Knee pain following a sporting injury, sudden twisting or pivoting movement—or even a seemingly minor movement in a middle-aged or older person—should not always be dismissed as a routine strain. In some cases, the pain may be associated with a meniscus tear, an injury involving one of the two C-shaped pieces of fibrocartilage inside the knee that help distribute load, absorb shock, and contribute to joint stability.

How Does a Meniscus Tear Happen?

In younger and physically active individuals, acute meniscus tears commonly occur when the knee twists or rotates, particularly during sports involving sudden changes in direction or pivoting. Football, cricket, badminton, basketball, and similar activities can place considerable rotational stress on the knee.

With increasing age, the meniscus can undergo degenerative changes and become more vulnerable to tearing. In such cases, a tear may sometimes occur with relatively minor movement and may not necessarily involve a major sporting injury.

Know the Warning Signs

Symptoms can vary depending on the type and severity of the injury. Common symptoms may include:

•        Pain along the inner or outer side of the knee

•        Swelling, particularly following activity

•        Clicking, catching or a sensation of the knee getting stuck

•        Difficulty fully bending or straightening the knee

•        Pain during squatting, climbing stairs or twisting movements

•        A sensation of instability or the knee “giving way”

Particular attention is warranted if the knee becomes locked or cannot fully straighten. A displaced or displacing acute meniscal tear that restricts knee movement may require prompt orthopaedic assessment.

Why Is the Meniscus Important?

The meniscus is an important component of the knee. It helps distribute forces across the joint, contributes to stability, and helps protect the articular surfaces.

For this reason, when surgery is indicated, contemporary orthopaedic guidance recommends preserving as much functional meniscal tissue as possible. Meniscal preservation is considered important because removal of meniscal tissue can increase the risk of subsequent degenerative changes in the knee.

Not every meniscus tear requires surgery.

Depending on the patient’s symptoms, age, activity level, tear characteristics, and associated knee problems, treatment may include activity modification, rehabilitation and physiotherapy, and appropriate medical management. Some patients improve without an operation.

However, certain acute tears—particularly displaced tears that restrict movement or tears with potential for successful repair—may be considered for surgical treatment. In appropriately selected cases, meniscus repair may be preferred over removing part of the meniscus when the tear has healing potential.

The decision must be individualized rather than based solely on the presence of a tear on imaging.

How Is a Meniscus Tear Diagnosed?

Clinical assessment remains an important part of diagnosis. An orthopaedic specialist may evaluate the knee through history-taking and physical examination, including specific meniscal tests.

For an acute meniscal injury, MRI is the preferred imaging modality because of its high diagnostic accuracy. The final diagnosis and treatment plan should, however, be based on the patient’s symptoms, clinical examination, and imaging findings taken together.

Does a Meniscus Tear Mean Surgery?

Not necessarily.

The appropriate treatment depends on several factors, including the patient’s age, symptoms, activity requirements, type, size and location of the tear, its potential to heal or be repaired, and the presence of other knee injuries.

When non-operative treatment is appropriate, rehabilitation and physiotherapy can play an important role. When surgery becomes necessary, the current treatment principle is to preserve as much healthy, functional meniscal tissue as possible.

Can You Return to Sports?

Many patients can return to sports and an active lifestyle following appropriate diagnosis, treatment and rehabilitation. The time required varies considerably depending on the injury, treatment selected, and individual recovery.

Following meniscus repair, rehabilitation generally takes longer than after partial meniscectomy because the repaired tissue needs time to heal.

Early recognition of a significant meniscal injury may help identify patients who could benefit from meniscal preservation or repair.

About the author: Dr. Rajeev Raman, Consultant – Arthroscopy & Sports Medicine Specialist, JBCH, Salt Lake & Manipal Hospital, Broadway, Salt Lake, Kolkata