Meniscus Tears

Meniscus tears are common injuries to the knee joint. They are an umbrella term for many different types of tissue change

The meniscus normally ages in adults and can develop natural ageing which includes tearing. Surgery is very rarely necessary for these.

The meniscus can also be injured traumatically.

Traditionally, we have been told that meniscal tears benefit from early surgery, typically to stitch the meniscus together. Despite being commonplace, there is a surprising lack of any robust evidence in favour of surgery when compared with high quality rehabilitation. There is also evidence that many meniscal tears can in fact heal.

FAQs

I have been told a torn meniscus cannot heal. Is this true?

No. Meniscus tears have been proven to have a good capacity to heal as far back as 1994, based on a gold standard of a ‘second look arthroscopy,’ where the meniscus is surgically inspected with a camera inserted through a key hole(1).

I have been told I need a knee ‘clean up’/arthroscopy. Do I need this?

There is no such thing as a knee ‘clean up.’ A knee arthroscopy is where a surgeon enters the knee via a small incision, and uses cutting implements to removal meniscal tissue and/or cartilage. This surgery has been shown to be no better than a pretend surgery and increases risk of long term osteoarthritis(2)

My knee clicks and hurts. Does that mean I have a torn meniscus?

Not necessarily. Clicking can be a feature of normal knees, but if painful, can indicate things like tight muscles or stiffness in a joint. It could also be a sign of a meniscal tear, however as mentioned above, many people can have meniscal tears without symptoms.

I have mechanical symptoms from my knee, do I need meniscal surgery?

Not necessarily. Research has shown that people with mechanical symptoms from their knee are no more likely to benefit from knee surgery than people that do not have these symptoms.

I have been told because my meniscal tear is in the ‘white zone” it will not heal, is this true?

The red zone/white zone theory of meniscal healing is hypothesis that the inner area of the meniscus receives little to no blood supply, therefore tears will not heal in the location. This has never been proven, and recent evidence has shown that the entire meniscus receives blood.

What is the failure rate of meniscal repair surgery?

This varies by study however, is approximately 1 in 5.

I have a meniscal ramp tear. Can it heal?

Yes, ramp tears have been shown to have substantial healing potential3

When does a meniscus need surgery?

A meniscal tear may benefit from surgery if it is causing you ongoing pain and symptoms despite a trial of physiotherapy.

What is the best treatment for a meniscal root tear?

High quality research has not been performed on treatment of meniscal root tears. By high quality, this means randomised trials where surgery is compared with quality physiotherapy. A 2024 systematic review (a summary of all science performed on the topic) concluded that it is unclear which treatment is best (4). This means that physiotherapy is a valid option for your meniscal root tear.

Some low quality research has shown rapid osteoarthritis progression with meniscal root tears in some people, however this research did not control for many confounding factors and the participants did not receive high quality physiotherapy.

Resources

(1) Ihara H, Miwa M, Takayanagi K, Nakayama A. Acute torn meniscus combined with acute cruciate ligament injury. Second look arthroscopy after 3-month conservative treatment. Clin Orthop Relat Res. 1994;(307):146-154.

(2) Papalia R, Del Buono A, Osti L, Denaro V, Maffulli N. Meniscectomy as a risk factor for knee osteoarthritis: a systematic review. Br Med Bull. 2011;99:89-106. doi:10.1093/bmb/ldq043

(3) Misir A, Yuce A. The fate of unrepaired stable ramp lesions: a systematic review. Acta Orthop Belg. 2024;90(3):543-548. doi:10.52628/90.3.11174

(4) Hayashi M, Isaji Y, Kurasawa Y, Kitagawa T. Effectiveness of Meniscus Root Tear Repair Versus Conservative Therapy and Adjunct Therapies: A Systematic Review. Cureus. 2024;16(12):e75645. Published 2024 Dec 13. doi:10.7759/cureus.75645