniscus with a contusion posterior aspect medial tibial plateau (I got that from the MRI report). My doctor seemed to be more concerned about the bruise than the meniscus. I took 5 weeks completely off, just doing leg raises. It’s now been 8 weeks and my knee felt pretty good so I ran a little the last 2 days and it’s hurting today. I’ve never had swelling and can fully extend my knee with no problem. It doesn’t hurt going up and down stairs. I’m very frustrated and know I probably just need to be patient a little longer. Do you think dry needling helps? Also, when it comes to icing – is the ice massage with the Styrofoam cup the best way? After everything I’ve read, I think surgery would be a mistake. I’m just ready to start running again. Any advice or support would be appreciated.

  • I’m happy to find this form. I am 23 years old. I’ve been running for 2 years now until I fell and twisted knee. I made MRI scans later on and found a horn tear in my horizontal medial meniscus (left knee). I did physiotherapy for 6 months and I still have pain in the same area and swelling after running. Doctor says it needs repairs and possibly trimming some meniscus off. I would really like hear your thoughts sir.

    • HI Omar… it’s possible that these tears can continue to bother you. One thing I would mention is that we can actually repair horizontal cleavage tears quite often. That means we put sutures in the knee to heal the tear. We try to avoid trimming pieces if possible.

  • Dear Dr Howard
    Thank you for making the time to answer my questions about my recent diagnosis of my lateral meniscus issue(s).
    I was recently told that my right knee had a tear at the junction of the body and anterior horn of the lateral meniscus and there is oedema in the medial patella, with minimal overlying chondral fissuring in both facts. What I understand from the latter is that is swelling. Is that correct? The diagnosis did say that the meniscus, LCL, iliotibial band, biceps femoris and popliteus tendons are intact. Incidental small intramedullary lesion in the distal femur likely an enchondroma.
    I am a runner and have been running for over 30 years and as you can appreciate it is very unpleasant not being able to run! I have been doing more trail runs over the past few months and I don’t feel sore after doing this. Some of the courses are quite technical but I never experience any significant knee pain afterwards. When I bend down doing day-to-day activities, my knees sometimes feel stiff and make crunching sounds (sounds more painful than it is!) and have been doing this for many years.
    I realised the issue I had with straightening my right leg (felt like the knee was clogged up) maybe 6 weeks ago but it didn’t hurt whilst I was running. I did a sprint session about four weeks and went a bit too hard and believe that’s when the meniscus crossed the line to being broken as I was limping and hurting quite significantly for a good two weeks. I haven’t run for four weeks now.
    When the doctor told me of the results, unfortunately, I didn’t ask many important questions (very unusual for me) and she said that my options were to get an operation (wait time could be 6 months or more under public health system in Australia) but in the meantime, go to physio and see how that goes. She is not a runner but got the feeling of being a bit brushed off.
    One important question I didn’t ask her is what activities can I do in the meantime if I cannot run? Can I swim (freestyle) and do some form of yoga? I have found some exercises/stretches online that I have started doing which seem to be helping but don’t really match the same activity levels as running.
    What do you suggest?
    I read that the meniscus tears are categorised in red and white zones. Can you please advise if this tear is in the red or white zone? I can walk fine without pain but I notice discomfort more so when I walk downhill. It sometimes feels that that diagnosis was incorrect but I guess the MRI scan doesn’t lie! I may still be in denial. I really want to fix this without the need for surgery.
    Thank you.

    • HI
      These tears are common.. they are usually radial tears and involve both the “red” and “white” zones. These radial tears do not always require surgery. The pain associated with them will often settle down. If the pain does not settle down then we can consider repairing them. Despite partially being in the white zone many of these tears can be fixed by suturing the two halves together. Without seeing you or your studies I cannot tell what type of tear you have though.

      There is often no harm in trying the activities you mentioned. Far too many people decondition and lose muscle bulk because they have stopped exercising. The risks associated with loss of conditioning and loss of muscle bulk and cardiovascular status are worse than the risk to the knee. I often advise people to let pain be your guide. If the pain is 3 or less on a pain scale out of 10 then they can continue… if the pain migrates to a 4 or above then they should cross-train. I hope that helps

  • Hello,
    Any help would be hugely appreciated. I am a very desperate and depressed injured 47 years old female runner. I have run many marathons (PB sub 3hrs). I tore my meniscus 3 years ago and had surgery. I went back to running and happily ran for the past 3 years pain free. I ran the London Marathon this year (first one for 7 years) and since then my knee has not been right and it feels like I have torn the meniscus again…similar pain on impact (even walking) and I have not run for 8 weeks and my mental health is not good – running is very much my stress buster and my therapy. I had an MRI scan but the results seem inconclusive as to whether there is a fresh tear or it is showing the old tear? I am waiting (long wait here in UK to see a surgeon). The report said ‘There is heterogeneous signal in the posterior horn of the medial meniscus extending towards the body with what appears to be an oblique horizontal longitudinal tear. The heterogeneous signal may represent healing material and previous tear. There is some oedema deep to the medial collateral ligament but this is likely reactive oedema from meniscal changes. There is some reactive oedema in the medial gutter deep to the MCL. There is almost full thickness fissure on the tibial articular surface. ‘

    In your opinion do you think I have torn is again? I have rested for 8 weeks and no improvement and now my hip is sore as I am slightly limping. Do you think surgery is the only option or will this end my running career?

    Any advice would be greatly appreciated.


    • Most MRIs do not look normal after you have had meniscus surgery. So those findings aren’t too worrisome. Other than that, without seeing you, examining you and looking at your MRI I cannot tell you what is causing your pain. Edema near the MCL can also be localized bursitis that can hurt- something to discuss with your knee doctor.

  • I am addicted to running. I have been doing PT to strengthen my glutes, hamstrings, hips, and so on. My tear is described as medial meniscus, radial posterior horn, 6 mm from the posterior root, with loss of circumferential hoop containment of the meniscus and partial extrusion of body segment from medial joint line.
    My question is if the root is involved, what is the likelihood that I will be able to get back out there. I am swimming and cycling and lifting, but running is my nirvana.

    • Root tears do complicate the issue. Complete root tears pose a risk for developing progressive arthritic changes. Many of us would consider fixing a root tear if there is minimal arthritis present. I have a post on root tears that you may want to read.

  • Hi,
    I dislocated my patella in May this year and went through the recovery process. At the time doctors/physio told me my ROM would return once swelling had reduced and muscle strength returned. I was unable to extend my knee fully or fully flex. I seeked more medical advice and was told my knee appears locked and a bucket handle meniscus tear could be what’s wrong. I had an urgent MRI scan which came back inconclusive due to movement. The only thing they were able to see was bone bruises. I continued with PT and also had hydrotherapy. The doctor wanted to do another scan which I had last week. This was again blurry and the report said I had a previous ACL sprain (this I am unaware of) patella dislocations( I had suffered as a teenager) and a possible meniscus tear. The doctor told me this tear is only possible because scan quality not great but added that this tear would not be enough to lock the knee. So now I am still unable to straighten my left knee. I have made small progress with sitting/lying with legs straight. I also suffer pain under knee every day. My leg/knee feels a little stronger every day but it bothers me that I walk with a significant limp. I’m getting quite fed up now and my doctor has said my brain needs to reconnect to my knee. Is this right? Or is there a tear causing my issue?

    • Unless there is a displaced large bucket handle tear of the meniscus then it is unlikely that the tear is the reason you cannot fully extend the knee.

  • I have been training for a marathon and started having some really bad pain in my knee. I went to visit my PT and he did several tests and found that I had a meniscus tear. I can not think of a traumatic event that caused the injury and my PT suggests that the injury has occurred due to wear and tear. The swelling went down between my first and second appointments substantially. The marathon is in 2.5 weeks. He says I can run it if the swelling is down and it is worth it to me. I asked if I could do more damage to it and he said yes, but if I am willing to deal with the risk I can do it. Needless to say I am torn in more than 1 ways (lol). Suggestions?

    • Hi Jason… It will take a few months for the inflammatory phase to subside fully. There are many, many runners who run with a meniscus tear that has not been operated on. There’s always a risk of causing more damage, but that risk is low. There is a risk of developing arthritis with a meniscus tear, but that risk will not be altered or reduced by having surgery. These are always tough decisions. Unfortunately, I cannot make that decision for you.

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