If you’ve spent any time playing golf, lifting weights, or taking hikes with friends, there’s a pretty good chance you’ve heard this (or said it yourself):
“Well I’ve got a torn meniscus so I have to watch out for that.”
So, what do you do? Is all hope lost?
Here’s the long and short of it: A lot of people have torn their meniscus, and a lot of them are totally unaware because they don’t have pain. It’s not a death sentence, and it doesn’t necessarily require surgery to get back to normal.
Let’s dig in.
A Quick Anatomy Lesson
The meniscus is a cushion that sits in your knee. It looks like this:
You have a medial and a lateral meniscus, that join into various knee ligaments.
As a whole, your meniscus is meant to absorb rotational and compressive forces to protect the cartilage of your knees. That means it’s most likely to be torn by… rotational and compressive forces. Like you’d find when you golf, or change directions quickly in sports, or step in a hole.
(Of note, your hips should be taking care of a lot of the rotational forces. I'll link that blog article here once it's done.)
See? Quick.
How common are meniscus issues?
If you read nothing else in this paper, read this section. Seriously.
They are extremely common. Without diving way too deep, a study of 991 randomly selected people showed that between 19-56% of participants had a torn meniscus (19% was women 50-59 years old, 56% was men 70-90 years old).
But here’s the thing: 61% of people with meniscus tears in the study did not have knee pain.
For people with knee arthritis on their images, having a meniscus tear to go along with it almost didn't matter at all. 63% of people with meniscus tears had pain and stiffness... but so did 60% of people who DIDN'T have a meniscus tear.
I’m going to rephrase that so I can be sure nobody misses it.
Just because you have a meniscus tear, does not mean you will be living with pain. It might've even been there for years at this point!
This has implications.If you start having knee pain, go to the doctor, and get an MRI that shows a meniscus tear… what does that even mean?
If you just had a traumatic injury, you’ll probably have some clear answers. But if you didn’t, it’s much more of a chicken-and-egg situation.
Is it a new injury, or was it already there but wasn’t causing symptoms? Does the pain even have anything to do with the meniscus tear?
Why would you jump to surgery in that circumstance?
How do I know if my meniscus is torn?
The usual symptoms of an acute meniscus injury are:
Delayed swelling, but not immediate (usually starting 24 hours after injury)
A pop sensation when injury occurs
Difficulty straightening or bending the knee (or feeling it is completely locked)
If you really want to get a better idea but don’t want to get looked at yet, you can try doing a test on yourself, like the Thessaly test. (Just make sure you’re holding onto something or someone so you don’t fall down!)
So how will I treat it?
The first question is typically surgery vs no surgery.
Surgery is usually performed when...
Your knee completely locks up and won’t bend or straighten beyond a certain point.
You have specific kinds of tears, like meniscus root tears, which tend not to respond to treatments other than surgery.
You haven’t responded to conservative care and you need to get back to your life.This is not medical advice here. You’ll want to consult with your healthcare professional to make a determination.
Outcomes for surgery and physical therapy - when your knee isn’t locking up - are essentially the same.
If you want the research, here’s the best available. I’m not going to do a deep dive here, but here’s the summary: Surgery scores were better by such a small margin that they aren’t even noticeable by the patient. You can read about the 2 year follow-up study here, and the 5-year study here.
As a result, physical therapy is often the first line treatment.
PT Without Surgery
You’ll go through controlled motion and strength training to help regain your normal function. Often you’ll address other parts of your body like your hip and ankle to help reduce certain stresses from your knees that would aggravate your knee down the line. This could mean improving hip and ankle function and muscular endurance to be sure you’re not shifting extra responsibilities to your knee.
Injections and surgery can also be utilized if you aren’t getting back to normal.
Recovery after surgery:
This all depends heavily on whether you have a mensicectomy where part of the meniscus is removed, or a meniscus repair.
With a meniscectomy, you’ll often be in PT for 4-12 weeks before you go back to your sport. You can view a sample rehab progression here. (It's written for clinicians but gives more detail than would be feasible here.)
With a meniscus repair, which is less common, your protocol will vary heavily depending upon the extent of the repair and your surgeon’s preferences. In any case, it's a much longer time frame and is usually reserved for younger athletes. Here's a sample protocol.
Need help with a meniscus injury?
Schedule a free discovery call with MyPhysio owner Jared Cave and let's come up with a plan for you.
We have hour long, one-on-one sessions every time, are available between sessions to help bridge the gap, and will communicate with your physicians and coaches to make sure your transition back to life is as smooth as possible.
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