Updated: Feb 15
“Should I go for meniscus tear surgery?” and “How long is the recovery time for a meniscus tear?” are two questions we often get asked. In this article, we explain what the meniscus does, how it gets injured, why surgery is not the automatic meniscus tear treatment option anymore, and how long this injury takes to recover. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.
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What is a meniscus?
A meniscus is a horseshoe-shaped piece of cartilage that forms part of your knee joint. It sits between the bottom end of your thigh bone (femur) and the top end of your shin bone (tibia). Actually, as you can see in the picture, you have two of them in each knee – one on the inside of the knee (medial meniscus) and one on the outside (lateral meniscus).
Their function is to ensure that the two bones fit together comfortably, and they act as shock absorbers.
What causes a meniscus to tear?
A meniscus typically tears when the knee joint is subjected to a sudden, forceful twisting or a deep squat with a heavy load.
In some cases, this is preceded by a gradual straining of the meniscus due to overuse – when you've really worked it hard in a way that it didn't want to be worked, over a long period of time, or by repetitive straining due to poor biomechanics. In these cases, it can be a very simple movement that finally does it. One of my patients was merely bending down to get logs out for the fire when it happened.
But a healthy meniscus can also be injured by a sudden, traumatic movement, for example when you fall and twist your knee.
Meniscus tear surgery vs. conservative treatment
When I first started studying physiotherapy, at about the turn of the century, meniscus tears were regarded as something that always needed surgery. An arthroscopic partial meniscectomy is the most frequent procedure done by orthopaedic surgeons for meniscus injuries. They enter the knee through a few small incisions and, with the help of a camera, remove part of the meniscus.
A meniscus is meant to absorb shock in your knee, but a meniscus of which a part has been cut away cannot do this as well as before. Research has shown that knees with a meniscectomy are more likely to get arthritis later on.
Also, as soon as you remove a part of a meniscus, you're changing the biomechanics in the knee – how it carries your weight.
A recent study followed people with meniscus tears who have had surgery and who have not had it over a two-year period. They found that there was no significant difference between the two groups after two years: some still had pain, others’ knees felt a bit iffy, and others had no pain.
The researchers also tracked the progress of people who started out with just rehab and no surgery but, later during the two-year period, decided to have surgery after all; they didn’t find any extra benefit from it.
So, surgery is not necessarily a silver bullet for meniscus tears.
There is one exception, though, and this is if you have a bucket handle tear, where the tear in the meniscus turns back on itself, and then the knee gets stuck. If you haven't regained most of your range of movement within four to six weeks, you should definitely go and consult a surgeon to see whether surgery is needed.
But if your knee regains most of its range of movement within the first four weeks, I would recommend that you first go for conservative treatment consisting of a good rehab programme for meniscus tears and follow that for three to six months. As long as you see small improvements, stick with it rather than having surgery.
Will a meniscus tear heal?
This is one of the more frequent questions we get asked. The reason many people ask is because they read on the Internet that a meniscus cannot heal because it has such poor blood supply.
Well, nothing in a joint has a good blood supply, but joint injuries generally do heal. A joint relies on synovial fluid instead of blood to supply it with nutrients and take away waste products. And for the synovial fluid to do its thing, the joint needs to move.
Therefore, you don't need a massive blood supply to get your meniscus functional again, you just need a graded exercise plan and the right nutrients (balanced diet).
We don’t really know whether a tear in a meniscus always knits together again. People’s knees are usually only scanned shortly after they’ve been injured to see what the problem is. If it’s a meniscus tear, it isn’t scanned again later on to see whether it has healed. How well it has healed is judged based on how much your symptoms have improved. The evidence also suggests that a meniscus tear doesn't have to knit together for you to have a fully functional and pain free knee.
Painless meniscus tears
Meniscus tears are also very common in people who have no knee pain. In one study, researchers looked at MRI scans of 991 patients and found that 61% of them had meniscus tears but reported no pain or symptoms in their knees. So, it is possible to have a functional, pain-free knee despite the meniscus being torn.
We’ve also observed this in our own patients. After we’ve rehabbed them successfully from a meniscus tear, they’ve gone back to doing their sport without any problem and then, years later, they get another injury, and when they’re scanned for that injury, it turns out that, by the way, their meniscus is still torn!
So, try not to worry about whether it's healing or not healing. Rather go according to how your knee is functioning; how much more can you do today compared with what you could do yesterday or last week?
Meniscus tear recovery time
A meniscus injury can take a long time to get better.
A mild meniscus tear – especially for younger people – can get better in about four to twelve weeks.
But for older people – and unfortunately, I’m referring here to anyone over the age of 35 – it can usually takes three to six months, but often even longer.
Something that can really increase your recovery time is if you’re trying to force the pace with your rehab. If you overdo it with how many repetitions you’re doing or using too much weight, you can actually aggravate your pain and delay your recovery. Therefore, it's quite important to get some guidance on the right level of exercise for you.
So, the long and the short of it: Recovery times for meniscus tears can vary quite dramatically, but as long as you're seeing small improvements it means that rehab will likely work for you.
Conservative treatment for a torn meniscus
A well-rounded conservative treatment plan for meniscus tears has these elements:
Relative rest – as opposed to total rest – involves starting to use your knee joint gently as soon as possible after you’ve injured it while avoiding movements that cause additional pain.
This is because your joint needs some movement to get that synovial fluid in and out to help your meniscus recover.
However, there are some movements and activities that are likely to increase your pain and delay recovery, and which we advise our patients to avoid during the early stages of recovery:
Twisting movements of the leg. So, for example, if you want to swivel around while standing. Rather move your feet with your upper body.
Deep squatting or kneeling.
Walking on uneven terrain or steep downhills.
Walking or standing for long periods. Your injured meniscus needs time to regain its strength and endurance and it won’t yet be able to tolerate long periods of weight bearing. If you find that your knee is significantly more swollen or uncomfortable in the late afternoons or evenings, then it may be that you’re doing too much.
Rehab exercises for meniscus tears should evolve and progress as your injury recovers.
During the early stage of recovery, the exercises consist of low-load repetitive movements with the aim to feed the joint, improve range of motion, and activate the muscles that support the knee and control your leg. We have created a detailed article and a video demonstrating exercises that can be used during the first few weeks of meniscus tear rehab.
In the later stages of rehab, once your knee can tolerate more load, the exercises should slowly increase in intensity and complexity until you’ve regained the full strength and control required by your sport. It should include exercises that:
Strengthen the muscles around the knee.
Strengthen the muscles that improve your leg control, e.g. gluteal and ankle muscles.
Strengthen your core muscles.
Improve your position sense, which is your brain’s awareness of and ability to control your leg without you having to look at it.
Any activity that involves low-load, repetitive movements of the knee can be a useful cross-training option to help your recovery. The most common two are cycling and swimming.
Cycling with a meniscus tear
Cycling can be a good cross-training option if you have a meniscus tear, but it won’t suit everyone. If your knee feels uncomfortable, check whether it makes a difference if you adjust your saddle (higher is often better) or where you place your feet on the pedals. Often, the knee feels quite stiff and uncomfortable when you start pedalling and then improves as you continue.
If you have a relatively recent meniscus injury and want to try out cycling for cross-training, I would suggest that you use a stationary bike because:
It is easier to control your movements and the resistance against which you pedal.
You may reinjure yourself if you have to stop suddenly while cycling out on the roads.
Your knee should not feel worse after you’ve cycled, and you should not experience actual pain while cycling.
Swimming with a torn meniscus
I’ve shared detailed advice on swimming with a meniscus tear in the video below, but in short: Do NOT do breast stroke – the circular movement of the legs will likely aggravate your injury.
Squeeze a flotation device between your legs to prevent you from kicking if your knee feels uncomfortable when you kick. You can start doing freestyle once you feel your knee is fine with straight-line kicking.
How we can help
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Kise Nina Jullum RMA, Stensrud Silje, Ranstam Jonas, Engebretsen Lars, Roos Ewa M. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ 2016;354 :i3740