Meniscus Tear

adrian wong physio

Article by J. Miller, A. Wong

What is a Meniscus?

meniscus tear

Your knee meniscus is fibrocartilage that separates thigh bone (femur) from your shin bone (tibia). It is commonly referred to as your "cartilage". Each knee joint has a medial meniscus and a lateral meniscus.

Your knee meniscus has unique shapes. They are a wedged, kidney shape.

Your meniscus act like a wedge to assist with the rotational stability created by the anterior cruciate ligament. The meniscus also acts as a shock absorber. As we walk, run, and jump the knee absorbs tremendous forces. Your meniscus helps to absorb these forces so that the bone surfaces are not damaged. 

The amount of force increases exponentially as the speed of movement increases from walking to running to jumping. Your meniscus helps to disperse the compressive forces over the entire knee rather than isolating them.

What is a Meniscus Tear?

In the younger population, your knee meniscus is usually torn traumatically, by twisting on a slightly flexed knee.

The traumatic type of meniscal injuries is most often sports-related. The meniscus can be torn anterior to posterior, radially (parrot beak), or can have a bucket handle appearance.

In the older adult, the tear may be due to a natural age-related degeneration of the meniscus or a rough arthritic femoral bone surface tearing into the softer meniscus. In this case, surgery may be required to attend to both the meniscal repair and to repair the damaged joint surface.

Depending on the type of meniscus tear, meniscus repair may be complicated. A large meniscus tear that is inadequately treated may cause premature degenerative bony (arthritis) changes.

How Do You Know if you have a Torn Meniscus in Your Knee?

Torn meniscus symptoms normally start with with a mechanism of injury that involves a history of a painful twist occurring on a slightly flexed knee. However, degenerative meniscus tears can slowly present with signs and symptoms.

Signs & Symptoms of a Meniscus Tear

You may also experience clicking, popping, or locking of the knee. These symptoms are usually accompanied by pain along the knee joint line and a joint swelling.

Clinical examination may reveal tenderness along the knee joint line. You will usually notice it is painful to squat.

Your physiotherapist or doctor will use McMurray's test and other clinical tests to confirm a meniscus tear diagnosis. 

X-rays or MRI?

A MRI scan is the most accurate non-invasive test to confirm a meniscus tear. X-rays do not show a meniscus tear. 

Can a Meniscus Tear Heal on its Own?

Meniscus tear healing is dependent upon your meniscal blood supply, which is limited. Your meniscus receives its nutrition from blood and synovial fluid within the joint capsule. Your meniscus has two distinct regions that affect their ability to heal. We call these the Red Zone and the White Zone

meniscal tear

Red Zone

The red zone has blood supply, which means they can heal naturally. A "longititudinal tear" is an example of a meniscal tear htta is likely to heal naturally. The outer edge of the meniscus has blood supply from the synovial capsule. Lateral meniscal tears may heal without the need for surgery.

White Zone

The white zone doesn’t have a blood supply and won’t heal naturally. The inside of the meniscus gets its nutrition from the synovial fluid. Due to this, tears of the inner meniscus do not usually heal due to a lack of blood supply to trigger an inflammatory response. These injuries often require surgery to remove the torn component.

What Happens if you Leave a Torn Meniscus Untreated?

An untreated meniscus tear can deteriorate and may come loose within the knee joint. This can result in knee locking or giving way. Untreated meniscus tears can also increase in tear size and extend the damaged area of the meniscus.

Treatment Options for a Knee Meniscus Tear

A small meniscus tear, or a tear in the red zone, will usually respond quickly to physiotherapy treatment.

One of the major roles of your meniscus is shock-absorption. Luckily, the other vital shock absorbers around your knee are your muscles. Researchers have discovered that if you strengthening your leg muscles, your bone stresses will reduce as your muscle strength improves and your knee becomes more dynamically stable.

Your physiotherapy treatment will aim to: 

  • Reduce pain and inflammation. 
  • Normalise joint range of motion. 
  • Strengthen your knee: esp quadriceps (esp VMO) and hamstrings. 
  • Strengthen your lower limb: calves, hip and pelvis muscles. 
  • Improve patello-femoral (knee cap) alignment. 
  • Normalise your muscle lengths Improve your proprioception and balance Improve your technique and function eg walking, running, squatting, hopping and landing. 
  • Minimise your chance of re-injury. 

Meniscal injuries are commonly associated with other knee injuries, which need to be treated in conjunction with your meniscal tear.

meniscus

How Long Does It Take For a Meniscus to Heal Without Surgery?

Your meniscal tear will commonly take up to six or eight weeks to fully heal if the injury is in the red zone. As mentioned previously, some meniscal tears will require surgery. Your physiotherapist will guide you as to what is most likely for your knee injury.

It is important to avoid activities and exercises that place excessive stress through your meniscus and further delay your healing. In some cases, your physiotherapist may advise you to keep weight off your knee. In this instances, crutches may be recommended. Everyone is different, so be guided by your physiotherapist.

Will You Require Surgery for a Meniscus Injury?

Most surgeons will recommend a few weeks of physiotherapy treatment prior to contemplating surgery.  

Pre-operative physiotherapy has two main benefits:

  • Successfully rehabilitating your knee injury without the need for surgery. 
  • Strengthening your knee to better prepare you for your post-operative rehabilitation. 

If surgery is required, surgery is usually performed arthroscopically (via a fibre-optic camera about the size of a pencil) to either resect (remove) the torn fragment or repair (stitch) a tear in the outer zone. 

torn meniscus

Generally, the best treatment option is to repair the torn meniscus and save as much of the shock absorber as possible. This will leave you with near "normal" structures and decrease the likelihood of degenerative arthritic changes in later life.

Post-Surgical Physiotherapy for Meniscal Injuries

Resected Meniscal Tears

Physiotherapy rehabilitation for resected meniscal tears can normally be reasonably aggressive, targeting early return to function. You will be progressed through rehabilitation as your pain and swelling allow. Most arthroscopic patients can return to normal function within 3 to 6 weeks. 

Post-Meniscal Repair

Rehabilitation after a meniscus repair is usually different than a resection due to healing time require where a meniscus has been stitched. Most surgeons will have you non-weight bearing for 4 to 8 weeks to allow the meniscus to heal before commencing weight-bearing exercises.

Physiotherapy rehabilitation should focus on early mobilisation of the knee (tibiofemoral) and kneecap (patellofemoral) joints, plus strengthening of your quadriceps, hamstrings and leg muscles.

Your treatment guidelines will be similar to the nonoperative approach taking into consideration the findings and operative procedures performed. For more specific information, please ask your physiotherapist. 

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FAQs about Knee Meniscus Tears

Can You Walk on a Meniscal Tear?

A meniscus tear usually produces a localised knee pain. The pain may be present on weight-bearing and any walking in this instance should be avoided. You should be advised to utilise crutches. In these cases, walking is not advisable for a meniscus tear. 

In less severe instances, meniscal pain is worse during twisting or squatting motions. If this is the case straight-line and predictable surface walking can normally be okay. But, walking on unstable or loose surfaces eg bushwalking should be avoided.

  • Common Physiotherapy Treatment Techniques
  • What is Pain?
  • Physiotherapy & Exercise
  • When Should Diagnostic Tests Be Performed?
  • Can Kinesiology Taping Reduce Your Swelling and Bruising?
  • How Can You Prevent a Future Leg Injury?
  • How Do You Improve Your Balance?
  • How Much Treatment Will You Need?
  • Runners: How to Reduce Your Knee Stress
  • Sports Injury? What to do? When?
  • What are the Common Massage Therapy Techniques?
  • What are the Early Warning Signs of an Injury?
  • What Can You Do To Help Arthritis?
  • What is a TENS Machine?
  • What is Chronic Pain?
  • What is Nerve Pain?
  • What is Sports Physiotherapy?
  • What's the Benefit of Stretching Exercises?
  • When Can You Return to Sport?
  • Why Kinesiology Tape Helps Reduce Swelling and Bruising Quicker
  • Call PhysioWorks

    Book Online

    Knee Pain

    Common Causes

    knee pain

    Knee Ligament Injuries

    Knee Meniscus

    Knee Tendonitis

    Muscle Injuries

    Children's Knee Conditions

    Other Knee-Related Conditions

    Knee Surgery

    Common Treatments for a Knee Meniscus Tear

  • Early Injury Treatment
  • Avoid the HARM Factors
  • Soft Tissue Injury? What are the Healing Phases?
  • Acupuncture and Dry Needling
  • Sub-Acute Soft Tissue Injury Treatment
  • Active Foot Posture Correction Exercises
  • Gait Analysis
  • Biomechanical Analysis
  • Balance Enhancement Exercises
  • Proprioception & Balance Exercises
  • Agility & Sport-Specific Exercises
  • Medications?
  • Heel Cups
  • Orthotics
  • Soft Tissue Massage
  • Brace or Support
  • Dry Needling
  • Electrotherapy & Local Modalities
  • Heat Packs
  • Joint Mobilisation Techniques
  • Kinesiology Tape
  • Knee Arthroscopy
  • Prehabilitation
  • Strength Exercises
  • Stretching Exercises
  • Supportive Taping & Strapping
  • TENS Machine
  • Video Analysis
  • Yoga
  • Helpful Products for a Meniscus Tear

    Knee Mensical Injuries


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    Last updated 05-Jul-2019 01:15 PM

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