Meniscal tear
A tear of the cartilage menisci (the medial or lateral cushioning pads) within the knee joint. Acute tears in young patients are often traumatic; degenerative tears in middle-aged adults are common and associated with early knee osteoarthritis.
📊 Meniscal tears are the most common knee injury, with an estimated prevalence of 12-14% in the general population. They are present on MRI in over 60% of adults over 60 with knee pain.
What is a meniscal tear?
The menisci are two C-shaped fibrocartilaginous structures (medial and lateral) that sit between the femoral condyles and tibial plateau. They serve as shock absorbers, increase joint congruity, and contribute to knee stability. The outer one-third (red zone) has a blood supply and can heal; the inner two-thirds (white zone) are avascular and cannot heal spontaneously.
Traumatic meniscal tears occur in younger patients, typically after a twisting injury to the knee. Bucket-handle tears (a longitudinal split that displaces centrally into the joint) can cause a locked knee - the knee suddenly locks in a bent position and cannot be fully extended. Radial, horizontal, and complex tears also occur. Degenerative tears are common in middle-aged adults, often associated with early knee osteoarthritis, and may cause pain without a clear injury history.
Multiple high-quality randomised controlled trials (ESCAPE, METEOR, FIDELITY) have demonstrated that for degenerative meniscal tears in middle-aged adults, physiotherapy produces equivalent outcomes to arthroscopic surgery (meniscectomy) at 12-24 months. Surgery is therefore not recommended as first-line treatment for degenerative tears. Acute traumatic tears causing a locked knee, and reparable tears in young patients, remain indications for arthroscopic surgery.
Common causes
- Twisting injury to the knee (traumatic tear)
- Deep squatting or sudden direction change
- Degenerative wear in association with knee osteoarthritis
- Repetitive loading activities
Who is at risk? Young athletes engaged in pivoting sports (football, rugby, basketball, skiing) are at highest risk of traumatic tears. Male sex, age, and obesity are risk factors for degenerative tears.
Symptoms
Symptoms vary depending on the severity and duration of the condition. Common symptoms include:
- Knee pain, localised to the joint line (medial or lateral)
- Swelling (effusion) developing hours after injury
- Clicking, catching, or locking of the knee
- Difficulty fully straightening the knee (in bucket-handle tears)
- Joint line tenderness on examination
- Pain with squatting and twisting movements
When to seek help: See your GP if knee pain after a twisting injury does not improve within 2-3 weeks, if the knee locks or gives way, or if swelling is significant. A locked knee requires urgent assessment.
How is it diagnosed?
Your surgeon will take a detailed history and examine the joint. The following investigations may be arranged to confirm the diagnosis:
- Clinical examination - McMurray test, Thessaly test, and joint line tenderness
- MRI - gold standard for meniscal tear diagnosis, grading, and pattern classification
- X-ray - to exclude bony injury and assess for associated arthritis (weight-bearing views)
MRI findings must be interpreted in the clinical context. Meniscal signal changes and tears are extremely common in adults over 40 and may be incidental findings unrelated to symptoms. The decision to treat is based on symptoms, examination, and response to conservative treatment - not MRI findings alone.
Treatment pathway
Treatment is tailored to the severity of the condition, your age, activity level, and overall health. Most conditions are treated in a stepwise fashion, starting with the least invasive options.
Physiotherapy and activity modification
A structured quadriceps and hamstring strengthening programme. Activity modification to avoid provocative positions. Supported by multiple RCT evidence showing equivalence to surgery for degenerative tears. Should be the standard first-line treatment for degenerative tears in adults over 35.
Arthroscopic meniscal repair or meniscectomy
For locked knees (bucket-handle tear), arthroscopic surgery to reduce the displaced fragment and repair it (if in the vascular zone) or remove the unstable portion (partial meniscectomy). Meniscal repair is strongly preferred in young patients as it preserves the meniscus and reduces the risk of future arthritis.
Arthroscopic partial meniscectomy
Removal of the unstable or symptomatic torn portion of the meniscus, preserving as much normal meniscus as possible. Should not be offered for degenerative tears as a first-line treatment. Reserved for patients who have failed adequate physiotherapy.
Recovery
After partial meniscectomy, recovery is rapid - most patients return to work within 1-2 weeks and sport within 4-6 weeks. After meniscal repair, a period of protected weight-bearing (4-6 weeks) and restricted range of movement is required to allow healing.
- After meniscal repair: crutches: 4-6 weeks
- After meniscectomy: weight-bearing immediately:
- Return to low-impact sport after meniscectomy: 4-6 weeks
- Return to sport after repair: 3-6 months
What results can I expect?
For acute traumatic tears requiring surgery, outcomes are generally good with rapid return to activity. For degenerative tears, physiotherapy achieves equivalent results to surgery. Partial meniscectomy is associated with an increased risk of knee osteoarthritis in the long term; this risk is reduced by meniscal repair and preservation.
Meniscal tear - when is surgery needed?
In numbers
Typical activity timelines for this condition. These are approximate and vary considerably between patients. Always follow the specific guidance given by your surgeon and physiotherapist.
| Activity | Typical timeline | Notes |
|---|---|---|
| Try physiotherapy first | At least 8-12 weeks | For degenerative tears without true mechanical locking, structured physiotherapy is the appropriate first step.[2] |
| Seek urgent assessment | If knee locks | A locked knee (cannot fully straighten) is a true mechanical problem and is an indication for surgery.[3] |
| Walk and bear weight | Immediately after partial meniscectomy | Full weight-bearing from day 1 is usual after partial meniscectomy.[3] |
| Restricted weight-bearing after repair | 4-6 weeks | After meniscal repair, weight-bearing and bending are often restricted for around 6 weeks to protect healing.[3] |
| Drive after meniscectomy | 1-2 weeks | When you can react and brake safely. Sooner for left knee in an automatic.[4] |
| Return to work | 1-6 weeks | Desk work: 1-2 weeks. Manual work: 4-6 weeks. After repair, longer.[3] |
| Return to sport | 6-8 weeks (meniscectomy) | After partial meniscectomy. After repair, return is 4-6 months to allow healing.[3] |
Common concerns from patients with this condition or recovering from treatment, and whether they are expected or worth mentioning to your team.
Your questions, answered
Plain-English answers to the things people most often ask, grounded in UK clinical guidance. Tap a question to open it.
About thisWhat is the meniscus and how does it tear?
The menisci are two C-shaped pads of tough cartilage that cushion and stabilise the knee. A tear can happen suddenly through a twisting injury, often in sport, or gradually as the cartilage becomes worn with age, when even a minor movement can cause symptoms.
SymptomsWhat are the typical symptoms?
Common symptoms are pain along the joint line, swelling that comes on over a day or so, and a feeling of catching, clicking or the knee locking. The knee may feel like it cannot fully straighten or that it could give way.
TreatmentDo all tears need surgery?
No. Many tears, especially age-related ones in an otherwise worn knee, settle with physiotherapy, activity changes and pain relief, and UK guidance advises against routine keyhole surgery for these. Surgery is more likely to help a clearly mechanical tear that is locking the knee or a specific tear in a younger, active person.
HealingCan a meniscal tear heal on its own?
It can, but only in part. The outer rim of the meniscus has a blood supply and can heal or be repaired, whereas the inner portion has little blood flow and tends not to heal. Where possible surgeons aim to repair rather than remove cartilage, to protect the knee long term.
RecoveryHow long until I am back to normal?
If treated without surgery, symptoms often improve over several weeks of rehabilitation. After a trim of the torn part recovery is usually a few weeks, while a meniscal repair is protected for longer, often a few months, to let the cartilage heal.
When to worryWhen is it more urgent?
A knee that is truly locked and cannot be straightened, marked swelling immediately after an injury, or inability to weight bear should be assessed promptly, as these can point to a tear that may benefit from earlier surgery.
- 1.NHS: Cartilage damage
- 2.Cochrane Review: Arthroscopic surgery for degenerative knee disease
- 3.British Association for Surgery of the Knee: Patient information
- 4.Royal College of Surgeons of England: Recovering from surgery, driving guidance
References are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.
Preparing for surgery?
Read our step-by-step guide - what to expect before, during, and after your procedure.
How is it diagnosed?
- ✓Clinical examination - McMurray test, Thessaly test, and joint line tenderness
- ✓MRI - gold standard for meniscal tear diagnosis, grading, and pattern classification
- ✓X-ray - to exclude bony injury and assess for associated arthritis (weight-bearing views)
Recovery milestones
- ●After meniscal repair: crutches: 4-6 weeks
- ●After meniscectomy: weight-bearing immediately:
- ●Return to low-impact sport after meniscectomy: 4-6 weeks
- ●Return to sport after repair: 3-6 months