Anatomy
Each knee has two menisci — one on the inner (medial) side and one on the outer (lateral) side. They spread load across the joint, provide shock absorption and add stability. Their blood supply is limited, particularly in the inner portions, which influences healing potential.
Types of meniscal tear
- Vertical / longitudinal tears
- Horizontal / flap tears
- Radial tears
- Oblique tears
- Bucket-handle tears (a displaced longitudinal tear)
- Complex tears with multiple patterns
- Root tears at the attachment of the meniscus to the bone
Symptoms
- Pain on the side of the tear
- Swelling, usually appearing within days rather than minutes
- Catching or locking sensations
- Inability to fully straighten the knee
- Feeling of instability or giving way
Non-surgical treatment
Many tears settle with conservative care, especially small degenerative tears:
- Rest and activity modification
- Ice and elevation
- Anti-inflammatory medications
- Physiotherapy and a guided exercise programme
- Low-impact exercise to maintain fitness
Surgical treatment
Meniscectomy
The torn portion of the meniscus is trimmed away through knee arthroscopy, leaving healthy meniscus intact. Recovery is generally rapid.
Meniscal repair
Where the tear is in the better-supplied outer portion and the tissue quality is good, the tear is sutured back together. Recovery is slower than meniscectomy but preserves the meniscus and reduces long-term arthritis risk.
Meniscal root repair
A specialised repair where the root of the meniscus has pulled off the bone. The root is re-attached through a small bone tunnel to restore its load-sharing function.
Degenerative tears
Tears occurring with established knee arthritis often respond better to anti-inflammatory medications, physiotherapy and injections than to arthroscopic surgery. In some cases, the underlying arthritis is the dominant problem and knee replacement is more appropriate.