Meniscus Tear: Do You Need Surgery or Will It Heal?

A meniscus tear is a tear in one of the two rubbery C-shaped cushions inside your knee. What to do depends mostly on HOW it happened.

Wear-and-tear tears, usually over about 40, often with no clear injury: physio and exercise first. Keyhole surgery to trim the tear did no better than a FAKE operation in trials
A sudden twisting injury, especially in younger people: may need a repair, particularly if the knee locks

Many tears found on MRI in people over 50 cause no pain at all.

Symptoms

Pain along the inside or outside edge of the knee joint
Swelling, often coming on over a day after an injury
Pain with twisting, squatting or getting up from a low chair
Catching or clicking
True locking: the knee suddenly jams and WON’T straighten. This is different, and needs a prompt check

Pain at the front of the knee, around or behind the kneecap, is more often runner’s knee than a meniscus tear.

Meniscus tears are very common on MRI as we age, including in people with no knee pain
In one large study, most tears found in people over 50 were in knees that didn’t hurt
So a tear on your scan may not be the cause of your pain, especially if you also have early arthritis. See knee arthritis

Over 40, a torn meniscus on MRI is often just a sign of an ageing knee, not the thing that needs fixing.

Exercise: strengthening the thigh and hip muscles over about 12 weeks. In trials, this did as well as keyhole surgery for most people
Surgery to trim the tear (partial meniscectomy) did no better than a fake operation in a well-known trial. Guidelines now strongly advise against it for wear-and-tear knee problems
Removing meniscus may also raise the long-term risk of knee arthritis
Catching and clicking alone aren’t usually a reason for surgery. They often improved just as much with exercise

A locked knee that won’t straighten, from a flap of meniscus caught in the joint. Usually needs surgery soon
A younger person with a fresh tear in a part that can heal. REPAIRING (stitching) the meniscus protects the knee better long term than cutting it out
A tear alongside an ACL injury is often repaired at the same time. See ACL recovery

Pain on the inside of the knee after a twist or a blow from the side can also be a ligament sprain rather than a meniscus tear. See MCL injury.

Exercise-based treatment: most people notice improvement over 6 to 12 weeks
After trimming (meniscectomy): walking within days. Back to most activities in about 4 to 6 weeks
After repair: much slower, because the stitched meniscus needs time to heal. Often limited weight or bending for about 6 weeks, and around 4 to 6 months before sport. Follow your surgeon’s rules closely

Keep walking within comfort. Avoid deep squatting and twisting on a bent knee for a while
Ice and elevation when it swells
Sit-to-stands, step-ups and straight leg raises, building up over weeks
A stationary bike is usually well tolerated

The knee locks and won’t fully straighten
It swelled up quickly (within hours) after an injury. That can mean an ACL tear or bleeding in the joint
You can’t put weight on it
The knee is hot, red and swollen, especially with a fever

Worn tear: strengthen, don’t trim. Injury tear that locks: see a surgeon soon.