Meniscus tears are very common. Each knee has two menisci which serve as cushions. They can tear due to degeneration, or they can tear due to trauma or a sports injury. The treatment of a meniscus tear will depend on the type of tear you have, whether or not you also have osteoarthritis and the nature of your complaints.
Many people do not understand why many meniscus tears do not require surgery. Having a firm understanding of what the meniscus does and why some tears do not require surgery should go a long way in assisting you in your surgical decision-making.
Meniscus tears are a very common source of pain in the knee. They are also commonly seen on MRIs obtained for other reasons – and are not necessarily the cause of your pain. Many people come in on a daily basis and ask if surgery for their meniscus tear is always necessary. In this post, we will explore
- what a meniscus is,
- what are meniscus tears,
- why meniscus tears are so common
Meniscus Tears
What is a meniscus? It is a cartilage disk that’s found in the knee.
There are actually two of them. We have one on the inner side of the knee which we call the medial meniscus and one on the outer side of the knee which we call the lateral meniscus. These two disks function as shock absorbers or cushions to minimize the stress on another type of cartilage that we have in the knee which we call the articular cartilage. The articular cartilage is the cartilage that actually coats the ends of the bones. If the two menisci are not present or they’re torn, then the articular cartilage sees an increase in stress and can trigger the onset of osteoarthritis. Meniscus tears are by no means the only cause of osteoarthritis. However, they certainly are a significant contributor.
Why do meniscus tears occur?
Now I see many patients every week who present with knee pain and many of them are suffering from meniscus tears. Why/How do we get meniscus tears? Why do these little meniscal disks tear so easily once we reach our fourth, fifth decades and beyond? Our meniscal tissue is non-regenerative. It’s similar to our brain or our heart tissues. If we have a heart attack or a stroke, we do not regenerate those areas of our heart or our brain. It simply scars in. Yet if we cut our skin, our skin heals. Our skin tissue is regenerative, same with some muscle and a lot of other tissues in our body.
The meniscus tissue in our knee has very few mechanisms for repairing itself. Therefore, every step that you’ve taken, every twist that you’ve done, every time you’ve knelt down or squatted down, you’ve put a force across that meniscus and eventually it wears out and the meniscus tears. (This is why most tears are referred to as being “degenerative”. A lot of times people will note that they simply knelt down to pick up something up and when they went to stand up they felt something rip inside their knee and noted the onset of pain.
Why does a meniscus tear hurt?
The typical patient with a meniscus tear doesn’t have much in the way of pain with walking straight ahead. Sometimes they do. It depends on the size of the tear but usually, they’ll tolerate walking in a single direction very well. Patients with meniscus tears will occasionally complain of pain going downstairs. They’ll have pain getting up from a seated position. They’ll have pain with turning, pivoting and twisting and some patients, if the meniscus tear is large will complain that the knee is buckling or giving way or feels unstable. Many of you will also find you need to sleep with a pillow between your legs at night.
A meniscus tear hurts because they sometimes irritate the lining of the knee joint called the synovium. Tears can also hurt if there is a loose piece which is getting caught in the joint.
Types of meniscus tears?
What are the different types of meniscal tears? The majority of tears are degenerative meniscal tears. When you look at the cartilage disc, the edges are simply frayed. The tissue has been destroyed from years and years of use. Nothing you did wrong. The tissue simply wore out. It’s like the front of a pair of blue jeans that you’ve worn for decades and the material just simply wore out.
Then there are those who have suffered more acute meniscus tears and these tears can have different shapes and different patterns. The shape and pattern will determine how symptomatic or how bothersome the meniscus tear will be. If a loose flap of tissue is created and that flap is moving around within the knee – that’s when you’re going to have given way and you’re going to have pain with many activities. You’re not going to tolerate flap tears well and those patients with flap tears (or unstable tears) will usually (not always) go on to require an arthroscopy or a scope to try to either repair or remove that torn piece.
We Treat Patients, NOT MRI findings…
Many patients with meniscus tear pain will improve within a few weeks of onset… in many cases, there is no need to rush into surgery.
- If your pain is starting to improve and
- if the pain does not interfere with your quality of life
- If compression sleeves work to control the pain
- If your range of motion is well maintained and
- You can participate in your normal daily activities —
Then why would one consider meniscus surgery a necessity? Not all “tears” require surgery. Again, we as physicians need to treat the patient, and not the disease.
Consider this article which demonstrated that a sham surgery (incisions made, but nothing done) was no better than treating a meniscus tear when the patient had a degenerative meniscus tear. There are also plenty of studies which show that a degenerative tear can be treated with physical therapy.
How are meniscus tears treated?
If you have knee pain, and you’re found to have a degenerative meniscus tear — I typically advise patients to simply just wait. A lot of times your symptoms will go away. If you sustain an injury and you have an unstable tear, a tear we call a horizontal cleavage tear, a radial tear or a flap tear — those are the tears tend to remain bothersome. If after four, five, six weeks, you still have the same degree of discomfort and quality of life issues, then you might be a good candidate for surgery, which we call an arthroscopy.
Physical therapy can help those of you whose knees feel unstable or weak, and it can help those of you with significant swelling to gain back your motion, stability and strength. Therapy can be beneficial before surgery (pre-habilitation), instead of surgery, or after surgery.
Many patients feel that a compression sleeve makes them feel better and improves their sense of stability – see some of our patients’ favorite knee compression sleeves here.
Do all meniscus tears require an arthroscopy?
What exactly is an arthroscopy?
Basically, an arthroscopy involves bringing you into the operating room, inducing a light sleep, injecting local anesthesia and then placing a fiber-optic camera into your knee through a ¼ inch incision. We then inspect the entire joint, find the tear and determine if it will be removed or stitched back into place. Most procedures take 15-45 minutes and you are able to go home the same day. Whether or not you can return to sports soon will depend on which procedure you had — repair versus removal. More on the recovery from meniscus surgery here.
So if you have a meniscus tear, it’s not all doom and gloom. Many tears do not require meniscus surgery. Some of them do. Some meniscus tears are repairable. Sometimes the torn portion of the meniscus is simply removed.
We try to repair – or suture- meniscus tears whenever possible — but only certain tears are in fact repairable. One caveat: If you have a meniscal tear and you’re experiencing instability or giving way, be very careful with your activities. You don’t want to find yourself on the stairway carrying a load of objects and your knee gives way. If you have instability symptoms, make sure that you have a hand available to hold onto something at all times while you are in your recuperative phase or awaiting surgery or simply waiting to see if the symptoms are going to recover on their own.
Hope you enjoyed this post. For more information there is a more in depth section on meniscus tears here.
And by no means is meniscus surgery or emergency surgery. Take your time, rest and consider a second opinion.
After your meniscus surgery, what should you expect as your recovery from an arthroscopy for a meniscus tear?
Due to the overwhelming popularity of this post, I want to make sure that the many and varied needs that each of you have is met during your visit here. With that in mind, you may benefit in reviewing these related posts on this site:
Deborah
Dr. Luks, I want to thank you for this blog — which I read until 2am last night. I feel much better prepared to make informed decisions when I go to the orthopedist next week for what I am now pretty sure is a tear (I did a Thessaly test on myself and yup, it hurt.) I’m 61, it happened two weeks ago but there was no swelling and my pain is only intermittent sharp twinges on stairs or when walking. So if I hadn’t found sites like yours I might have waited months and wasn’t even icing as I thought it would “go away.” Ha. Also, thanks to your blog, I realize surgery is probably not going to the best option given my age. I just wish I had known more ahead of time as had I had a healthy fear of “the dreaded meniscus” I might have done some things differently.
I also wish there could be more info on workouts for people (esp 50+ ) who choose not to have surgery as being active is the key for me anyway, to managing a stressful career. I really haven’t found a good website resource for this. For instance, I have figured out recumbent bike seems good (and did that today) but would like to see specially designed workouts and maybe a site that provides good advice — such as, can you do Pilates?
It seems especially given the New England Journal of Medicine article recently about non-surgical options there may be more interest in a conservative approach and how to live with tears and stay active. Any thoughts on resources for this appreciated! Anyway, thank you!!
Howard J. Luks, MD
Deborah… thank you so much for your kind praise. Along the years I have found that many patients with meniscus tears and osteoarthritis do well with some activities, but not others. Sadly, it also varies patient to patient. What doesn’t hurt one patient, may hurt others. In general “uniplane” activites… only moving in one direction without turning, pivoting or twisting — are better tolerated. Some patients tolerate Pilates, and Yoga, yet others do not. So I try to work with each patient to see where their comfort zone is and work with the therapist or a trainer to design a program to suit each individuals needs.
I know it’s not what you were looking for… but I hope it helps nonetheless.
Howard Luks
Michael Beitchman
Dear Dr. Luks,
Thank you for your very informative video.
I have been told (based upon MRI) that I have a complex tear of the medial cartilage of my left knee.
I am 68 and for many years have noticed that the inside of my left knee is often larger than the inside of my right knee. Sometimes it aches mildly but has never really bothered me until a month ago when I had pain and very restricted motion. My GP prescribed a 6 day RX of methlyprednisolone which totally eliminated the pain and my limited motion.
Presently I have my long-time slight swelling and occasional aches as in the past. (I think I am more aware of these factors due to being told about the results of the MRI.)
I would like to know
– should I restrict gym activities such as cycling and aerobics (which often involves rapid motion and some twisting),
– if there is a “mild” degree of discomfort during the above activities, might I be doing more damage or could I just be more aware of the symptoms,
– is there a medicine like what my GP prescribed that I should keep on hand in the event of another
serious flare up,
– can a steroid shot into my knee sooth it and prevent problems for a period of time?
Thank you,
MB
Howard J. Luks, MD
Chances are you have had that tear for quite a while. You experienced a flare up, and it subsided. Although I can not issue medical advice, it seems logical that you can return to your prior activities. If the knee acts up, you can always act on it in the future. Injections are useful for episodic pain and swelling. Good Luck!
Sunil
Dr. luks I’m Sunil from India i want to ask you about my mother , MRI report shows that tear of knee cartilage .Due to this she is facing too much knee pain and also she cannot walk . sometimes her knee locks. sometimes unbearable pain occurred in her knee. Doctor suggests us arthroscopy but doctor said that pain may not be go ,so i need your advice should we do arthroscopy or not . can we try some physiotherapy first.
Howard J. Luks, MD
No harm in trying physiotherapy first. You also might inquire how much arthritis is present on the Xray. That may be why the surgeon doesn’t know if the surgery will help her. Once you have moderate to severe arthritis the likelihood that an arthroscopy for a meniscus tear will work diminishes dramatically.
Jennifer
Good evening Dr. Luks,
I typed this once already but it doesn’t appear to be above. LOL. soooo here we go again.
In March/April I did something to my LT knee. It started hurting to where I couldn’t walk around the block from the pain. I had been doing a “30 day squat challenge” and working out on an older elliptical. I went to the doctor in May and had a normal xray of my knee.
Over the last few months, my knee has hurt but not as badly. I have started walking/jogging on a treadmill approx 2 mi a day. I also do an aerobics-type class twice a week. My knee aches afterwards but it’s not horrible. I do try to ice it afterwards. The worst part is when I bend my foot into my thigh (during a stretch), i can’t bend my leg completely w/out pain. My knee pops when I walk occasionally, but it does not feel weak or that it’s going to give out.
I went for an MRI today and learned there is a “complex tear of the body and posterior horn of the medial meniscus”. the lateral meniscus is fine, articular cartilage is fine, quads and patellar tendons are normal. cruciate and collateral ligaments are intact. I do have a small baker’s cyst.
I will be visiting with the doc about it tomorrow, but i was wondering what you thought about it. I do not want to have surgery. I am sure that he will push for it. My thought is that I will stop the aerobics class, and tone down the walking/jogging, but my concern is that I will injure it more. How do I know when I’ve pushed too far?
I appreciate your thoughts….
Thank you for this site! It has helped calm my nerves (and fears) about this diagnosis.
Howard J. Luks, MD
Jennifer,
Many meniscus tears can be successfully managed with physical therapy, activity modification, etc. If you fail to improve with those treatments then you have a qulaity of life decision to make. Given all options, some might chose to have surgery and some might not… but at least it was their own “informed” decision.
Good Luck
Ivan Ospina
I had a meniscus tear a year ago and doctor adviced me to rest 2 weeks, it was enough to me because I have recovered 100% my knee movement. This post is excellent.
Howard J. Luks, MD
Thanks Ivan !!