Meniscal tear

Expert reviewer, Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
Next review due December 2023

A meniscal tear is an injury to a part of your knee called the meniscus and is a common injury. The menisci are two crescent-shaped pads of thick, rubbery shock-absorbing cartilage in your knee joint. They lie between your thigh bone (femur) and your shin bone (tibia).

About meniscal tears

You have one meniscus on each side of your knee – the medial meniscus on the inside and the lateral meniscus on the outside. Your menisci act like shock absorbers, absorbing the impact of your upper leg on your lower leg. They also help to stabilise your knee joint and keep the movements of your knee smooth.

Meniscal tears often happen when you play sports, but you can also get them as a result of wear and tear as you get older. When people talk about ‘torn cartilage’ in their knee they usually mean a meniscus injury. They’re given different grades depending on how severe an injury it is. If your injury is severe, it’s possible you might damage other parts of your knee as well as your meniscus. For instance, you might sprain or tear a ligament in your knee such as your anterior cruciate ligament.

Causes of meniscal tears

In younger people, meniscal tears are usually caused by twisting your knee. This often happens when playing sport, for instance football or basketball. In older people, the menisci can become worn down and tears can result from more minor injuries, such as twisting awkwardly when you stand up. These are called degenerative tears.

Symptoms of meniscal tears

You might feel a ‘pop’ if you tear your meniscus. Many people find they can still walk on their injured knee, but it might become gradually stiffer over the next day or so. Other symptoms include:

• pain in your knee, which can vary in severity – the pain might only be mild, severe, or the pain may come and go
• swelling – this usually happens several hours after you injure your meniscus
• a feeling that your knee is catching or locking, usually when it’s bent – you may notice it clicking
• your knee feeling unstable and that it’s going to give way
• not being unable to bend and extend your knee fully
• your knee feeling tender along the line of the joint

Self-help for meniscal tears

If you injure your knee, you should follow the POLICE procedure to manage any type of soft tissue injury to your knee. POLICE stands for protect, optimal loading, ice, compression and elevation.

Additionally, there are certain things you should avoid in the first three days after your injury so you don’t damage your knee further. These can be remembered as HARM, which stands for heat, alcohol, running and massage.

To find out more about POLICE and HARM, you can visit our page on what to do if you injure your knee.

If you’re having difficulty bearing weight on your knee, you may need to use crutches or wear a brace to support you for a while. Your doctor or physio will explain how long you’ll need to use these for.

Treatment for meniscal tears

If you have symptoms of a meniscal tear, it probably won’t heal by itself and you’ll need some form of treatment. You’ll usually need to go to A&E with this kind of injury, where they’ll examine you and take some X-rays of your knee. You may then be referred to an acute knee clinic, which will organise any investigations and treatment you need.

What treatment you’re offered will depend on exactly where the tear is, how big it is, how severe your injury is and your age. The initial treatment will be to control your pain and swelling using the POLICE and HARM self-help measures (see above). Further treatments include physiotherapy, medicines and surgery.

You may see a physiotherapist or an orthopaedic surgeon (a doctor who specialises in bone surgery) for treatment.

Medicines for meniscal tears

You can take over-the-counter painkillers, such as paracetamol or ibuprofen, to help relieve any pain from a meniscal tear. Your doctor may prescribe stronger painkillers if your pain is really bad. As well as easing your pain, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help to reduce inflammation and swelling. Always read the patient information that comes with your medicine, and if you have questions, ask your pharmacist or GP for advice.

Physiotherapy for meniscal tears

Your physiotherapist will carefully assess your knee and they will then plan an individual programme of rehabilitation exercises. These will be designed to help strengthen your knee and leg muscles gradually. This should help your knee recover its full range of movement, as well as its strength and stability. Make sure you do the exercises as this is an important part of your recovery from a meniscal tear.

Surgery for meniscal tears

If you have a large meniscal tear, or you’ve tried physiotherapy on its own for at least three months and it hasn’t helped, you may need to have an operation to repair it. Surgery may involve either repairing your torn meniscus, or removing the damaged part of your meniscus. Your surgeon will usually do the operation in a knee arthroscopy, which is a type of keyhole surgery. You’ll need to have physiotherapy afterwards to get your knee back to normal, and working as it should.

Ask your doctor about the pros and cons of surgery, and how it might help you.