Meniscus Tears

The meniscus is a C-shaped piece of cartilage in the knee that acts as a shock absorber and stabilizer between the femur (thighbone) and tibia (shinbone). There are two menisci in each knee — one on the inside (medial meniscus) and one on the outside (lateral meniscus).

A meniscus tear is one of the most common knee injuries. Early recognition and treatment are important to preserve the health of the knee joint and reduce the risk of future arthritis.

Meniscus Anatomy

The meniscus has a limited blood supply, which plays an important role in healing:

• Red-Red Zone: Outer third of the meniscus, good blood supply, better healing potential.

• Red-White Zone: Middle third, moderate blood supply, variable healing.

• White-White Zone: Inner third, poor blood supply, limited ability to heal on its own.

The location of the tear is a key factor in determining the best treatment approach and the likelihood of successful healing.

Types of Meniscus Tears

Meniscus tears come in several forms, including:

• Longitudinal tears: Along the length of the meniscus, often in the red-red zone.

• Radial tears: Across the meniscus, disrupting its ability to distribute load.

• Bucket-handle tears: Large, displaced tears that often cause locking.

• Root tears: Tears at the attachment point of the meniscus to the bone, which functionally destabilize the entire meniscus.

Root tears deserve special attention:

• Acute root tears: Often traumatic, particularly in active individuals. Timely repair improves healing and function.

• Chronic root tears: Develop over time, typically in older patients with early degeneration. Outcomes are more variable, but repairing these tears early can help prevent rapid joint deterioration.

What Causes Meniscus Tears?

Meniscus tears can happen from:

• Acute injury: Sudden twisting or pivoting motions, especially in sports.

• Degenerative changes: Wear and tear over time can weaken the meniscus and lead to tears, especially in the setting of osteoarthritis.

• Associated injuries: Meniscus tears frequently occur with ligament injuries such as ACL tears.

Symptoms of a Meniscus Tear

Common symptoms include:

• Pain along the joint line of the knee

• Swelling or stiffness

• Catching, locking, or a feeling of the knee "giving way"

• Limited range of motion

• Pain with squatting or twisting movements

Symptoms vary depending on the type and severity of the tear.

Diagnosis

Diagnosis involves:

• Physical examination: Special tests can reproduce symptoms.

• MRI: The best imaging tool to assess the location, type, and severity of the tear, as well as associated injuries.

Understanding the tear pattern and location is essential for guiding treatment decisions.

Treatment Options

Treatment depends on the type of tear, location, patient activity level, and associated injuries.

• Non-Surgical Treatment:

  • For small, stable tears or tears in low-demand patients.

  • Includes physical therapy, activity modification, and anti-inflammatory medications.

  • Tears in the inner white-white zone, with poor healing potential, are more likely to require symptom management.

• Surgical Treatment:

  • Meniscus Repair: Whenever possible, we aim to repair the meniscus rather than remove it.
    Recent advancements allow us to be more aggressive about repairing tears, including root tears and tears in less favorable zones, to preserve the meniscus and protect long-term knee health.

  • Partial Meniscectomy: Removal of the damaged portion when repair is not feasible.

  • Biologic augmentation: Techniques like fibrin clot, PRP, or marrow stimulation may be used to enhance healing, especially in challenging tear locations.

Meniscus repair is increasingly preferred, especially in younger or active patients, as preserving meniscal tissue reduces the risk of future arthritis and improves knee biomechanics.

Recovery and Outlook

• Non-Surgical:
  Recovery focuses on reducing symptoms and maintaining knee function.

• Surgical:

  • Meniscus repair requires a period of protected weight-bearing and activity restrictions to allow healing.

  • Physical therapy gradually restores motion, strength, and function.

  • Full return to activity typically occurs around 3–6 months, depending on the type of tear and healing response.

Root repairs and more complex tears may require slightly longer rehabilitation timelines.

Conclusion

Meniscus tears are common but treatable causes of knee pain and dysfunction. Advances in surgical techniques and a greater emphasis on meniscus preservation have improved outcomes for many patients. Early diagnosis and appropriate treatment are important to protect your knee health and maintain an active lifestyle.

If you’re experiencing knee pain, swelling, or mechanical symptoms, contact our office for a full evaluation and personalized treatment plan.