The meniscus is a C-shaped cartilage in the knee that cushions and stabilises the joint. Tears in the meniscus are common and can result from sudden twisting movements, sports injuries, or gradual wear over time. The type of tear affects symptoms, treatment, and recovery. This guide explains the different types of meniscus tears, their symptoms, and available treatment options.
Types of Meniscus Tears
Radial Tear
A radial tear extends from the inner edge of the meniscus towards the outer rim, cutting across the cartilage fibres. It is one of the most common types of meniscus injuries and often occurs due to sudden knee movements, such as pivoting or squatting. These tears occur in the central part of the meniscus, where blood supply is limited, reducing the likelihood of natural healing. They typically cause sharp pain, difficulty straightening the knee, and occasional catching sensations. Small radial tears may be managed with physiotherapy, but larger ones often require surgery to restore knee function.
Horizontal Tear
A horizontal tear splits the meniscus into upper and lower layers. It is commonly associated with gradual degeneration rather than a sudden injury, making it more frequent in older adults. This type of tear can cause a flap of cartilage to form, which may get caught in the joint, leading to clicking or locking sensations. While some horizontal tears are painless, others may cause persistent irritation or mechanical symptoms. If the torn tissue becomes unstable, treatment may involve physiotherapy or surgical trimming to remove the loose fragment.
Vertical (Longitudinal) Tear
A vertical tear runs along the natural fibre orientation of the meniscus, parallel to its outer edge. These tears often develop from twisting movements, making them more common in athletes. When they occur in the outer portion of the meniscus, where blood flow is better, there is a chance they may heal with physiotherapy or surgical repair. If a vertical tear enlarges, it can develop into a bucket-handle tear, where a section of the meniscus flips into the joint, causing the knee to lock. This requires surgical intervention to reposition or remove the displaced fragment.
Oblique (Parrot-Beak) Tear
An oblique tear has a sharp, curved shape that resembles a parrot’s beak. It often starts as a minor radial tear that worsens over time. This type of tear can cause intermittent pain and catching sensations, particularly during knee movement. Smaller oblique tears may not require surgery, and symptoms can improve with physiotherapy. If the tear becomes unstable or interferes with movement, surgical trimming may be required.
Complex Tear
A complex tear combines multiple tear patterns within the same meniscus, often involving both radial and horizontal components. These tears are more common in degenerative meniscus injuries and typically affect older adults. Due to their irregular shape, complex tears are less likely to be repairable, and treatment focuses on symptom management or removing unstable fragments. Physiotherapy can help strengthen the knee and maintain mobility, but if symptoms persist, surgical intervention may be considered.
Symptoms of a Meniscus Tear
Meniscus tears can cause a range of symptoms depending on their type, size, and location within the knee. Some tears cause immediate discomfort, while others start with mild irritation that worsens over time.
Pain: Typically felt along the knee joint and may worsen with movements such as bending, twisting, or squatting. The intensity can vary from a dull ache to sharp discomfort, depending on the severity of the tear.
Swelling: May develop soon after the injury, but in some cases, it appears gradually over several hours or even days. The knee may feel tight or appear visibly swollen due to fluid buildup in the joint.
Locking or Catching: Some meniscus tears create loose fragments of cartilage that can interfere with smooth knee movement. This may cause the knee to catch or lock in place, making it difficult to straighten or bend fully.
Instability: The knee may feel weak or give way unexpectedly, particularly during walking or changing direction. This can make weight-bearing activities feel unsteady and increase the risk of further injury.
Treatment for a Meniscus Tear
The approach to treatment depends on the size, location, and severity of the tear, as well as the individual’s level of activity. Some tears heal with non-surgical methods, while others require surgery to restore knee function.
Non-Surgical Approaches
For smaller tears or those that do not cause significant mechanical symptoms, non-surgical treatments may be recommended to reduce pain and improve knee stability.
Rest and Ice: Limiting activities that put stress on the knee and applying ice packs can help reduce swelling and discomfort. Avoiding movements that involve deep bending, twisting, or sudden direction changes can prevent further irritation.
Physiotherapy: Strengthening the muscles around the knee improves joint stability and reduces strain on the meniscus. Targeted exercises enhance flexibility, balance, and movement control, supporting knee function and reducing the risk of reinjury.
Bracing: A knee brace may provide additional support and limit excessive movement, helping to stabilise the joint and protect the meniscus while it heals. This is particularly useful for individuals who experience instability or difficulty walking.
Medication: Anti-inflammatory medication may help relieve pain and swelling, particularly in degenerative meniscus tears where inflammation contributes to discomfort. These medications should be used as directed and may be combined with other treatments for better symptom relief.
Surgical Treatments
If a meniscus tear is large, affects knee function, or causes ongoing symptoms despite non-surgical management, surgery may be considered. The choice of procedure depends on the type and severity of the tear.
Meniscus Repair: If the tear is in a well-supplied blood region, sutures may be placed to support natural healing. This procedure is often preferred for younger patients and those with recent injuries, as it helps preserve knee function. However, recovery is longer compared to other surgical options, as the meniscus needs time to heal.
Meniscectomy: If the damaged portion of the meniscus cannot be repaired, the torn section may be trimmed to remove unstable or irritating tissue. This procedure has a shorter recovery period than a meniscus repair but may increase the risk of knee arthritis over time, especially if a large portion of cartilage is removed.
Meniscus Transplant: In cases where the meniscus is severely damaged or completely removed, a donor meniscus may be used to replace the lost cartilage. This procedure is typically reserved for younger individuals with significant meniscus loss who have ongoing knee pain and instability despite previous treatment.
Surgical treatment is followed by a structured rehabilitation programme to restore knee function, strength, and flexibility. Recovery time varies depending on the procedure and individual factors such as age, activity level, and overall knee health.
When to Seek Medical Advice
Some meniscus tears may heal with rest, but certain symptoms indicate the need for a professional assessment. If knee pain persists for more than a few days, swelling does not improve, or the knee frequently locks, catches, or feels unstable, the tear may be affecting joint function. A medical evaluation can clarify the best treatment approach and help prevent additional joint damage.
Conclusion
Meniscus tears vary in type and severity, affecting treatment and recovery approaches. Some heal with rest and physiotherapy, while others require surgical intervention to restore knee stability. Recognising the symptoms and seeking appropriate treatment can help prevent long-term joint issues. If knee discomfort or restricted movement persists, consulting a specialist can provide clarity on the best course of action.
If you’re experiencing knee pain or difficulty moving, schedule a consultation to discuss your options.
