Meniscus Tears

The menisci are fibrocartilaginous structures located within the knee joint that play essential roles in load distribution, shock absorption, joint stability, and proprioception. They are among the most frequently injured structures of the knee. Each knee contains two menisci: the medial (inner) and the lateral (outer) meniscus.

The outer portion of the meniscus has good blood supply (the “red zone”), while the inner portion has very limited vascularity (the “white zone”). This anatomical difference directly affects the healing potential of tears and influences treatment decisions. Therefore, individualized treatment planning is essential in managing meniscus injuries.

How Do Meniscus Tears Occur?

Meniscus tears occur due to either acute trauma or gradual degeneration over time.

• Traumatic meniscus tears: Most common in young and active individuals. They often occur during sports due to sudden twisting of the knee, abrupt directional changes, landing incorrectly after a jump, or falling onto the knee.
• Degenerative meniscus tears: Develop more frequently in older adults as the meniscus weakens with age. Tears can occur during routine movements such as squatting, turning while standing, or descending stairs. These tears often accompany knee osteoarthritis.

What Symptoms Do Meniscus Tears Cause?

Symptoms depend on the tear’s type, location, and size. Common complaints include:

• Sudden pain on the inner or outer side of the knee following an injury
• Swelling and increased joint effusion
• A feeling of catching, locking, or instability
• Pain aggravated by squatting, twisting, or stair descent
• Large tears may cause the knee to lock, limiting flexion or extension. In some cases, the locking may not resolve spontaneously and may require urgent arthroscopic intervention.

Diagnosis and Treatment

Diagnosis is made through a combination of clinical examination and appropriate imaging.

• Physical examination: Joint line tenderness, special meniscal tests (e.g., McMurray), and range of motion assessment.
• Magnetic Resonance Imaging (MRI): MRI accurately shows the tear’s location, configuration, stability, and any associated ligament or cartilage injuries.

Not all meniscus tears require surgery. Treatment decisions depend on:

• Patient’s age and level of activity
• Type, size, and location of the tear
• Presence of mechanical symptoms (locking, catching)
• Healing potential (red vs. white zone)

Non-surgical (conservative) treatment options:

• Rest and activity modification
• Ice application and compression or bracing
• Anti-inflammatory or pain-relief medications
• Physical therapy to strengthen quadriceps and hamstring muscles, increase joint stability, and restore mobility

Surgical (arthroscopic) treatment options:

• Surgery is recommended when the tear is large, symptomatic, or located in a zone with good healing potential—especially in younger and active patients.
• Arthroscopy is a minimally invasive procedure performed through small incisions using a camera and specialized instruments.
• When possible, meniscal repair is performed to preserve meniscal tissue.
• When the meniscus is too damaged to be repaired, the torn portion is removed while preserving as much healthy tissue as possible (partial meniscectomy).
• Complete removal of the meniscus is never performed, as it significantly increases long-term osteoarthritis risk.

Postoperative Recovery

Recovery varies depending on the type of tear and the surgical procedure applied.

• Most patients require only one night of hospitalization.
• After meniscal repair, weight-bearing and knee motion are restricted for a period to allow healing. Rehabilitation is more gradual and prolonged.
• After partial meniscectomy, most patients return to daily activity within a few days, supported by strengthening exercises.
• Physical therapy and structured rehabilitation programs are essential for restoring strength, reducing pain, and protecting long-term knee health.

Frequently Asked Questions (FAQ)