What is a meniscus tear?
Each knee has two menisci. These are C-shaped pads of cartilage that sit between the thigh bone and the shin bone. They cushion the joint and help spread your weight.
A tear can happen in two main ways. A sudden twist or hit can tear a healthy meniscus, often during sport. This is called a traumatic tear. A tear can also build slowly as the tissue wears with age. This is called a degenerative tear.
Common symptoms are pain along the side of the knee, swelling, and a feeling of catching. Some knees lock and will not fully straighten. A locked knee should be checked soon.
The type of tear matters more than the word “tear” on your MRI report. Sudden tears and wear-related tears are often treated in very different ways.
Do I need surgery for a meniscus tear?
Not always. For wear-related tears, starting without surgery is often the right plan. Several randomized trials found no added benefit from partial meniscectomy compared with non-surgical care or sham surgery. A sham operation is a placebo procedure in which the tear is not treated.
A European expert consensus concluded that partial meniscectomy should not be the first treatment for these tears. It should be considered only after a proper exam and imaging, and only when non-surgical care has not helped enough (Beaufils, 2017). Non-surgical care usually means physical therapy, changes in activity, and pain control.
Sudden tears are a different question, especially in younger, active people. A separate expert consensus said that saving the meniscus should be the first goal when possible. It also noted that stable tears of the outer (lateral) meniscus left alone appear to do better than tears of the inner (medial) meniscus (Kopf, 2020). So not every sudden tear needs an operation.
When a repair is needed, that consensus advises doing it as early as possible. This is a reason to get a clear answer soon, not a reason to panic. Most of the advice in that report rests on lower-quality studies, because good trials of sudden tears are rare.
Repair or partial meniscectomy?
These are the two main operations. In a repair, the surgeon stitches the torn edges so they can heal. In a partial meniscectomy, the surgeon trims away the torn piece and leaves the healthy part in place.
A repair keeps more of the meniscus. The trade-off is a slower recovery and a greater chance of a second operation. In a review comparing the two, reoperation rates over the long term were 3.9% after partial meniscectomy and 20.7% after isolated repair. Even so, the smaller group of studies with long-term scores favored repair, with better knee scores and less wear on X-ray (Paxton, 2011).
Whether a tear can be repaired depends on where it is, its pattern, and the quality of the tissue. The expert consensus says that many tears once thought unfixable should be repaired, such as older tears and long tears (Kopf, 2020). In the earlier review, repairs done during ACL surgery had a lower failure rate than repairs done on their own (Paxton, 2011). If you have also torn your ACL, you can read more in the ACL reconstruction guide.
Sometimes the final choice can only be made once the surgeon sees the tear during surgery. Dr. Pareek will talk through both possibilities with you ahead of time.
What is a meniscus root tear?
The root is the strong attachment that anchors the back of the meniscus to the shin bone. When the root tears, the meniscus can no longer hold its position. It may stop doing its job of spreading weight, even though most of the tissue looks intact.
Root tears need their own discussion. A review looked at repair versus meniscectomy for tears of the medial root, with more than five years of follow-up. Arthritis worsened on X-ray in 22% of people after repair and 66% after meniscectomy. About 10% of the repair group went on to knee replacement, compared with 36% of the meniscectomy group (Krivicich, 2022).
Those numbers come from small groups that were not randomized, so they need care. People chosen for repair may have had healthier knees to begin with. Repair also did not stop arthritis in everyone. The authors recommended considering repair when wear in the knee is not severe. If your knee already has advanced arthritis, a root repair may not be the right plan, and non-surgical care may make more sense.
What happens in surgery?
Meniscus surgery is done by arthroscopy. The surgeon works through small incisions with a camera inside the knee. Most people go home the same day. Other problems in the joint, such as cartilage damage, can be checked at the same time.
Like any surgery, this carries risks. These include infection, blood clots, stiffness, ongoing pain, and a repair that does not heal. Results vary from person to person, and no surgeon can promise a certain outcome.
Should I get a second opinion?
It can help, especially if you were told the meniscus must be removed and you want to know if it could be repaired. It can also help if surgery was suggested before you tried therapy for a wear-related tear. Here’s how a second opinion works.
Where can I see Dr. Pareek?
Dr. Pareek sees meniscus patients at HSS in New York and at HSS in New Jersey. Bring any MRI images and reports you already have.
What does recovery look like?
These are typical ranges. Your surgeon’s plan comes first, and recovery varies from person to person.
- Weeks 0-2: Protect the kneeAfter a repair, many people use crutches and sometimes a brace, with limits on weight and bending that depend on the tear. After a partial meniscectomy, most people can put weight on the leg early as comfort allows.
- Weeks 2-6: Regain motionPhysical therapy works on swelling, knee motion, and thigh muscle control. Root repairs often need a longer period of limited weight than other repairs.
- Weeks 6-12: Walk normallyMost people are off crutches and back to a normal walking pattern. Strength work builds up, while deep squatting and twisting are usually still limited after a repair.
- Months 3-4: Build strengthTherapy moves toward harder strength and balance work, then light running if your knee is ready.
- Months 4-6: Return to sportAfter a repair, many people return to sport in this window once strength and testing allow. Recovery after a partial meniscectomy is often shorter. These are typical ranges, and your surgeon's plan governs.
Related reading
Sources
- Beaufils P, et al. Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 2017;25:335-346.
- Kopf S, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 2020;28:1177-1194.
- Paxton ES, et al. Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy 2011;27:1275-1288.
- Krivicich LM, et al. Comparison of long-term radiographic outcomes and rate and time for conversion to total knee arthroplasty between repair and meniscectomy for medial meniscus posterior root tears: a systematic review and meta-analysis. Am J Sports Med 2022;50:2023-2031.