Meniscus Tears
Background
The menisci are two C-shaped pieces of cartilage between the thighbone and shinbone. They help absorb force, distribute weight across the knee, and support joint stability. Each knee has a medial meniscus on the inside and a lateral meniscus on the outside.
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A meniscus can tear suddenly during a twist or pivot, often while playing sports. Tears can also develop gradually as the tissue changes with age. The location and pattern of a tear matter because they affect whether it can heal after repair. Whenever possible, treatment aims to preserve healthy meniscus tissue.
Symptoms
Patients with a meniscus tear may experience:
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Pain along the inside or outside of the knee
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Swelling, which may develop gradually after an injury
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Pain with squatting, twisting, or pivoting
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Catching, clicking, or a feeling that something is moving inside the knee
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Difficulty fully bending or straightening the knee
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A knee that becomes stuck and cannot fully straighten, sometimes called locking
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A true locked knee, especially after a recent injury, should be evaluated promptly because a displaced tear may be blocking motion
Diagnosis
Diagnosis begins with a history of the injury and an examination of knee motion, swelling, stability, and tenderness along the joint line. X-rays do not show a meniscus tear, but they help assess arthritis and other causes of knee pain. An MRI can show the tear’s location and pattern, along with associated injuries of the knee.
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An MRI finding does not automatically mean surgery is needed. Treatment depends on whether the tear matches the patient’s symptoms, how the knee functions, and the condition of the surrounding cartilage.
Treament Options
Degenerative Tears
Degenerative tears develop gradually and may occur alongside knee arthritis. Physical therapy is usually the first treatment, with a focus on improving strength and knee function. Activity changes, medication when appropriate, and occasionally an injection may also help with symptoms.
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If pain remains limiting despite treatment, surgery may be discussed for selected patients. The amount of arthritis is an important part of that decision because surgery on the meniscus may not address pain coming primarily from arthritis.
Repairable Tears
Some tears, particularly those in areas with better blood supply and healthy tissue, can be repaired with sutures. Meniscus repair preserves the tissue that protects the knee, but it requires time for the tear to heal. The repair method and rehabilitation plan depend on the tear’s location and pattern.
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When a tear cannot be repaired and continues to cause symptoms, a partial meniscectomy may be considered. This removes only the unstable portion of the meniscus while preserving as much healthy tissue as possible.
Bucket-Handle Tears
A bucket handle tear is a large tear in which a portion of the meniscus flips into the center of the knee. It can prevent the knee from fully straightening. A displaced tear that blocks motion may need more prompt surgical evaluation. When the tissue is suitable, the goal is to move it back into position and repair it.
Mensical Root Tears
The meniscus root anchors the meniscus to the bone. A root tear can prevent the meniscus from distributing force normally, placing greater stress on the knee cartilage. Treatment depends on symptoms, the quality of the meniscus tissue, alignment, and the amount of arthritis.
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For an appropriate patient without advanced arthritis, root repair may be recommended to restore the attachment. Rehabilitation after root repair generally includes a period of restricted weight bearing to protect the healing tissue. When advanced arthritis is present, nonsurgical care is often more appropriate.
Return to Sport
The timeline depends on the tear and its treatment. After a partial meniscectomy, many patients return to sports in approximately four to six weeks. After a meniscus repair, return to sport commonly takes around four to six months; root repairs and other complex tears may require a more cautious progression. Clearance depends on swelling, strength, knee motion, and the ability to run, jump, and change direction comfortably.