Meniscus tear: symptoms, treatment and recovery

What the meniscus is

Each knee has two menisci, one on the inner side and one on the outer side, sitting between the thigh bone and shin bone. They spread load across the joint, add stability and help the knee glide smoothly. The outer edge has a blood supply and can heal; the inner part has very little, which affects how tears are managed.

Meniscus problems are one of the most common reasons people see a physio about their knee, and the word tear sounds worse than it usually is. Many tears are small and stable, and the knee can become strong and comfortable again with the right plan.

Meniscus tears come in two broad types, and they behave quite differently. Understanding which one you have is the first step to choosing the right treatment.

Traumatic and degenerative tears

Traumatic tears usually happen in younger, active people during a twisting movement with the foot planted, such as turning in football, getting up quickly from a deep squat, or a pivot on the court. They often happen alongside an ACL injury. Some traumatic tears can flip or displace and block the knee from straightening.

Degenerative tears develop gradually from about 40 onwards, as the meniscus becomes less elastic with age. They may appear after a minor movement, such as standing up from a crouch, or with no clear trigger at all. Research consistently shows that meniscus tears are common on MRI scans of middle-aged and older people who have no knee pain, so a tear on a scan does not always explain the symptoms. They are often part of the picture of early knee osteoarthritis.

Typical symptoms

• Pain along the inside or outside of the knee joint line
• Swelling that builds over several hours to a day after injury
• Pain with twisting, deep squatting, kneeling or pivoting
• Clicking or catching sensations
• True locking, where the knee gets stuck and cannot straighten fully
• A feeling of the knee giving way

Catching and clicking are common and not always a problem. True locking, where something mechanically blocks the knee from straightening and you cannot get it straight by gently moving it, is different and needs prompt assessment.

What a physio assessment looks at

Your physio will ask how it started, check swelling and range, feel along the joint line, and use specific tests that load the meniscus. They will check the ligaments, especially if there was a twisting injury, and test strength and function in tasks like squatting and stepping.

They will also want to know what you are hoping to get back to. A 55-year-old who wants to walk the dog pain-free and a 25-year-old who plays five-a-side twice a week may have similar tears but quite different plans, and the right approach depends on your goals as much as the scan.

For degenerative tears, a scan is often not needed to start treatment. An MRI may be recommended after significant injuries, when the knee is locking, or if symptoms are not improving with rehab. If you already have a scan, your physio will explain what it means in context.

What usually helps

For degenerative tears, exercise-based rehab is the first-line treatment. Research has shown that keyhole surgery to trim a degenerative tear offers little extra benefit over a good exercise programme for most people, which is why UK practice has moved away from routine surgery for these tears. The programme builds quad, hamstring and hip strength, restores movement and gradually reintroduces the activities you want to do.

For traumatic tears in younger people, especially if the knee is locking or there is an ACL injury too, a specialist opinion is usually needed. Some tears can be repaired surgically, particularly those in the outer part of the meniscus, which has a blood supply. Many stable traumatic tears still do well with rehab first.

Manual therapy may ease pain and stiffness in the short term. Swelling management, such as compression and raising the leg above heart level, helps in the early days.

What you can start with at home

1. Quad sets and straight leg raises, 3 sets of 10 to 15, to keep the thigh muscles working.
2. Heel slides to maintain bending, 10 to 15 slow reps.
3. Sit to stand from a chair, 3 sets of 10.
4. Step-ups onto a low step, 3 sets of 8 to 10.
5. Exercise bike with low resistance for 10 to 20 minutes, if comfortable.

As the knee improves, progress to exercises such as the goblet squat to a comfortable depth, split squats and hamstring curls. Avoid deep twisting and pivoting until strength and confidence are back.

Swelling is a useful guide. If the knee is puffier after a session, the load was probably a little too much; ease back slightly and build again more gradually. If swelling keeps returning despite that, get it reviewed.

Recovery time and when to get help

Many people with degenerative or stable tears improve significantly over 6 to 12 weeks of consistent rehab, although some take longer. After surgical repair, recovery commonly takes 3 to 6 months, following the surgeon's protocol. The on-site physio at Lycan Strength can guide your rehab and return to training, with 20% off for members; book a physio appointment online.

• Go to A&E if you cannot bear weight after an injury, or the knee is deformed.
• See a GP or physio promptly if the knee locks and will not straighten, or keeps giving way.
• Go to A&E if the knee is hot, red, very swollen and painful, especially with a fever.
• Call NHS 111 or see a GP urgently for a swollen, warm, painful calf. Call 999 if you also have chest pain or breathlessness.

Questions