Protecting Your Knee.
Supporting Every Movement.
The meniscus plays an essential role in protecting the knee joint, distributing loads, absorbing shock, and maintaining joint stability. Discover how it works, why meniscus injuries occur, and which treatment options are available.
What Is the Meniscus and What Does It Do?
The menisci are C-shaped fibrocartilaginous structures located between the articular surfaces of the thigh bone (femur) and shin bone (tibia) within the knee joint. Each knee contains two menisci: the medial meniscus on the inner side and the lateral meniscus on the outer side.
The menisci act as natural shock absorbers within the knee. They are attached to the upper surface of the tibia and remain in contact with the articular surface of the femur.
These structures perform several important functions, including distributing forces across the knee joint, reducing stress on the articular cartilage, supporting cartilage nutrition, improving joint congruence, contributing to proprioception (the body’s sense of joint position), and enhancing knee stability.
Because of these essential functions, preserving the menisci and preventing meniscal injuries are extremely important for long-term knee health.
The menisci receive nutrients through both absorption from the synovial fluid and their blood supply. However, blood vessels primarily supply the outer one-third of the meniscus.
This difference in blood supply is particularly important when determining treatment options for meniscal tears. Tears located in well-vascularized areas generally have a greater potential for healing than those in regions with limited blood supply.
How and Why Do Meniscus Tears Occur?
The causes of meniscus tears vary depending on the patient’s age and activity level.
In younger individuals, meniscus tears commonly occur as a result of sports injuries, excessive strain, or trauma. Sudden twisting movements of the knee, particularly when the foot remains firmly planted on the ground, may cause a meniscal tear.
In older adults, the meniscal tissue gradually becomes weaker due to age-related degenerative changes. As a result, even a minor fall or an ordinary movement may cause a tear.
These age-related injuries are known as degenerative meniscus tears and may be more difficult to repair because of changes in tissue quality.
The medial meniscus is less mobile than the lateral meniscus, making it more susceptible to certain types of injury.
What Are the Symptoms of a Meniscus Tear?
A meniscus tear can cause a variety of symptoms depending on the location, size, and severity of the injury.
Common symptoms include:
- Sharp or stabbing pain in the knee
- Restricted knee movement
- Pain when climbing or descending stairs
- A locking or catching sensation when bending or straightening the knee
- Swelling around the knee joint.
- Difficulty walking or moving the knee
- Clicking or popping sounds during knee movement
- A sensation that something is catching inside the joint
In patients with long-standing meniscus tears, pain may occur during everyday activities, even when swelling is absent.
Some patients may also experience persistent restriction of knee movement.
How Is a Meniscus Tear Diagnosed?
Diagnosis begins with a detailed assessment of the patient’s medical history, symptoms, and a physical examination of the knee.
During the examination, the physician evaluates the location of pain, tenderness, range of motion, and specific findings associated with meniscal injuries.
Pain along the inner side of the knee may suggest a medial meniscus tear, while pain along the outer side may indicate a lateral meniscus tear.
Clinical examination is one of the most important steps in diagnosing a meniscus tear.
Magnetic resonance imaging (MRI) can provide additional information about the location, size, and type of tear.
MRI is also useful for identifying associated injuries, such as cartilage damage or ligament injuries.
However, not every abnormal finding reported as a meniscus tear on MRI necessarily represents the cause of the patient’s symptoms.
For this reason, treatment decisions should be based on a comprehensive assessment of the patient’s history, physical examination, and imaging findings.
Over time, certain meniscal injuries may contribute to secondary osteoarthritis of the knee. However, some tears, particularly degenerative tears, may become less symptomatic without surgical intervention.
What Are the Treatment Options for a Meniscus Tear?
The treatment of a meniscus tear depends on several factors, including the patient’s age, activity level, symptoms, and the type, size, and location of the tear.
Not every meniscus tear requires surgery.
In patients with small, stable tears and mild symptoms, particularly older individuals with degenerative tears, conservative treatment may be recommended initially.
Non-surgical treatment options may include physical therapy, muscle-strengthening exercises, activity modification, and appropriate pain management.
For younger and physically active patients with larger, unstable, or potentially repairable tears, arthroscopic surgery may be considered.
The decision to perform surgery should take into account the patient’s symptoms, functional limitations, tear characteristics, and response to conservative treatment.
Arthroscopic Meniscus Surgery
Arthroscopic surgery is a minimally invasive procedure performed through small incisions at the front of the knee.
A small camera and specialized surgical instruments are inserted into the joint, allowing the surgeon to examine the meniscus and other internal knee structures.
The procedure helps confirm the diagnosis and, when appropriate, allows treatment of the damaged meniscal tissue.
The primary goal of meniscus surgery is to preserve as much healthy meniscal tissue as possible.
Depending on the characteristics of the tear, treatment may involve meniscus repair or partial meniscectomy.
Meniscus repair is generally preferred when the tear’s location, tissue quality, and configuration offer a reasonable chance of healing.
When the damaged tissue cannot be repaired, the unstable portion may need to be removed through partial meniscectomy.
Complex degenerative tears, chronic tears, and severely damaged meniscal tissue may not always be suitable for repair.
However, whenever possible, preserving the meniscus is important because excessive loss of meniscal tissue increases the risk of developing knee osteoarthritis in the future.
For this reason, repair is particularly considered in younger patients with acute, repairable meniscus tears.
What Determines the Success of Meniscus Repair?
The success of meniscus repair depends on several factors, including:
The surgical technique used
The location and characteristics of the tear
The time between injury and surgery
The patient’s age and activity level
The quality of the meniscal tissue
Compliance with postoperative rehabilitation
Early repair of suitable meniscus tears, followed by appropriate rehabilitation, may improve the likelihood of successful healing.
Clinical studies have reported meniscus repair success rates of approximately 65%–85%, although outcomes vary depending on the type of tear, surgical technique, and how success is defined.
Following meniscus repair, weight-bearing on the operated leg may need to be restricted for a period of time.
The duration of these restrictions depends on the size and location of the tear, the repair technique, and the surgeon’s postoperative rehabilitation protocol.
What Are the Advantages of Knee Arthroscopy?
Knee arthroscopy is commonly preferred because it requires only small incisions and causes minimal damage to the surrounding soft tissues.
Compared with traditional open surgery, potential advantages include:
Less Postoperative Pain: Smaller incisions and reduced tissue disruption may result in less postoperative discomfort.
Greater Comfort During Recovery: The minimally invasive approach may provide a more comfortable postoperative experience.
Shorter Hospital Stay: Many arthroscopic procedures can be performed as day-case surgery.
Lower Risk of Wound Complications: Smaller incisions may help reduce certain wound-related complications.
Earlier Return to Daily Activities: Depending on the procedure, patients may resume work and routine activities sooner.
Less Visible Scarring: Small incisions generally result in smaller surgical scars.
Minimal Soft Tissue Damage: Healthy tissues surrounding the knee can be preserved while the affected structures are treated.
Recovery time varies significantly depending on whether the procedure involves meniscus repair, partial meniscectomy, or additional ligament or cartilage surgery.
Why Do I Still Have Symptoms After Arthroscopic Meniscus Surgery?
Some patients may continue to experience knee pain, swelling, or restricted movement following arthroscopic surgery for a meniscus tear.
Persistent symptoms may occur for several reasons.
Residual or Recurrent Meniscus Tear: Part of the original tear may remain symptomatic, or a new tear may develop.
Other Knee Conditions: Pain may be caused by problems unrelated to the meniscus, such as plica syndrome, ligament injuries, or cartilage damage.
Incomplete Recovery: The patient may still be in the early stages of postoperative healing.
Insufficient Rehabilitation: Inadequate physical therapy or muscle strengthening may contribute to persistent symptoms.
Re-tear After Meniscus Repair: A previously repaired meniscus may tear again, requiring further evaluation.
In some patients, pre-existing cartilage degeneration or osteoarthritis may also contribute to persistent knee pain after surgery.
If symptoms continue or return after arthroscopy, patients should consult their orthopedic specialist for a detailed clinical assessment.
Additional imaging or diagnostic tests may be recommended when necessary to identify the underlying cause and determine the most appropriate treatment approach.
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