Meniscus Tears: Causes, Symptoms & Treatment Options
By Dr. Scott Welsh
Your knee has a piece of cartilage that acts as a cushion between your shinbone and your thigh bone. It’s called a meniscus.
Since most of us rely on our knees to perform a variety of activities, you can imagine how easy it might be to tear your meniscus.
A torn meniscus can result from any activity that involves twisting or rotating your knee — even kneeling, deep squatting, and heavy lifting.
Who’s At Risk for Meniscus Tears?
The most common meniscus tears happen in athletes involved in contact sports (like football) or pivoting sports (like snow skiing, basketball, soccer, and tennis). If you have had an ACL tear, that puts you at high risk for having a meniscus injury as well.
Typically the athlete’s tear is a result of aggressively planting the knee and twisting it. For example, if you try to change directions, or get slide tackled — those are really common ways to damage your meniscus.
But non-athletes can also tear their meniscus. We see a lot of tears from car accidents or bad falls.
We also see it happen in arthritic knees. Patients who are between 60 and 80 years old can have meniscus tears without any related trauma whatsoever.
In arthritic patients, their cartilage is getting thinner. The meniscus takes on the brunt of the weight-bearing, starts to weaken, and tears easier without any trauma.
Low energy type activities can cause meniscus tears in the older population. That means you can tear your meniscus just by walking or getting out of bed or out of a car. Those minor little twisting movements or squatting motions can cause the meniscus tear.
How Do I Know if I’ve Torn My Meniscus?
The symptoms of a meniscus tear have a lot to do with the type of tear and your age. The pain can be dramatic or subtle, immediate, or delayed.
You can imagine the immediate, acute pain a snow skier or football player might experience from a fall, pivot, or tackle.
However, some cases aren’t a result of a specific injury. You could start experiencing pain out of the blue without any warning signs. For example, if you have a degenerative tear from arthritis, you might notice a subtle increase in pain.
If you’ve been in a car wreck, you might not have pain in your knee until a couple of days later, once the adrenaline has stopped pumping from the excitement of the accident. It’s not unusual to have delayed onset of symptoms.
Other symptoms besides pain (which is usually a sharp, stabbing type of pain) include:
- Knee swelling (dramatic or subtle, often delayed onset)
- Feeling your knee giving way when you put weight on it (common with an ACL tear)
- Difficulty straightening your knee fully or feeling it “catch” in a certain spot
- Feeling as though your knee is locked in place when you try to move it
The catching and locking sensation in the knee is the result of a little fragment of tissue that can get caught in between your two weight-bearing leg bones. And that can also cause a sharp, stabbing pain.
Arthritic pain is usually a more stiff and achy type of discomfort.
When Should I Visit a Doctor?
If you suspect you’ve torn your meniscus, it’s best to arrange an orthopedist’s evaluation. If left untreated, you could make your meniscus tear worse, depending on your tear.
I’ve seen patients that tried to go play basketball with an untreated meniscus tear and they ended up causing more damage to their knee.
Since tearing your meniscus may not be the result of a major injury or trauma, it isn’t always obvious that you’ve torn it.
Your symptoms might be mildly worse than what you normally experience. Arthritic patients tend to come in on a delayed basis for this reason.
What is APC’s Approach to Meniscus Tear Treatment?
Tearing your meniscus doesn’t always require surgery. Most meniscus tears — 80 to 90% — need surgery. But we never assume that’s what you need without assessing you first.
If you’re highly functional with minimal symptoms, there are other options.
Our conversations with our patients are important in determining the right plan of care. We discuss how the injury impacts your lifestyle, we perform a physical examination, and in some cases, we get an MRI.
When we examine your knee, we perform rotational type movements to see how much pain it provokes. If your knee is irritable and shows a lot of swelling, then we likely need to operate.
If you have minimal to no pain during the exam — no swelling, catching, locking, or giving way — those we can treat without surgery.
Steroid and gel injections are an option for arthritic patients.
Physical therapy is also an option, which can help stabilize the knee and strengthen all of the supporting muscles.
Low-impact activities may include:
- Pool exercises
- Stationary bike
- Elliptical machine
- Light leg exercises (to prevent muscle atrophy)
Activities you should avoid are running, jumping, heavy lifting, and any pivoting type movements.
If you do need surgery, your recovery time can vary — from six weeks to six months — depending on your tear and the type of surgery it requires.
Ideally, we want to save and repair your meniscus as much as possible to minimize the arthritic process later down the road.
We consider your age — how quickly your body will heal itself.
We think about your body mass index (BMI) — how much weight you’ll be putting on your knee.
And your occupation is also really important to us. Maybe you’re a general contractor building homes or doing a lot of manual labor — we realize you might be looking at three to six months off your job.
So while the type of tear is the number one driver in determining whether surgery is required, we also consider your physical and emotional well-being as part of that decisionmaking.
How is APC Different?
APC’s multidisciplinary approach is a novel concept, and it makes sense. There’s a lot of interplay between orthopedists and pain physicians. We’re often treating the same problems, but we have different techniques and tools to bring to the table.
For example, if you have a total knee replacement, you might still have pain after the procedure (usually about 10 to 20 percent of knee replacement patients experience delayed pain).
In those situations, an orthopedist may ask a pain doctor to do genicular nerve blocks around the knee to try to minimize your pain so you can recover more effectively.
There’s good communication among the physicians from the orthopedic, neurosurgery, and the pain medicine departments. We have a working relationship among the physicians that ensures comprehensive care.
The ability of the pain management physicians to help you manage your pain — whether it be with oral medication or injectables — is a nice bonus for you as a patient to experience better pain control.
I’ve seen pain management physicians perform a nerve block on a patient before I start the surgery. It’s nice to have your treating physician, who knows you well, show up in the presurgical area and take care of you. It helps put you at ease.
Another perk of all this collaboration is the continuity of care for our patients. I oftentimes see my patient’s pain doctor in the hallway and I’ll show them pictures of the procedure so they know what we did. That level of communication is a key benefit to our patients.
If you have any questions regarding meniscus tears or our multidisciplinary approach to pain management, contact us through our 24/7 live chat or book an appointment with one of our specialists.