Meniscus Injuries: Types, Diagnosis, and Treatment Decisions

The Role of the Meniscus in Knee Function

Each knee contains two menisci — the medial (inner) and lateral (outer) — each a C-shaped wedge of fibrocartilage that sits between the femoral condyle above and the tibial plateau below. The menisci serve multiple critical functions: they distribute load across the knee joint, absorb shock during impact, provide stability, and help lubricate the joint surface. Removing or losing meniscal tissue has consequences for joint health, which is why treatment decisions aim to preserve as much of the meniscus as possible.

How Meniscus Tears Occur

Acute meniscus tears typically result from a twisting or rotational force applied to a partially flexed knee — common in sports like basketball, soccer, and skiing. A player who pivots on a planted foot or is struck from the side may hear or feel a pop, followed by pain and swelling over the next several hours. Younger patients sustain meniscus tears primarily through this type of traumatic mechanism.

Degenerative meniscus tears occur differently. In older adults, the meniscal tissue becomes stiffer and more brittle with age, and tears can develop through cumulative wear or even routine daily activities — squatting, rising from a chair, or stepping off a curb. These tears often develop gradually and may not correlate with a single identifiable event.

Degenerative tears frequently coexist with knee osteoarthritis, which complicates treatment decisions.

Recognizing the Symptoms

The classic presentation of a meniscus tear includes pain along the joint line (the inner or outer edge of the knee where the menisci sit), swelling that develops within hours to days of injury, and limited range of motion. Some patients describe a sensation of the knee locking or catching, which occurs when torn tissue becomes mechanically trapped within the joint.

Not all meniscus tears cause significant symptoms — particularly degenerative tears, which may be found incidentally on MRI performed for other reasons. When a tear is asymptomatic, treatment is generally not indicated.

Diagnostic Approach

Diagnosis begins with a physical examination. Your physician will assess joint line tenderness, range of motion, and perform specific provocative tests — notably McMurray's test and Thessaly's test — that stress the meniscus and reproduce symptoms if a tear is present. MRI provides definitive characterization of tear location, pattern, and extent, and helps identify concurrent injuries to ligaments or articular cartilage.

Treatment: Matching the Approach to the Tear

Nonoperative management is first-line for most degenerative tears and for smaller acute tears that are stable and not causing mechanical symptoms. This typically involves a course of physical therapy to strengthen the surrounding musculature, activity modification, and anti-inflammatory measures. Many patients with degenerative tears — especially those without locking — achieve acceptable outcomes with conservative care.

Arthroscopic surgery is indicated when nonoperative care fails, when the knee is mechanically locked, or when the tear pattern suggests it is repairable. Two main procedures are performed:

• Partial meniscectomy involves trimming the torn portion of the meniscus. It provides quick symptom relief and short recovery but removes tissue permanently, which carries long-term implications for joint loading.
• Meniscus repair involves suturing the torn edges together to restore the intact meniscal structure. Recovery is longer — typically four to six months — but for tears in vascularized zones of the meniscus, repair preserves tissue and is preferable when technically feasible.

Your surgeon's recommendation will depend on the tear pattern, its location within the meniscus, your age, activity level, and whether arthritis is present.

If you're experiencing knee pain or suspect a meniscus injury, the specialists at Maryland Orthopedic Specialists can help. Call (301) 515-0900 or [schedule an appointment online](https://www.mdorthospecialists.com/contact).