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A Physical Therapy Guide to Meniscus Tears

Introduction

You may have read news articles recently stating that surgery is no longer necessary for meniscus tears. Scientific research has certainly evolved over recent decades, and surgery is not always the go-to treatment for a meniscus injury as it once was. While surgery still has its place, there are many instances when a physical therapist is the best person to help you with your meniscus injury.

Continue reading to learn more about how a physical therapist can help you assess and recover from an injury to your meniscus.

Table of Contents

Understanding Meniscus Tears

You have two menisci in each knee, medial and lateral. When viewed from above, they are crescent-shaped. In cross section, they are shaped like a wedge. The meniscus transmits force vertically across your knee. The meniscus absorbs shock and transfers weight when you are pushing through your legs, as in walking, running, jumping, or climbing stairs.

Interestingly, the meniscus does not merely serve a mechanical role during physical activity. The menisci also seem to protect the knee joint and cartilage over time.1 They may contribute to proprioception — your ability to sense the position of the joint — in your knee as well.2

A sudden awkward movement, such as a forceful twist, may cause an acute meniscus tear. A succession of micro-injuries over time may cause a chronic meniscus tear. Below, we discuss further whether chronic changes to the meniscus may be a "normal" part of aging.

Acute meniscus tears can occur in both athletes and in people who are less active. In general, chronic meniscal tears tend to occur more in individuals who are older.

Symptoms of a Meniscus Tear

Many of the common symptoms of meniscus tears are similar to other knee injuries, such as pain and swelling, as well as difficulty bearing weight or climbing stairs. If it is an acute (traumatic) injury, you may notice a painful pop at the moment of injury with inability to put any weight on that leg. With chronic or acute meniscus injuries, you may also experience the following:

  • Knee pain along the joint line
  • Sensation of catching or locking when moving the knee
  • Difficulty fully straightening or bending the knee.

Some people even have meniscus tears without any symptoms at all, and are able to live their lives normally. This is particularly true of older individuals with chronic tears. In one study, asymptomatic people had their knees imaged. Among over age 70, more than 50% had meniscus tears or damage without any symptoms.5 In addition to older individuals, this may be the case for athletes. In one study of asymptomatic athletes, meniscus pathology was present in over 30% of those able compete or participate in their sport.6

Just as you develop wrinkles on your skin with age, the same may occur on the inside of your body. The types of studies referenced above indicate that chronic meniscal "damage" may not be anything to cause alarm, as long as it's not causing you any difficulty.

What are the Most Common Causes of Meniscus Tears?

A meniscus tear results from a sudden force or a succession of repeated forces, across the meniscus, beyond the strength of the tissue to withstand that force. This could occur with squatting, pivoting, or possibly with even a sudden misstep.

People who participate in certain sports, such as football, soccer, basketball, and wrestling, are at a higher risk.3

There is also a higher incidence among people who work in occupations that require repetitive activities such as squatting, lifting and carrying weights greater than 10-20kg.4

Diagnosing a Meniscus Tear

Before any assessment, your physical therapist will have you describe the details of your injury, how it happened, and what symptoms you have been having since the injury. Your physical therapist will then perform several tests and measures to determine whether a meniscus tear is likely:

  • Observing your walking and other movements.
  • Measuring your knee range of motion and strength.
  • Performing special tests which apply stress to the meniscus to help determine the likelihood that a meniscus injury is contributing to your pain and symptoms.

Historically, a meniscectomy—partial or full removal of your meniscus—was the typical treatment for a meniscus tear. However, more and more recent research shows conservative treatment, such as physical therapy, to be as effective, if not more effective than surgical removal.7,8,9

In very few instances, a surgical repair is indicated. The type of situation that would warrant surgical repair would be in an acute tear in a young or athletic person, when the tear occurs in the region that has good blood flow.10 If your physical therapist believes this is the case after evaluating you, they would refer you to an orthopedic surgeon. The surgeon would likely recommend magnetic resonance imaging and possible repair surgery, based on their interpretation of the imaging.

What to Expect from Physical Therapy

Once your physical therapist performs your evaluation and diagnosis, they will recommend a plan of care based on the results of their assessment.

Initial symptom management

Your therapist may recommend icing for short durations throughout the day to help with pain. They may also recommend compression wrapping if there is swelling around your knee.

Range of motion

You and your therapist will likely initially focus on restoring your range of motion through the knee joint. The therapist will teach you exercises to perform daily to help you regain the ability to bend and straighten your knee. They may perform manual therapy—hands on stretches, joint mobilizations, and therapeutic massage to the area to enhance the recovery process.

Progressive exercises

Your therapist will also guide you through progressive exercises to help your strength, control, and confidence to return over time. The types of treatments and exercises are quite similar if you have undergone a meniscectomy, or if you have not had surgery.

The ultimate goal of these exercises is for you to return to your prior level of activity: your occupation, your daily routine, or your sport. A secondary goal would be to help you develop the quad strength and coordination necessary to protect the knee joint to decrease the risk of future injury in the long term. Read more about injury prevention below.

Post-operative rehabilitation

After a surgical repair, your surgeon will likely recommend you work with a physical therapist. The initial 4-6 weeks tends to involve a strict protocol of non-weightbearing on your repaired side: using crutches for all standing and walking.

You will then work with your therapist to gradually restore your range of motion, strength, and control, and to return to your prior level of athletic performance.

What If Conservative Treatment Doesn't Work?

A majority of people with a meniscus tear do well with rehabilitation under the guidance of a physical therapist. If the symptoms do not improve even after working with a physical therapist, then you may be a candidate for surgery, likely a meniscectomy, as described above.

Furthermore, if you have worked with a physiotherapist pre-operatively, you will have the advantage of going into surgery with a stronger and more flexible knee, improving your outcomes after surgery.

Preventing Meniscus Tears

Unfortunately there is not a lot of research yet about how to prevent a meniscus injury or tear, in particular. General injury prevention includes:

  • A good warmup before engaging in sport or strenuous activity
  • Training and cross-training to keep your body prepared for the physical demands of your sport or occupation
  • Proper hydration and nutrition
  • Adequate sleep
  • Stress management

Other factors, such as obesity, hypertension, or diabetes, may also increase the risk of musculoskeletal injury. However it is still unclear how much those conditions impact the risk of an injury if we control for other lifestyle factors, such as nutrition or physical activity.

Is It Time to Seek Treatment?

If you suspect a meniscus tear — whether you recently injured your knee or you experience chronic knee problems — a physical therapist will help you get your diagnosis figured out and guide you on the path to recovery.

CityPT can connect you to a therapist with training and experience in knee conditions and sport. Click to book with one of our skilled clinicians.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.

References


  1. Roemer FW, Kwoh CK, Hannon MJ, et al. Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year. Eur Radiol. 27, 404–413 (2017). https://link.springer.com/article/10.1007/s00330-016-4361-z. Accessed July 26, 2022.
  2. Basar B, Basar G, Aybar A, Kurtan A, Basar H. The effects of partial meniscectomy and meniscal repair on the knee proprioception and function. J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(1). [https://journals.sagepub.com/] (https://journals.sagepub.com/doi/pdf/10.1177/2309499019894915). Accessed July 26, 2022.
  3. Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008; 359:1108-1115. https://www.nejm.org/doi/full/10.1056/nejmoa0800777. Accessed July 12, 2022.
  4. Beals CT, Magnussen RA, Graham WC et al. The prevalence of meniscal pathology in asymptomatic athletes. 2016. Sports Med. 46:1517–1524. https://link.springer.com/article/10.1007/s40279-016-0540-y. Accessed July 12, 2022.
  5. Gee SM, Tennent DJ, Cameron KL, Posner MA. The burden of meniscus injury in young and physically active populations. Clin Sports Med. 2020 Jan. 39(1):13-27. https://pubmed.ncbi.nlm.nih.gov/31767103/. Accessed July 12, 2022.
  6. Bahns C, Bolm-Audorff U, Seidler A, et al. Occupational risk factors for meniscal lesions: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021 Dec. 22. https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04900-7#article-info. Accessed July 12, 2022.
  7. McDermott ID, Amis AA. The consequences of meniscectomy. 1 Dec 2016.Bone Joint J. https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.88B12.18140. Accessed July 12, 2022.
  8. Beaufils P, Pujol N. Management of traumatic meniscal tear and degenerative meniscal lesions: save the meniscus. Orthop Traumatol Surg Res. 2017 Dec;103(8S):S237-S244. https://www.sciencedirect.com/science/article/pii/S1877056817302311?via%3Dihub. Accessed July 12, 2022.
  9. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebosurgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. Br J Sports Med. 2020 Aug;54:1332–1339. https://bjsm.bmj.com/content/bjsports/54/22/1332.full.pdf. Accessed July 12, 2022.
  10. Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. Treatment of meniscal tears: an evidence based approach. World J Orthop. 2014 Jul 18;5(3):233-41.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095015/#B20. Accessed July 12, 2022.