Torn meniscus: Symptoms, diagnosis, and treatment options

A torn meniscus is a common knee injury that can affect anyone, from athletes to older adults. The meniscus is a piece of cartilage in your knee that cushions and stabilizes the joint. When it tears, it can cause pain, swelling, and difficulty moving your knee. Understanding the symptoms and treatment options can help you recover and return to your daily activities.

What is a torn meniscus?

The meniscus (plural: menisci) is a C-shaped piece of cartilage located between your thigh bone (femur) and shinbone (tibia). Each knee has two menisci: one on the inside, nearest the other knee (medial meniscus) and one on the outside (lateral meniscus). The meniscus acts as a shock absorber and helps the knee move smoothly.

A meniscal tear occurs when the cartilage is damaged, either due to a sudden injury or gradual wear and tear (also called chronic degenerative meniscal tear). These tears are classified based on their location, shape, and severity; for example, they may be described as a "bucket handle" or "flap" tear, or a complete or incomplete tear.

Symptoms of a torn meniscus

The most common sign of a meniscus tear is feeling like the knee pops, locks, catches, or is "giving out." Some people may hear or feel a popping sensation at the time of injury. Other common but less specific symptoms include:

• Pain: You may feel pain in your knee, especially when twisting or rotating it.
• Swelling: The knee may become swollen within hours or days of the injury.
• Stiffness: It may be hard to bend or straighten your knee.

The symptoms of a torn meniscus can vary depending on the severity of the tear. Severe tears often cause intense pain and swelling, and quickly limit knee movement. For milder tears, symptoms don't always show up right away but tend to develop slowly over time. Some people may experience no symptoms at all.

What causes meniscal tears?

Meniscal tears can result from both acute injuries and degenerative changes in the knee. Common acute causes include:

• Sudden movements: Twisting, pivoting, or turning quickly can tear the meniscus. This often happens in sports like soccer, basketball, football, and others that require quick stops and sudden changes in direction.
• Trauma: Direct impact to the knee, such as during a fall or accident, can also lead to a tear.

The natural aging process is a common cause of many types of chronic knee pain in older adults, including degenerative meniscal tears. Over time, cartilage becomes weaker and more prone to tearing, even with minor movements and minimal or no trauma.

Diagnosing a torn meniscus

To diagnose a torn meniscus, a doctor will ask about your symptoms and how the injury (if there was one) occurred. They will also perform a physical exam, checking for stability, tenderness, swelling, and range of motion in your knee.

Specific tests, like the McMurray test, involve moving your knee in certain ways to help identify the tear. Imaging tests can provide more detailed information. These include:

• X-rays: While they don't show soft tissues like the meniscus, x-rays can rule out other conditions, such as a fracture or osteoarthritis.
• Ultrasound: This test uses sound waves to produce images of the knee, which can help detect a tear or other soft tissue injuries.
• MRI: This imaging test uses magnetic fields to create detailed pictures of the knee, helping to identify the tear and its location. An MRI is the best test for finding small tears. However, it's usually not needed unless a meniscal tear is suspected, symptoms are significant, and surgery would be offered to repair a confirmed tear.

Treatment options for a torn meniscus

The treatment for a torn meniscus depends on factors like the tear's severity, size and location, and your activity level. Options range from conservative care (including pain relievers and exercises) to surgery. Small or incomplete meniscus tears may heal naturally depending on their location.

Nonsurgical treatments

If there's no severe pain, swelling, or major instability, you can often manage a meniscal tear through the following nonsurgical means.

• Rest your knee: Avoid activities like squatting, kneeling, twisting, running, or swimming with frog kicks until the pain and swelling go away.
• Ice and elevate: Ice your knee for 15 minutes every four to six hours for a few days and keep your leg elevated (especially if swelling is present).
• Use crutches: Use crutches if it hurts too much to put weight on your leg.
• Wear a knee brace: A brace may help if your knee feels weak or unstable.
• Take pain medications: Over-the-counter pain relievers including acetaminophen (Tylenol), and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) or naproxen (Aleve), can ease discomfort. These drugs can have side effects, so consult your doctor if you need to use them daily for more than a few days.

As the pain starts to improve, you can slowly resume physical activity. The focus should be on strengthening the muscles in the front of your thigh (your quadriceps) that support the knee joint. It can be helpful to work with a physical therapist to create a personalized exercise program.

If you have a degenerative meniscal tear along with osteoarthritis, your doctor may recommend a steroid injection to provide temporary pain relief.

Surgical treatments

If nonsurgical treatments don't work or the tear is severe, surgery might be needed. See your doctor if your symptoms persist despite following the nonsurgical treatment recommendations for three to four weeks. Your doctor may recommend an MRI if not done already, and refer you to an orthopedic surgeon to discuss your options. Surgical options include:

• Meniscus repair: Surgeons stitch the torn edges of the meniscus together. This option is best for younger patients or tears in areas with good blood supply.
• Meniscectomy: In this procedure, the damaged portion of the meniscus is removed to restore knee function.
• Meniscus replacement: This is an uncommon option in which donor tissue is used to replace the torn cartilage. Artificial meniscus implants are also being developed. Neither option has enough research yet to be widely available.

Physical therapy for a torn meniscus

Physical therapy plays a key role in recovery, whether you have surgery or not. A physical therapist will design a program to improve your knee strength, flexibility, and range of motion. Rehabilitation involves exercises to strengthen and improve the flexibility of the muscles around the knee, including the hamstrings, quadriceps, and calf. Exercises may include gentle stretches, strengthening moves, and balance training to help you regain full use of your knee and prevent future injuries.

A torn meniscus may disrupt normal walking patterns, so gait retraining may be helpful. A physical therapist evaluates your gait, provides guidance on walking correctly, and may recommend exercises or footwear adjustments to support recovery.