Knee meniscal tear

A knee meniscal injury refers to a tear of the shock-absorbing cartilage that lines both sides of the knee joint. Meniscus tears can occur in two ways.

In younger individuals, a meniscus can be torn when playing contact sports that require rapid changes of direction such as football, rugby or netball.

In middle aged or older individuals, they may have some areas of degeneration in their menisci. As such a meniscus can suffer a tear when doing innocuous activities, such as walking or climbing stairs.

Pain and swelling of the knee are typical signs that part of the meniscus has torn. These symptoms may increase if the weight is placed on the knee joint, for example when running.

Another common symptom is a ‘locking’ of the knee joint. This is when you are unable to fully straighten your leg and you must then handle the knee to ‘unlock’ the joint. Occasionally, this can be accompanied by a ‘catching’ or ‘clicking’ feeling in the knee. This action may also be associated with pain. You may also have the sensation of the knee giving way in your leg.

Often you may recall the specific activity that you were doing when the injury was sustained. The tear can happen in either the lateral or medial meniscus and it usually follows a trauma that involves the rotation of the knee while it was slightly bent. This movement can also aggravate the pain after the injury, such as when getting into or out of a car.

If the meniscus is torn while you are doing an activity then there will be an immediate onset of pain. The pain will also be localised to the specific meniscus. If the pain is on the inside of the knee then you have torn the medial meniscus.

If the pain is on the outside of the knee then the lateral meniscus has been torn. You may also notice some swelling of the knee later on.

Although the pain and swelling will often improve over the course of a few weeks following a torn meniscus, complete recovery from symptoms may be prolonged. Regular activity and strengthening exercises of the knee can ease symptoms.

Ongoing symptoms may also occur with walking and heavier impact activities such as jogging, running or sports requiring rapid changes of direction.

A doctor or physiotherapist will be able to diagnose a torn meniscus knee by looking a history of your condition or by conducting a physical examination. The main feature on examination is tenderness directly over the joint line of the knee. Other physical tests may help in confirming the diagnosis.

X-rays of the torn meniscus or MRI scans are not routinely required. They may be requested if symptoms are ongoing or the injury is limiting normal activity or surgery is being considered.

The cost of this treatment varies between locations. It also depends on other important factors, such as:

• Which Circle hospital you receive treatment in;
• The reason why you are getting this treatment, and
• Your individual healthcare needs.

The cost includes all your hospital visits, such as initial consultation, the surgery and recovery afterwards when you are an inpatient. We provide high-quality care throughout and we reflect that within our costs.

We also understand that your treatment needs to be tailored to your needs, both physical and emotional. This no one-size-fits-all approach means that the cost of knee replacement surgery often varies from person to person.

Non-surgical management

Your consultant will discuss with you the management of degenerative meniscal tears and the role of surgery in an acute meniscal tear of the knee. The torn meniscus recovery time is around six to eight weeks without surgery.

In the majority of cases, particularly in the older age group, meniscal tear management can help maintain flexibility and strength of the knee joint. Meniscal tear management involves doing a series of regular exercises.

Exercises for a torn meniscus

These exercises need to be performed regularly on the affected knee joint: 5×30 second holds, 2 times per day 3-4 sets of 10 reps, 3-4 times per week 3-4 sets of 10 reps, 3-4 times per week

Corticosteroid injection therapy

For individuals who have done a course of supervised physical therapy and followed the advice of a doctor, a corticosteroid injection may occasionally be offered as a treatment. These injections can be useful for patients who have had significant age-related changes to the meniscus or knee joint. You can read more about local corticosteroid injections here. Corticosteroid injections are not normally offered for individuals with mechanical symptoms, such as locking.

Surgical management

If management of the knee pain fails and the range of motion of the knee remains limited then an orthopaedic surgeon may examine your knee. Arthroscopic (keyhole) surgery may be an effective option for patients who:

• Have trialled a course of non-surgical management without success
• Have pain which limits walking distances or a return to normal sporting activities
• Have a satisfactory Body Mass Index (BMI) or have made lifestyle changes to lose excess bodyweight by working with your doctor

In a few cases where the knee becomes “locked”, an urgent arthroscopy will be offered as the first line of treatment. Please note that there is evidence to indicate that undergoing a knee arthroscopy will increase the risk of requiring a knee replacement in the future. Therefore, a decision on whether to proceed with surgery should only be taken on the basis of current symptoms and limitations.