Meniscal tear

Knee pain after an uncontrolled pivot or a simple squat movement. Meniscus tears affect athletes as well as people over 40. The good news is that in most cases, physiotherapy offers results equivalent to surgery, without the associated risks.

Menisci play a crucial role as shock absorbers in the knee. A tear can occur suddenly due to trauma or develop gradually with wear and tear. Important fact: up to 76% of people with a degenerative tear experience no pain.¹ This guide explains how to recognize a meniscal tear, understand treatment options, and know when to seek professional advice. To better understand all the causes of pain in this area, consult our complete guide to knee pain.

What is a Meniscus Tear?

A meniscus tear is an injury to one or both menisci of the knee. These crescent-shaped tissues act as cushions between the thigh bone (femur) and the shin bone (tibia). This injury can occur suddenly due to trauma or develop gradually with age.

The knee contains two menisci: the inner (medial) meniscus and the outer (lateral) meniscus. These fibrocartilaginous structures perform several essential functions for the proper working of your joint.

The inner meniscus is more commonly affected because it is less mobile and more exposed to twisting forces. Tears can appear in various forms, such as horizontal, vertical, bucket-handle, or complex.

Now that you understand the anatomy, let's look at what causes these tears.

What causes a meniscus tear?

Meniscus tears typically happen in two main ways: either from a sudden injury, often involving a twisting motion of the knee while the foot is planted, or from gradual wear and tear as you age.

Traumatic tear. It occurs during a pivoting movement with the foot planted on the ground, a direct fall onto the knee, or a lateral impact. Sports with rapid changes in direction (soccer, basketball, skiing) are particularly at risk. The injury is often accompanied by a "pop" sensation and immediate pain. Degenerative tear. It develops gradually with the wear and tear of the menisci over the years. The meniscal tissue becomes less elastic and more fragile. A simple squatting movement or prolonged crouching position can then cause a tear.

Certain factors increase the risk of a degenerative tear: a body mass index (BMI) over 25, a job requiring squatting or kneeling positions for more than one hour per day, and male gender.²

These mechanisms lead to specific symptoms. Let's see how to recognize them.

How to recognize the symptoms of a meniscus tear?

Typical symptoms include pain on the inside or outside of the knee, which gets worse with twisting, squatting, or climbing stairs. Swelling may occur, and some people describe a feeling of their knee locking or catching.

For a traumatic tear:

• Sudden pain at the time of injury
• Swelling that develops within 24 hours
• Difficulty putting weight on the leg
• Sensation of locking or instability
• Increased pain when bending the knee or doing a squat

For a degenerative tear:

• Gradual onset of pain
• Pain localized on the inner side of the knee
• Discomfort during pivots or sports activities
• Stiffness after prolonged sitting

An essential point to remember: up to 76% of people with a degenerative meniscal tear experience no pain.¹ The presence of a tear on imaging does not automatically mean it is the cause of your pain.

These symptoms require a professional evaluation. Let's look at how a diagnosis is made.

How is a meniscus tear diagnosed?

Diagnosis is primarily based on your symptom history and a physical examination performed by a physiotherapist or doctor. While an MRI can confirm the diagnosis in some cases, it often doesn't change the treatment plan for most situations.

The clinical evaluation involves several specific tests:

Provocation tests. The McMurray test and Apley test involve rotating the knee to reproduce symptoms. Pain or a clicking sound during these maneuvers suggests a meniscus injury. Mobility assessment. The physiotherapist checks the knee's range of motion and identifies movements that cause pain. Stability tests. Other structures (cruciate ligaments, collateral ligaments) are evaluated to rule out associated injuries.

Combining several clinical tests offers high diagnostic accuracy.³ MRI is reserved for cases where the diagnosis remains uncertain or when surgery is being considered. In the majority of cases, imaging does not change the initial recommendation: start with physiotherapy.

Now that the diagnosis is established, let's discuss when to seek help.

When should you see a physiotherapist for a meniscus tear?

Consult a physiotherapist if you experience knee pain along with the symptoms described above, especially if the pain has lasted for more than a few days or is impacting your daily activities. You do not need a doctor's referral to see a physiotherapist.

Consult a professional quickly if you have:

• Sudden pain after a knee injury
• Significant knee swelling
• Difficulty putting weight on the leg
• A sensation of locking or instability

An assessment is also recommended if:

• Your knee pain has lasted for more than 10 days
• The pain limits your sports or daily activities
• You have already been diagnosed with a meniscal tear

Your physiotherapist can assess your condition, provide a diagnosis, and suggest a personalized treatment plan. If your situation requires a doctor's visit or imaging, they will guide you to the appropriate resources.

Now, let's look at what physiotherapy treatment involves.

What physiotherapy treatments are available for a meniscus tear?

Physiotherapy treatment aims to reduce pain, restore knee mobility and strength, and help you return to your activities. The approach is personalized based on the type of tear, its severity, and your goals.

The initial assessment includes:

• Analysis of your joint mobility
• Evaluation of your movement quality
• Knee strength and stability tests
• Nerve gliding assessment

Interventions may include:

Physiotherapy yields results equivalent to surgery for most meniscal tears.^4,5 Individuals who do not respond to conservative treatment after 8 to 12 weeks may then consider other options.

A common question concerns the necessity of surgery. Let's see what the science says.

Is surgery necessary for a meniscal tear?

In most cases, surgery is not necessary. Studies show that physiotherapy offers results equivalent to surgery for both degenerative and traumatic tears, in both the short and long term, without the risks associated with the procedure.

What research tells us:

For traumatic tears, surgery may offer a slight short-term advantage (3 to 6 months). In the long term, outcomes are similar between surgery and physiotherapy.⁴

For degenerative tears, physiotherapy is as effective as surgery. Meta-analyses confirm that arthroscopy does not provide superior benefits compared to conservative treatment.^5,6

An important factor to consider: meniscus surgery increases the risk of developing knee osteoarthritis later on. A meniscectomy (partial removal of the meniscus) changes how forces are distributed in the joint and speeds up cartilage wear.

Surgery remains indicated in certain specific situations: persistent mechanical knee locking, an unstable tear in a high-level athlete with specific performance goals, or failure of well-managed conservative treatment.

While waiting for your appointment or in addition to treatment, certain measures can help.

What can I do at home for a meniscus tear?

Temporarily reduce movements that cause significant pain, then gradually reintroduce them. For a recent traumatic tear, follow the PEACE and LOVE principles to optimize healing during the first few days.

Practical advice for a meniscus tear: Compression. Use a compression bandage or light taping around the knee to control initial swelling. Gradual weight-bearing. Gradually resume walking and putting weight on your leg without significantly increasing pain. Wait until you are no longer limping before increasing the duration of your walks. Adapted cardiovascular activity. Light to moderate pain-free cardio activity promotes healing:

• Stationary bike (adjust seat height to limit flexion)
• Swimming or aqua fitness
• Walking on flat ground

Temporarily avoid:

• Deep squats
• Prolonged kneeling or squatting positions
• Pivots and rapid changes of direction

If you don't see any improvement after 10 days, consult a physiotherapist.

Key takeaways

• A meniscal tear can be traumatic or degenerative
• 76% of degenerative tears cause no pain
• Physiotherapy offers results equivalent to surgery in most cases
• MRI generally does not change the initial treatment plan
• Surgery increases the long-term risk of osteoarthritis
• You do not need a prescription to see a physiotherapist

If you would like an assessment of your condition and a personalized treatment plan, our physiotherapists can help you regain a functional and pain-free knee.

Sources

1. Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008;359(11):1108-1115. doi:10.1056/NEJMoa0800777

1. Snoeker BA, Bakker EW, Kegel CA, Lucas C. Risk factors for meniscal tears: a systematic review including meta-analysis. J Orthop Sports Phys Ther. 2013;43(6):352-367. doi:10.2519/jospt.2013.4295

1. Décary S, Fallaha M, Frémont P, et al. Diagnostic validity of combining history elements and physical examination tests for traumatic and degenerative symptomatic meniscal tears. PM R. 2018;10(5):472-482. doi:10.1016/j.pmrj.2017.10.009

1. Kise NJ, Risberg MA, Stensrud S, et al. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ. 2016;354:i3740. doi:10.1136/bmj.i3740

1. Brignardello-Petersen R, Guyatt GH, Buchbinder R, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open. 2017;7(5):e016114. doi:10.1136/bmjopen-2017-016114

1. Petersen W, Achtnich A, Lattermann C, Kopf S. The treatment of non-traumatic meniscus lesions. Dtsch Arztebl Int. 2015;112(42):705-713. doi:10.3238/arztebl.2015.0705