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What is a meniscus tear
The menisci are two C-shaped cartilage pads between the thigh bone and the shinbone. The inner (medial) and outer (lateral) menisci absorb load, spread pressure on the cartilage and stabilise the knee.
A tear can be traumatic — from twisting the loaded knee, mostly in younger people and athletes — or degenerative: the tissue thins with age and tears without a clear injury, usually after 40. The medial meniscus is torn about three times more often than the lateral one, most often in the posterior horn.
The outer rim of the meniscus has a blood supply (the “red zone”) and can heal. The inner part (the “white zone”) has almost no vessels, so tears there do not heal on their own — which does not mean they always need surgery.
Meniscus tear at a glance
- ICD-10: S83.2 — acute tear, M23.2 — old tear
- Most often torn: medial meniscus, posterior horn
- Main diagnostics: examination and MRI
- Degenerative tear: usually starts with exercise therapy
- Locked knee: see a doctor promptly
- Exercise programme: usually 6–12 weeks
Types of tears and MRI grades
By cause
Traumatic — an acute tear after a twisting injury, often together with a cruciate ligament injury. Degenerative — gradual wear of the tissue, often with early osteoarthritis.
By location
Anterior horn, body and posterior horn. A tear of the posterior horn of the medial meniscus is the most common MRI finding in adults: this zone carries the most load when bending and squatting.
By shape
Longitudinal, horizontal, radial, flap and complex. A bucket-handle tear is a large longitudinal tear whose fragment flips into the joint and locks it.
| MRI grade (Stoller) | What is seen | What it means |
|---|---|---|
| Grade 1 | Dot-like signal inside the meniscus | Tissue change, not a tear |
| Grade 2 | Linear signal not reaching the surface | Degeneration, not a tear; often found without symptoms |
| Grade 3 | Signal reaches the joint surface | A true meniscus tear |
MRI often shows meniscus tears in people over 50 who have no symptoms. Treatment is therefore decided on symptoms, examination and images together, not on the report alone. See how to read a knee MRI.
Symptoms of a meniscus tear
Medial meniscus
Pain on the inner side of the knee along the joint line, worse when squatting, on stairs and when turning on the standing leg. Sometimes pain at night when lying on the side.
Lateral meniscus
Pain on the outer side of the knee, clicking when bending, pain when twisting the lower leg outwards. Less common, more often in younger people after an injury.
Warning signs
The knee is locked and will not straighten fully, marked swelling within hours of an injury, instability — the knee gives way. In these cases see a doctor within the next few days.
After a traumatic tear, swelling usually appears within a day. A degenerative tear often shows as gradually increasing pain without a clear onset. Similar symptoms occur with osteoarthritis, chondromalacia and a Baker’s cyst — see knee pain.
Diagnosis: examination and MRI
The physician checks tenderness along the joint line and performs specific tests (McMurray, Thessaly). MRI shows the location, shape and grade of the tear and the state of the cartilage and ligaments. An X-ray assesses the stage of osteoarthritis, because advanced osteoarthritis changes the approach.
If you already have an MRI, send it for a second opinion. If not, we arrange an MRI in Munich and forward the images to a clinic physician.
Can a meniscus heal without surgery
Small longitudinal tears in the red zone in younger patients can heal on their own or after a repair. Degenerative tears do not grow back, but symptoms improve noticeably in most patients within 2–3 months of exercise therapy.
Large randomised trials support this. In the Finnish FIDELITY trial, partial meniscectomy for a degenerative tear gave the same result as sham surgery. In the US METEOR trial and a Norwegian trial in the BMJ, physiotherapy was comparable to arthroscopy. Some patients in the physiotherapy groups later had surgery — a normal path if exercise does not help.
Treatment of a meniscus tear
| Option | When it fits | Recovery |
|---|---|---|
| Exercise therapy and physiotherapy | Degenerative tear without locking, tear with osteoarthritis | Usually 6–12 weeks of exercises |
| Injections (PRP, hyaluronic acid) | Pain persists despite exercise, signs of osteoarthritis | Take it easy for 1–2 days, then exercise |
| Meniscus repair | Acute traumatic tear in the red zone, mostly in younger patients | Crutches and limited bending for 4–6 weeks, sport after 4–6 months |
| Partial meniscectomy (arthroscopy) | Locking, bucket-handle tear, mechanical symptoms, failed non-surgical care | Walking at once, sport after 4–6 weeks |
| Meniscus transplant | Rarely: young patients after removal of most of the meniscus | Long rehabilitation, up to a year |
Regenerative methods are an addition to, not a replacement for, exercise therapy and surgery. PRP is sometimes used to reduce pain in degenerative tears or together with a repair; studies are still small, and an injection cannot regrow a meniscus. More options on treatment without surgery.
Recovery time and time off work
Times depend on the type of tear, the treatment and your job. The figures below are guide values; your physician sets the exact time.
| Work | Without surgery | After partial meniscectomy | After meniscus repair |
|---|---|---|---|
| Desk work | 1–2 weeks or no time off | 1–2 weeks | 2–4 weeks |
| Standing work, lots of walking | 2–6 weeks | 3–4 weeks | 6–12 weeks |
| Heavy physical work | 6–12 weeks | 4–6 weeks | 3–6 months |
| Return to running and pivoting sports | 2–3 months | 4–6 weeks | 4–6 months |
You can work with a meniscus tear if the knee does not lock and the pain allows it. Avoid deep squats, kneeling and heavy lifting until you have seen a physician.
When surgery is needed and who should not have injections
Surgery should be discussed promptly
The knee is locked and will not straighten, a bucket-handle tear, a large acute tear in a young patient that can be repaired, or a tear combined with an anterior cruciate ligament rupture and instability.
Injections are not suitable
Active infection, active cancer, clotting disorders, pregnancy, a recent corticosteroid injection into this knee.
Possible risks
Pain and swelling for 1–3 days after an injection, rarely infection. After arthroscopy: swelling, rarely thrombosis and infection. The effect may be absent, in which case the plan is reviewed.
Mention in your request whether the knee locks and whether there was an injury. The coordinator passes this to the clinic physician together with your MRI.
Prices are approximate. Each clinic sets its own conditions and price: we send your request to several clinics and forward their offers so you can compare. Price guidance is on the page “Treatment costs”.
Scientific evidence
Randomised trials on the treatment of degenerative meniscus tears:
- Sihvonen R et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med, 2013.
- Katz JN et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med, 2013.
- Kise NJ et al. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ, 2016.
Frequently asked questions about meniscus tears
Free knee MRI review
Send your MRI and tell us whether the knee locks. The coordinator replies within 24 hours; a clinic physician gives a preliminary opinion in 1–3 business days.
Send MRI