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Meniscus Tears and Treatment
The knee is the largest and most mobile joint in the body. Collateral ligaments and cruciate ligaments provide its stability.
The cushion-like structures between the thigh bone (femur) and the shin bone (tibia) are called menisci. In each knee there are two menisci—one medial and one lateral—which are C-shaped cartilage tissues.
Menisci increase the congruity between the femur and tibia and play a role in distributing body weight evenly across the knee joint and in absorbing shock.
Without menisci, the articular surfaces of the femur and tibia do not match perfectly, causing excessive load in certain areas and insufficient load distribution elsewhere. This inevitably leads to early wear and osteoarthritis in the overloaded regions. Therefore, meniscal function is important for knee health.
Menisci are frequently injured due to trauma (often seen in young athletes), but tears associated with osteoarthritis (seen in older patients) are also common.
The most common mechanism of injury is rotation of the body over a planted foot.
Meniscal tears can occur together with anterior cruciate ligament (ACL) and medial collateral ligament injuries, and they should be evaluated together for treatment.
The initial symptoms of a meniscal tear are pain and swelling. Knee locking (inability to fully extend or flex) may accompany it, indicating that the torn meniscus is obstructing joint movement.
Other possible findings include tenderness on palpation of the meniscus area, clicking sounds during movement, and reduced range of motion.
Every patient with knee pain should be evaluated for a meniscal tear. A thorough history and physical exam allow differentiation from other knee problems.
Knee X-rays and magnetic resonance imaging (MRI) are the most commonly used diagnostic tools. X-rays assess osteoarthritic changes. MRI is valuable for visualizing meniscal tears, but the presence of a tear on MRI alone is not enough to decide on arthroscopy.
In any knee injury, initial management includes cold application, rest, and immobilization. Analgesics relieve pain and reduce swelling.
In the next step, it is determined whether surgery is necessary for a meniscal tear.
Surgery should be considered if the tear causes pain that affects daily life.
There are two common options for treating meniscal tears:
Meniscal Repair: Repair is possible depending on the type of tear. Not all patients are candidates. Arthroscopic repair can be done, but recovery is longer than after meniscectomy.
Meniscectomy: This involves removing the torn part of the meniscus. It is used for tears in the inner portion where healing potential is low. When done arthroscopically, recovery is very rapid and the patient can bear weight on the same day.
Anterior Cruciate Ligament Tear and Treatment:
Cruciate ligaments connect the femur and tibia within the knee joint like short ropes, providing stability during flexion and extension. The front ligament is the ACL; the back one is the PCL.
The ACL can be injured in the following ways:
Sudden change of direction or twisting of the knee
Deceleration while running or cutting
Landing from a jump
Direct blow to the knee
When such trauma occurs, stop the activity (sports, walking, etc.) immediately.
Apply an ice pack around the knee for 20 minutes, repeating every 2 hours.
Until a definitive diagnosis is made by an orthopedic specialist using imaging like MRI, avoid weight-bearing as much as possible.
A diagnosis can only be confirmed after a proper exam and the gold-standard MRI.
Non-surgical Treatment;
Partial (incomplete) tears
Older individuals or those with generally low physical activity
Good overall stability on tests (e.g., pivot shift test)
In such cases, surgical treatment may not be required.
These patients should perform lifelong exercises to strengthen the quadriceps and hamstrings and use a protective knee brace during risky activities.
Surgical Treatment;
It is indicated for active patients with an ACL tear who wish to return to sports. It is also recommended for those with instability to restore confidence and prevent cartilage damage.
ACL reconstruction is usually performed arthroscopically using a tendon graft from around the knee to replicate the original anatomy.
When done by experienced surgeons, ACL surgery has a very low complication rate.
However, the most important factor for long-term outcome is the condition of any accompanying meniscal or cartilage injuries.
Aside from general surgical risks, there is a very low risk of surgery-specific complications such as infection, deep vein thrombosis, or graft non-integration.
The day after surgery, the patient can walk with two Canadian crutches, bearing weight as tolerated.
Return to desk work within 4–7 days.
Driving can resume within 3 weeks.
With immediate postoperative physiotherapy, the goal is to walk with one crutch by the end of week two and without crutches by the end of week three.