Meniscal or Cartilage Tear
Understanding causes, diagnosis, symptoms and treatments
What is a Meniscal Tear?
- Usually in middle-aged and older adults (aged 40 years plus), a meniscal tear will develop gradually, without a specific injury. With age, the meniscus becomes less flexible and more prone to thinning and fraying. This is also known as a ‘degenerative meniscal tear’.
- This fraying of the meniscus is not always painful. In fact, about one third of adults develop meniscal tears but have no knee pain.
- Knee pain and a degenerative meniscal tear can also be part of mild or early osteoarthritis. The good news is ongoing knee pain is not inevitable, and the prognosis is usually positive for someone with these early joint changes.
- In younger sports people or athletes, a meniscal tear can happen with a sudden twisting force during a sports activity. The information presented here is not about this type of injury.
What is the meniscus?
The meniscus is a thick, rubber like pad of cartilage tissue in your knee.
This cartilage acts as a ‘shock absorber within your knee’.
It also aids smooth movement and greater stability of the knee.
Expert Viewpoint
Watch the video to understand more about meniscal tears in middle aged and older adults, provided by Dr Helen O’Leary, Clinical Specialist Physiotherapist and Research Fellow.
Why have I developed this type of knee pain?
- Knee pain becomes more likely as we age, with an increased body weight, with work that involves lots of kneeling or squatting, or a sudden change in exercise or physical activity.
- In the past a meniscal tear was suspected as a source of pain. New information suggests that in middle-aged and older adults, pain is more likely to be linked to other tissue changes within the knee. These include changes to the smooth ‘articular ‘cartilage lining the bone ends, the underlying bone or inflammation of the joint lining. Often these changes occur together,
- Changes to the meniscus and cartilage are only part of the story. Pain is complex and is influenced by our both our body and mind. Having a healthier metabolism will reduce overall inflammation in the body and therefore knee pain. Having a more positive and optimistic outlook and addressing negative thoughts and emotions about your knee also reduces pain.
Do I need to ‘fix’ my knee to feel better?
Changes in your knee will have been there for much longer than you have noticed symptoms.
This means you can usually change your knee pain without having to reverse any changes inside the joint.
What are the clues that I have this type of knee pain?
- Typically, pain is along the inner side of the knee, where your thigh bone meets your shin bone and comes on during activities like prolonged standing, walking and jogging or stairs.
- Other knee symptoms could include clicking, locking, catching, or a sensation of your knee ‘giving way’.
- Activities like kneeling, twisting, squatting, walking on uneven surfaces, running, using stairs, and prolonged sitting, or standing can aggravate symptoms.
- Symptoms can vary and there is lots of overlap with the symptoms of knee osteoarthritis.
How is a meniscal tear diagnosed?
- Your GP or physiotherapist can make a diagnosis by gathering information on the activities that aggravate your knee, combined with a physical examination. Specific questions will help them rule out other causes of knee pain.
- Clues from the physical exam may include pain while the examiner presses along the inside joint line of your knee, or pain during a deep squat.
Usually an x-ray does not add any helpful information to aid the diagnosis.
Do I need an MRI scan?
MRI scans give us a detailed look inside the knee, but this level of detail is usually not needed.
If you have not experienced a specific traumatic injury, the information from an MRI can be confusing, as it’s hard to tell if the changes reported are causing your pain or simply the normal aging process.
If you are over 35 you are unlikely to have a completely ‘normal’ MRI report but that doesn’t mean these changes are causing a problem.
What to expect with a meniscal tear? Will my symptoms get worse with age?
- For the majority of people, in the medium-term, this type of knee pain will improve, but it can take several months. 70% of people diagnosed with degenerative meniscal tears make improvements over 3-6 months
- For some people symptoms will settle more rapidly. For others, improvements occur more slowly and can continue for up to 12 months after the onset of pain.
- Having poorer knee strength, a higher body weight, or suffering with low mood suggest can mean your symptoms are more likely to persist for longer.
- More osteoarthritic changes within the knee make it more likely that your knee pain may not resolve completely, but neither will it necessarily get worse with age.
Treatments for a Meniscal Tear
You should see your GP or a physiotherapist to help explain your treatment options and create a treatment plan.
Exercise is the mainstay of treatment for people with a meniscal tear. Not everyone needs to see a physiotherapist for this. Some people can make steady improvements by gradually becoming more active and trying some of the exercises suggested on this page. An assessment with a physiotherapist will provide you with a bespoke exercise programme.
Click here for more exercise advice and a sample exercise programmes.
Corticosteroid injections are sometimes used to give short-term pain relief (6 to 12 weeks) for this type of knee pain. Repeated use of corticosteroid injections has been linked to thinning of knee cartilage. For this reason, they are not recommended before other treatment options, such as exercise, have been tried. There is no strong proof yet from research studies to support the use of stem cells injections or platelet rich plasma for this type of knee pain.
Surgery is rarely indicated in people with this type of early joint pain. Research has shown that keyhole surgery for the meniscus or knee cartilage is no more effective than sham surgery (where skin incisions are made but no surgery is performed). People do report some improvement after surgery, but on average, after one year people who simply followed an exercise programme felt about the same.
Expert Viewpoint
Watch the video to understand more about treatments for meniscal tears, provided by Dr Helen O’Leary, Clinical Specialist Physiotherapist and Research Fellow.
What can I do right how to help my knee pain?
The initial focus is on taking simple steps to help settle your symptoms. Most people will improve with time, simple advice and exercise. Balance rest with activity. Slowly increase your amount of daily movement and exercise.
Temporarily reduce activities that are making your symptoms worse, for example, the length of time you spend on your feet or squatting down.
Ice (ice pack or frozen peas wrapped in a damp towel) can provide pain relief and ease symptoms. Apply this to the sore area for up to 15 minutes, up to four times a day, ensuring ice is never in direct skin contact.
Pain medication can help manage the discomfort in the short term. Your GP or pharmacist will advise you on your best options.
Do you have more questions about your meniscal tear?
Do knee cartilage ‘defects’ or ‘tears’ need to be repaired before my knee starts to feel better?
No. If you can address some of the factors that might have contributed to your knee becoming painful, it’s possible to be pain free again without any change to structures inside the knee. If you are over 40 years generally it’s not possible to repair the meniscal tear. Surgery will involve trimming back or removing part of the meniscus.
Would I have a better long-term result with keyhole surgery?
No. Following an exercise program can lead to similar improvements as keyhole surgery after one and five years. It’s better for your knee’s long-term health to avoid surgery because knee osteoarthritis can develop sooner if knee cartilage or the meniscus is trimmed or removed.
Does exercise damage my knee cartilage?
No. We know the opposite is true. Exercise improves the health of knee cartilage overall.
The key is to adopt a gradual approach and slowly build up the ability of the cartilage to tolerate load and exercise.
What can I do for healthier knee cartilage in the long-term?
- For long-term knee health, we know that regular exercise has a protective effect on joint cartilage. Knee pain often causes people to become less active. Scientific research has not found that exercise is harmful for our knees. In fact, the opposite is true. Choose activities you enjoy ensuring you stick with it in a long-term. You can walk, jog, swim, cycle, dance or play golf.
- Weight management is the single best thing you can do for your future knee health. If you are overweight, losing even a few kilograms is beneficial for cartilage health. Weight loss is a challenge, particularly when knee pain is present. Talk to your GP about getting help and support.
- Our mood, stress, and sleep quality, through their impact on our immune and pain systems, play a role in knee pain onset and recovery. Remember pain is designed to protect us and is part of the body’s alarm system. By looking after all aspects of our health that ‘pain’ alarm system is less likely to trigger.
Click here to read more about the link between body weight and knee pain.
What if things don't improve?
This type of knee pain will generally improve; however, you will need to give it time (sometimes several months). If the pain is worsening despite following advice, it’s important to check back in with your GP or physiotherapist. Usually, your GP will start by looking at your pain medication, at your level of activity and what continues to aggravate your knee pain. A few people may need further investigations.
How should I monitor my knee pain during activity?
It’s normal to feel a bit of pain when you start exercising. You may have a bit of muscle soreness if you haven’t used these muscles regularly or have some joint pain. The muscle soreness will decrease as you get used to exercising. It is important to decide the pain limits that are acceptable to you. These pain limits will be different for everyone and can change over time. Use the rules in the graphic provided here to help guide your exercise.
It’s important to listen to your body and strike a balance when exercising. Focus on your exercise goals to distract yourself from any pain. Don’t forget to have fun!
Exercises for a Meniscal Tear
The exercises below are designed to help settle your pain and build the capacity of your knee joint to tolerate load and activity. You can start at Level 1, 2 or 3. Each individual exercise is also described in the table below and accompanied by video links and downloadable files that you can print.
Monitoring your pain
Remember many people experience an increase in knee discomfort when performing exercises. Review the advice on monitoring knee pain during and after exercise above.
Where to start
If you are new to exercise or your knee pain is very easily irritated, we would suggest starting at Level 1. It can take two or three weeks of repeating these exercises daily to build confidence and strength to progress to Level 2. When you’re comfortable with the exercises on Level 2 and they’ve become easier, you can progress to Level 3. Holding a light weight (2 or 3kg) can increase the challenge as you perform the Level 3 exercises.
How many exercises?
Suggested repetitions for each exercise are provided but everyone will have a different starting point so don’t worry if you cannot complete all initially. You could repeat that more than once a day. When you are able to perform more exercises together, we would suggest performing once a day or every other day.
What if I experience a setback?
Experiencing a setback or ‘flare up’ of knee pain after starting a new exercise programme or activity can be normal. Stay calm, switch to easier exercises and use ice or pain medication until symptoms improve. If your knee pain does flare, you have not harmed or damaged your knee.
Preparing to exercise
Warm up if you can by walking or ‘marching on the spot’ for 3 to 4 minutes before you start your exercises. This will help your muscles prepare for the activity by increasing your circulation.
Level 1 Degenerative Meniscal Tear Exercise Programme
Level 2 Degenerative Meniscal Tear Exercise Programme
Level 3 Degenerative Meniscal Tear Exercise Programme
Now you have an understanding of all treatment options for meniscal tears, check out some of the other resources:
- Go to the Irish Resources section for more help on your journey,
- Learn about another joint condition.
The information in this website page was informed by the following sources/references:
Scientific Publications
- Berg B, Roos EM, Englund M, et al. Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial. Osteoarthritis Cartilage. 2020;28(7): 897-906. doi:10.1016/j.joca.2020.01.020
- Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(20):1268-1278.
- Herrlin S et al. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? a five year follow-up. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):358-364. doi:10.1007/s00167-012-1960-3.
- Hohmann E, Angelo R, Arciero R, Bach B R, Cole B, Cote M, et al. Degenerative meniscus lesions: an expert consensus statement using the modified delphi technique. Arthroscopy 2020; 36(2): 501-12.
- Katz JN et al. Five-year outcome of operative and non-operative management of meniscal tear in persons greater than 45 years old. Arthritis Rheumatol. 2020;72(2):273-281. doi:10.1002/ art.41082.
- Papalia, R. et al. Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. Br Med Bull, 99 (2011), pp. 89-106.
- Pihl, K, et al. “Wild goose chase–no predictable patient subgroups benefit from meniscal surgery: patient-reported outcomes of 641 patients 1 year after surgery.” . Br J Sports Med.54.1 (2020): 13-22.
- Sihvonen R et al; FIDELITY (Finnish Degenerative Meniscus Lesion Study) Investigators. Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. Br J Sports Med. 2020; 54(22):1332-1339. doi:10.1136/bjsports-2020-102813.
- Snoeker BAM, Bakker EWP, Kegel CAT, Lucas C. Risk factors for meniscal tears: a systematic review including meta-analysis.J Orthop Sports Phys Ther. 2013;43(6):352-367. doi:10.2519/jospt.2013.4295
- Sonesson S, Kvist J, Yakob J, Hedevik H, Gauffin H. Knee arthroscopic surgery in middle-aged patients with meniscal symptoms: a 5-year follow-up of a prospective, randomized study. Orthop J Sports Med. 2020;8(1): 2325967119893920. doi:10.1177/2325967119893920
- Swart, N. M., et al. “Effectiveness of exercise therapy for meniscal lesions in adults: a systematic review and meta-analysis.” Journal of Science and Medicine in Sport 19.12 (2016): 990-998.
Clinical Guidelines
- Siemieniuk, Reed AC, et al. “Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline.” Bmj 357 (2017). https://bjsm.bmj.com/content/52/5/313