What the meniscus is and how it gets damaged
The menisci are two crescent-shaped structures made of fibrocartilage, lying between the thigh bone and the shin bone. They spread the load in the knee, stabilise it and protect the joint cartilage. Tears fall into two main groups, which are managed in completely different ways.
An acute tear usually happens in a younger, active person when twisting on a bent knee – often together with an anterior cruciate ligament injury. A degenerative tear develops gradually, most often after the age of 40, without a clear injury, and is sometimes part of wider changes in the joint. Here the MRI picture and the symptoms often do not match.
In the assessment we check tenderness along the joint line, range of motion, the presence of swelling and how the knee responds to a squat and a loaded twist. Individual meniscal tests are not very accurate, so we look at the whole picture: the mechanism of injury, how the symptoms have developed and whether the knee really locks or just briefly “catches”. That distinction decides the next steps.
Surgery or exercise
For degenerative meniscus tears in people over 40, several large studies have compared arthroscopy with an exercise programme, and also with a sham procedure. The conclusions were consistent: arthroscopy does not give clearly better results, and exercise provides a comparable improvement in pain and function, without the risks of surgery. That is why guidelines recommend starting with conservative treatment in this situation.
It is different with an acute tear where the knee genuinely locks and cannot be straightened, and with a meniscus injury that accompanies a ligament rupture. Then you need an orthopaedic consultation, and the decision about a procedure – removing part of the meniscus or repairing it – is made by the doctor. If the meniscus changes are part of a wider joint disease, see also the page on knee osteoarthritis.
Rehabilitation after arthroscopy
After a partial meniscus removal you can usually put weight on the knee from the first days, and the return to everyday activity takes a few weeks. After a meniscus repair, healing takes time – for the first weeks the surgeon most often limits the range of flexion and weight-bearing, and loaded squats are avoided for longer. These rules vary between centres, which is why we always work to the surgeon’s instructions.
What both situations have in common is that after the procedure you need to regain full extension, get the swelling under control and rebuild the quadriceps. When the ligament has been reconstructed at the same time, we run the rehabilitation as after ACL reconstruction, with the extra restrictions that come from the meniscus repair.
With conservative treatment the plan is similar, only without the post-operative restrictions: we settle the joint, and then for several weeks run graded strength training and movement control exercises. Manual therapy can help regain range, but it is the exercise that determines the outcome.
Return to sport and when to come in
The return to running, jumping and sports with changes of direction is decided by leg strength, no swelling after training and the quality of movement, not by the number of weeks since the procedure alone. We compare the strength of both legs and check how the knee responds to each stage before you go back to full training. If your knee hurts, swells after exercise or “catches” and you do not yet have a diagnosis, start with an assessment – we will check whether the symptoms really come from the meniscus and whether an orthopaedic consultation is needed. You can arrange an appointment via the Contact page.