Torn Meniscus — Symptoms, Diagnosis, and Treatment

What are menisci and what do they do?

Each knee has two menisci—the inner (medial) and the outer (lateral). They are C-shaped fibrocartilage structures located between the femur and tibia, with essential roles: they act as shock absorbers with every step, stabilize the joint, distribute weight evenly across the articular surface, and nourish the cartilage.

Losing the meniscus (or part of it) is not a minor event—it accelerates cartilage wear and increases the long-term risk of osteoarthritis. That's why, whenever possible, repairing (suturing) the meniscus is preferred over removing it.

How does a meniscus tear occur?

In young people and athletes—usually through trauma: a sudden twist of the knee with the foot planted on the ground, a forced hyperflexion, or a side impact. Sports frequently involved: soccer, basketball, skiing, tennis.

In adults and the elderly—the meniscus becomes stiffer and more fragile with age. It can tear from minimal exertion: squatting, a sudden turn, getting up from a chair. This is called a degenerative tear and is often associated with knee osteoarthritis.

Symptoms

• Pain along the joint line—either inner (medial meniscus) or outer (lateral meniscus), worsened by deep flexion or rotation
• Swelling—can appear immediately (in acute tears) or over hours to days
• Joint locking—the sensation that the knee gets 'stuck' in a certain position and cannot be fully straightened
• A feeling of 'giving way'—the knee feels unsure, unstable
• Crepitus or popping sounds with movement

Diagnosis

Clinical examination—specific tests (McMurray, Apley) guide the diagnosis. An experienced orthopedist can accurately suspect a meniscus tear based on the clinical exam alone.

MRI (Magnetic Resonance Imaging)—confirms the diagnosis and shows the type, location, and size of the tear. It is essential for treatment planning.

X-ray—does not show the meniscus (which is a soft tissue), but is useful to assess if there is associated osteoarthritis.

Types of Tears

Not all meniscus tears are the same. The type of tear determines the treatment options:

Longitudinal tear—parallel to the circumference of the meniscus. Often repairable.

Radial tear—perpendicular to the circumference. More difficult to repair.

'Bucket-handle' tear—an extensive longitudinal tear where a fragment displaces. The classic cause of joint locking. Requires intervention.

Complex/degenerative tear—multiple tear patterns, common in the elderly. Usually not repairable.

Location matters: the peripheral area (vascularized, the 'red zone') heals better than the central area (avascular, the 'white zone').

Treatment

Conservative treatment—possible for small, stable tears without mechanical symptoms (locking). Includes: rest, ice, anti-inflammatory medication, physical therapy. Monitored at intervals.

Arthroscopy—meniscus repair—the meniscus is repaired with special sutures. Advantage: the meniscus is preserved, protecting the cartilage long-term. Disadvantage: recovery is longer (4-6 weeks of protection). Possible for peripheral, longitudinal tears in young patients.

Arthroscopy—partial meniscectomy—only the torn, unstable fragment is removed. As much healthy meniscus as possible is preserved. Quick recovery (immediate walking, return to sport in 4-6 weeks). It is the most common arthroscopic procedure.

→ Learn more about knee arthroscopy

What happens if you don't treat a torn meniscus?

It depends on the type of tear. Small, stable tears without mechanical symptoms can be successfully managed conservatively. But tears with locking, instability, or persistent pain, if left untreated, can damage the articular cartilage, accelerate the onset of osteoarthritis, and cause repeated episodes of locking and swelling.

Not all meniscus tears require surgery—but all require evaluation.

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