Knee Meniscus Injury
Date issued: July 2024
For review: July 2026
Ref: A-613/AR/Physiotherapy/Meniscus v2
PDF: Knee Meniscus Injury v2.pdf[pdf] 350KB
What is the meniscus?
Within the knee joint there are two fibrocartilaginous structures termed the meniscus.
The meniscus are two (medial and lateral) semicircular components that help to transfer load and aid joint stability.
For further information read the Degenerative Meniscal Tears page
What are the symptoms?
Common symptoms of meniscus injury include:
Pain along the knee joint (more commonly medially), swelling, joint stiffness and in a smaller number of patients the knee can click, catch or lock.
Symptoms vary between people and can vary from mild and intermittent to severe and persisting.
What are the causes of meniscus injury?
There are two main ways that the meniscus can be injured, trauma or degeneration.
Trauma:
Research has shown us that participating in pivoting sports such as football and rugby are associated with a higher risk of traumatic meniscal tears compared to people who did not participate in sport. However, interestingly evidence demonstrates that participating in running does not increase your risk. Usually caused by a significant memorable injury that involves twisting on a planted knee.
Degeneration:
Evidence has shown us that genetics, manual work, and an onset of pain gradually without injury where all associated with an increased risk of degenerative meniscal tears. Degenerative symptoms can happen at any age but are more common as we age.
Who gets meniscus injuries and are scans needed?
Evidence has shown us that the annual incidence of a meniscal injury was 79 in every 100,000 people. Traumatic tears are more common in young active populations. Whereas degenerative tears typically affect older adults and are commonly found alongside osteoarthritic changes.
Research has strongly demonstrated that a combination of clinical tests that provoke symptoms are able to diagnose meniscal injuries without further imaging being required.
Routine MRI and x-rays are not indicated in first line assessment of meniscal tears, particularly in middle aged and older adults as asymptomatic meniscal tears can be common.
MRI's may be used when symptoms suggest meniscal injury alongside potential other structural damage, to rule out sinister pathology or persistent symptoms without a clear diagnosis.
Management of meniscus injuries?
Research demonstrates that the first line treatment for both simple traumatic and degenerative meniscal tears should be managed non-operatively.
You do not routinely require physiotherapy for this type of injury, most find they improve with time and simple exercises. It is normal for both traumatic and degenerative meniscal tears to take between 3-6 months to resolve and have reduced symptoms.
If your knee pain does not improve after 12 weeks, then you may benefit from physiotherapy input.
Exercise as therapy?
The purpose of exercise for meniscus injuries is not to change the tear or degeneration that may have happened to the meniscus but rather to maintain muscular strength, knee range of movement and control, which can be affected by pain. Exercise may also help with general function and balance which can be affected by any knee complaint.
Examples of exercises include a progressive cycling programme or an adjusted walking programme. For those with intense or disabling pain, exercise approaches that do not directly provoke pain like swimming may be suggested.
Further information regarding exercises for knee injuries can be found at: https://www.youtube.com/@PLYMOUTHNHSPHYSIO
Is surgery required?
Routinely surgery is not required for both traumatic and degenerative meniscus tears.
Research has shown us that surgery comes with few additional benefits when compared to exercise therapy but does carry an increased risk of developing osteoarthritic changes later in life and an increased likelihood of future knee surgical interventions being required. Evidence has highlighted the importance of preserving the meniscus where possible.
However surgery may be required for certain cases of severe displaced tears and those with an associated traumatic ligament injury.
Surgical options?
Surgical options will depend upon the cause of the meniscal tear.
Surgery may be either via a menisectomy (removal of a portion of the meniscus) or repair.
The prognosis for both is favorable. Evidence shows us that 80- 87% of athletes return to pre-injury sports competition following surgery and do so within months.
Surgery should only be considered after a comprehensive discussion with a knee specialist.
