Meniscal tear

Knee pain after a poorly controlled pivot or a simple squatting movement. Meniscus tears affect athletes as well as people over the age of 40. The good news is that in most cases, physical therapy offers results equivalent to surgery, without the associated risks.

Menisci play an essential role as shock absorbers in the knee. A tear can occur suddenly during trauma or develop gradually with wear and tear. Importantly, up to 76% of people with a degenerative tear have no pain.¹ This guide explains how to recognize a meniscus tear, understand treatment options, and know when to seek medical attention. To better understand all the causes of pain in this area, see our comprehensive guide to knee pain.

What is a meniscus tear?

A meniscus tear is an injury to one or both of the knee's menisci, the crescent-shaped tissues that act as cushions between the femur and tibia. This injury can occur suddenly as a result of 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 functions that are essential for the proper functioning of your joint.

The medial meniscus is more commonly affected because it is less mobile and more exposed to twisting forces. Tears can take different forms: 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?

Meniscal tears occur in two main ways: through acute trauma, often involving rotation of the knee with the foot fixed to the ground, or through progressive degeneration linked to normal wear and tear with age.

Traumatic tear. It occurs during a pivoting movement with the foot planted on the ground, a direct fall on the knee, or a lateral impact. Sports involving rapid changes of direction (soccer, basketball, skiing) are particularly risky. The injury is often accompanied by a "popping" sensation and immediate pain. Degenerative tear. It develops gradually as the menisci wear down 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 degenerative tears: a body mass index greater than 25, a job that requires squatting or kneeling for more than one hour per day, and being male.²

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

How can you recognize the symptoms of a meniscus tear?

Typical symptoms include pain on the inside or outside of the knee, aggravated by rotation, squatting, or climbing stairs. Swelling may occur, and some people report a feeling of locking or catching in the knee.

For a traumatic tear:

- Sudden pain at the moment of injury - Swelling that develops within 24 hours - Difficulty putting weight on the leg - Feeling of locking or instability - Increased pain when bending the knee or squatting

For a degenerative tear:

- Gradual onset of pain - Pain localized on the inner side of the knee - Discomfort when pivoting or participating in sports activities - Stiffness after prolonged sitting

An important point to remember: up to 76% of people with a degenerative meniscus tear have no pain.¹ The presence of a tear on an imaging scan does not automatically mean that it is the cause of your pain.

These symptoms require professional evaluation. Let's see how the diagnosis is made.

How is a meniscus tear diagnosed?

The diagnosis is based primarily on your symptoms and a clinical examination performed by a physical therapist or doctor. An MRI scan can confirm the diagnosis in some cases, but it does not change the treatment plan in most situations.

The clinical evaluation includes several specific tests:

Provocation tests. The McMurray test and the Apley test apply rotation to the knee to reproduce the symptoms. Pain or a clicking sound during these maneuvers suggests meniscal damage. Mobility assessment. The physical therapist checks the range of motion in the knee and identifies any movements that cause pain. Stability tests. Other structures (cruciate ligaments, collateral ligaments) are evaluated to rule out associated injuries.

The combination of several clinical tests provides a high degree of diagnostic accuracy.³ MRI is reserved for cases where the diagnosis remains uncertain or when surgery is being considered. In most cases, imaging does not change the initial recommendation: start with physical therapy.

Now that the diagnosis has been made, let's see when to consult a doctor.

When should you see a physiotherapist for a meniscus tear?

Consult a physical therapist if you have knee pain with the symptoms described above, especially if the pain has persisted for more than a few days or is affecting your daily activities. You do not need a doctor's referral to consult a physical therapist.

Consult quickly if you have:

- Sudden pain after trauma to the knee - Significant swelling of the knee - Difficulty putting weight on the leg - A feeling of locking or instability

An evaluation is also recommended if:

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

Your physical therapist can assess your condition, make a diagnosis, and suggest a suitable treatment plan. If your situation requires a medical consultation or imaging, they will refer you to the appropriate resources.

Now let's take a look at what physiotherapy treatment involves.

What physiotherapy treatments are available for a meniscus tear?

Physiotherapy treatment aims to reduce pain, restore mobility and strength to the knee, and enable you to resume your activities. The approach is tailored to the type of tear, its severity, and your goals.

The initial assessment includes:

- Analysis of your joint mobility - Assessment of the quality of your movements - Knee strength and stability tests - Checking for nerve slippage

Interventions may include:

Physical therapy produces 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 science has to say.

Is surgery necessary for a meniscus tear?

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

What research tells us:

For traumatic tears, surgery may offer a slight short-term advantage (3 to 6 months). In the long term, the results are similar between surgery and physical therapy^.

For degenerative tears, physical therapy is as effective as surgery. Meta-analyses confirm that arthroscopy does not offer any greater benefit than conservative treatment.^5,6

An important factor to consider: Meniscus surgery increases the risk of developing osteoarthritis of the knee later in life. A meniscectomy (partial removal of the meniscus) alters the distribution of forces in the joint and accelerates cartilage wear.

Surgery remains indicated in certain specific situations: persistent mechanical blockage of the knee, unstable tear in a high-level athlete with specific performance goals, or failure of well-conducted 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 tailored to meniscus tears: Compression. Use a compression bandage or light taping around the knee to control initial swelling. Gradual loading. Start walking again and gradually put weight on your leg, without significantly increasing the pain. Wait until you are no longer limping before increasing the length of your walks. Appropriate cardiovascular activity. Light to moderate cardio exercise without pain promotes healing:

- Stationary bike (adjust the seat height to limit bending) - Swimming or aqua fitness - Walking on flat ground

Temporarily avoid:

- Deep squats - Prolonged kneeling or crouching positions - Quick pivots and changes of direction

If you see no improvement after 10 days, consult a physical therapist.

Key points to remember

- Meniscal tears can be traumatic or degenerative - 76% of degenerative tears cause no pain - Physical therapy offers results equivalent to surgery in most cases - MRI generally does not change the initial treatment plan - Surgery increases the risk of osteoarthritis in the long term - You do not need a prescription to see a physical therapist

If you would like to have your condition assessed and receive a personalized treatment plan, our physical therapists can help you regain a functional, 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

2. 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

3. 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

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

5. 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

6. 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