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Meniscus Injury

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  • A meniscus injury refers to damage or a tear in the meniscus, a C-shaped piece of cartilage in your knee. Each knee has two menisci – one on the inner side (medial) and one on the outer side (lateral).

  • The knee meniscus is very important because it plays several key roles in keeping your knee joint healthy and functional. It has multiple functions:
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    1. Shock Absorption
      The meniscus acts like a cushion between your femur (thigh bone) and tibia (shin bone). It absorbs the impact when you stand, walk, run, or jump - helping to protect the bones and articular (joint) cartilage from wear and tear.

    2. Joint Stability
      It deepens the socket where the femur sits, adding stability to the knee. It is especially important for preventing the knee from sliding or twisting, which could lead to injury.

    3. Load Distribution
      The meniscus helps spread out the weight evenly across the knee. Without it, the force gets concentrated in smaller areas, which can speed up cartilage breakdown and lead to arthritis.

    4. Lubrication & Nutrition
      It assists with the distribution of synovial fluid (your knee’s natural lubricant). This fluid helps reduce friction and nourishes the cartilage.

    5. Proprioception
      The meniscus has nerve endings that contribute to proprioception (your body's ability to sense movement and position). This is important for balance and coordination.

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    When the meniscus is torn or damaged, it can cause pain, swelling, limited motion, and instability in the knee. This can cause limitation in your activities, and increases the risk of developing osteoarthritis over time.

  • Meniscus injuries can happen due to:

    • Sudden twists or turns while the foot is planted, often during sports

    • Aging and wear and tear, making the meniscus cartilage more prone to injury

    • Direct impact or trauma to the knee

    • Pain in the knee joint, especially when twisting or rotating

    • A popping sensation during the injury

    • Difficulty fully straightening or bending the knee

    • Feeling of the knee locking or catching

    • Intermittent swelling of the knee

  • Diagnosis of a meniscal injury involves combining the symptoms, physical examination and imaging tests of the knee. MRI is usually necessary to confirm the diagnosis, but also to characterise the tear to allow a recommendation on successful treatment.

  • Vertical (longitudinal) 
    Runs along the length of the meniscus, and is common in younger athletes. It is often repairable, especially if in the outer (vascular) zone.
    Bucket-handle 
    A specific type of displaced longitudinal tear where the inner portion of the meniscus flips into the joint like the handle on a bucket. It often causes locking of the knee, and surgical repair is usually needed.
    Radial 
    A radial tear starts at the inner edge of the meniscus and radiates outward. If it involves the full width, it completely defunctions the meniscus, increasing forces on the articular cartilage.
    Horizontal (cleavage) 
    Runs parallel to the joint surface, splitting the meniscus into upper and lower parts. It is often associated with degeneration, and may be treated with a combination of partial meniscectomy (tidy up) and repair of any remaining tissue.
    Oblique (parrot-beak)
    This comprises an angled tear, combining features of radial and longitudinal tears. They are often unstable and may catch or lock. Treatment usually involves partial meniscectomy.
    Flap Tear
    A small piece of the meniscus is torn and forms a flap. This flap can catch in the joint and cause pain or locking, and is usually treated with meniscectomy.
    Complex Tear
    A combination of multiple tear patterns, and common in older, degenerative menisci. They are typically not repairable and may require partial meniscectomy.

    Types of meniscus tear

  • Treatment depends on whether the tear is traumatic or degenerative, size, character, and location of the tear.
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    • Traumatic versus degenerative: 

      • Traumatic tears (often in younger individuals), tend to be a clean tear, in a single plane. The meniscal tissue is usually of good quality, and so these tears are usually amenable to surgical repair.

      • Degenerate tears (usually older individuals) are often sustained from a relatively minor injury, and occur because the quality of the meniscus is poor due to the natural aging process. The tear is often in multiple directions, and fragmented. Degenerate tears, therefore are often irreparable, meaning that surgery is not always indicated. The majority of pain from a degenerate tear will settle within three months without any treatment.

    • Medications: Simple over-the-counter painkillers, including paracetamol and ibuprofen are often effective in treating the pain associated with meniscal tears. Topical formulations (painkiller gels and creams) applied directly to the area may also help.

    • Physiotherapy: Sometimes physiotherapy to improve the strength of the muscles around the knee may help, but this is often not indicated.

    • Steroid injection: in the case of a degenerate tear, injection into the knee (or into the tissue alongside the meniscus) can often help to settle down the irritation and inflammation of the lining of the knee (synovium) caused by the torn meniscus. This may be performed under ultrasound guidance by a radiologist.

    • Surgery: In cases of persistent pain or mechanical symptoms, meniscus repair or partial meniscectomy (removal of torn portion) is usually indicated and relieves symptoms. See here for more information.

  • If you have ongoing knee pain, swelling, or instability, or if your knee locks or gives way. Early treatment can prevent further damage and support a quicker recovery.

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