What is a Meniscus Tear?
The meniscus is a C-shaped piece of rubbery cartilage that acts as a cushion and shock absorber between your thighbone (femur) and shinbone (tibia). Each knee has two menisci: one on the inner side (medial meniscus) and one on the outer side (lateral meniscus).
A meniscus tear occurs when this cartilage is damaged, either through:
- Acute injury: Sudden twisting or pivoting, common in sports
- Degenerative tear: Gradual wear and tear from aging, more common after 40
Meniscus tears are among the most common knee injuries, with over 500,000 meniscal surgeries performed annually in the United States. The good news is that many meniscus tears can be successfully treated without surgery.
Types of Meniscus Tears
By Pattern
- Radial tear: Tear running from inner edge outward
- Horizontal tear: Split through the thickness of meniscus
- Vertical tear: Tear running along the length
- Bucket handle: Large vertical tear creating a flap
- Degenerative tear: Complex, irregular tears from aging
By Location
- Red zone: Outer third with blood supply; can heal
- White zone: Inner third without blood supply; cannot heal
- Red-white zone: Middle area with limited blood supply
The type and location of your tear significantly influence treatment options and healing potential.
Acute vs. Degenerative Tears
Acute Tears (Traumatic)
- Occur suddenly during sports or physical activity
- Often involve twisting while foot is planted
- Common in younger, active individuals
- Usually cause immediate pain and swelling
Degenerative Tears (Wear and Tear)
- Develop gradually over time in older adults
- Result from years of cumulative stress
- Often occur with minimal trauma or normal activities
- More common after age 40
- Frequently associated with early knee arthritis
Symptoms to Watch For
- Pain along the inner or outer joint line
- Swelling that develops within 24-48 hours
- Stiffness and reduced range of motion
- Catching or locking if a torn fragment blocks movement
- Giving way or feeling of instability
- Popping or clicking during knee movement
Treatment Options
Conservative (Non-Surgical) Treatment
Many meniscus tears, especially degenerative ones, heal or become asymptomatic without surgery.
- RICE protocol: Rest, ice, compression, elevation
- Physical therapy: Strengthen muscles to stabilize knee
- Activity modification: Avoid aggravating movements
- Over-the-counter pain relievers: NSAIDs for pain and inflammation
- Corticosteroid injections: Reduce inflammation and pain
- Hyaluronic acid injections: Improve joint lubrication and cushioning
Research shows: For degenerative tears in patients over 40, physical therapy is often as effective as surgery with lower risk and cost.
Surgical Treatment
Surgery may be necessary for:
- Large tears causing mechanical symptoms (locking, catching)
- Tears in the red zone with healing potential
- Acute traumatic tears in younger, active patients
- Failed conservative treatment after 3-6 months
Surgical Options:
- Meniscus repair: Stitching torn pieces together (preserves meniscus)
- Partial meniscectomy: Removing only the damaged portion
- Total meniscectomy: Removing entire meniscus (rarely performed now)
The Importance of Preserving Your Meniscus
The meniscus plays critical roles in knee health:
- Shock absorption: Distributes load across knee joint
- Stability: Helps keep knee aligned and stable
- Lubrication: Assists with fluid distribution
- Protection: Reduces stress on articular cartilage
Research shows: Removing meniscus tissue increases arthritis risk. When possible, preserving the meniscus through repair or conservative treatment is preferable to removal.
Questions to Ask Your Healthcare Provider
- What type of meniscus tear do I have, and where is it located?
- Do you recommend surgery or conservative treatment for my specific tear?
- What are the risks and benefits of surgery versus physical therapy?
- If I choose non-surgical treatment, what’s my rehabilitation plan?
- How long before I can return to my normal activities?
- What’s my risk of developing arthritis?