Meniscal tear: symptoms, recovery and when surgery is needed

The NHS describes a meniscus tear as a common type of damage to cartilage in the knee, cartilage that sits between the bones and protects them when you move. South Tees Hospitals explains there are two menisci in each knee, one on the inner side and one on the outer side, and that tears are grouped into acute traumatic tears and degenerative tears.

The distinction matters because the likely course and best treatment differ. A fresh tear in a young knee after a twist is a different problem from age-related fraying in a middle-aged knee that has been gradually wearing for years, even if the pain sounds similar.

The NHS says a tear usually happens when you twist your knee playing sport, but it can also follow more minor injuries such as twisting when standing up. Swelling may not start for a few hours or days. It lists knee pain or tenderness, stiffness or swelling, difficulty bending, straightening or moving the knee, the knee giving way when you try to stand, and a crunching or clicking feeling. It adds that the symptoms can be similar to sprains.

South Tees Hospitals notes that acute traumatic tears usually cause localised knee pain and sometimes locking, where the knee gets stuck in a position and you cannot release it, even with help. In degenerative tears some people get episodes of pain, swelling, giving way and, or locking, while many have no problems at all because wear and fraying are a normal part of ageing, rather like grey hair or wrinkles.

• Knee pain or tenderness, often worse with twisting

• Swelling that may appear hours or days after the injury

• Clicking, crunching or catching

• The knee giving way

• Difficulty bending or straightening fully

• True locking, where the knee is stuck and cannot be moved

The NHS advises stopping exercise and resting the knee when you can during the first few days, applying an ice pack or a bag of frozen peas wrapped in a towel for up to 20 minutes every 2 to 3 hours, wrapping a bandage around the knee or wearing a knee support (removing it for sleep), keeping the leg raised on a pillow and taking paracetamol or ibuprofen gel or tablets. It advises against heat packs, hot baths, alcohol, massaging the knee and carrying anything heavy, and says not to stop moving the knee completely: after a few days of rest, try gentle movements.

A pharmacist can advise on painkillers and knee supports. In many areas, the NHS says, you may be able to refer yourself to community musculoskeletal (MSK) services for help such as physiotherapy without a GP referral.

The NHS says to see a GP if knee pain is stopping you doing normal activities or affecting your sleep, is getting worse or keeps coming back, has not improved after home treatment, or if the knee is stiff for more than 30 minutes after waking.

Get an urgent GP appointment or NHS 111 help for very bad knee pain after a fall or injury, being unable to walk or put weight on the knee, swelling with hot skin, knee pain with a high temperature or feeling hot, cold or shivery, or being unable to bend or straighten the leg. Go to A&E if the knee has moved out of place, changed shape or is pointing at an odd angle, or if you have tingling or no feeling in the knee, leg or toes. Do not drive yourself to A&E.

South Tees Hospitals says degenerative tears happen in middle-aged or older people, often without a specific injury, and that factors such as being overweight may raise the risk. Management often starts with an X-ray to see if arthritis is present, physiotherapy, weight loss if overweight, and pain relief medicines that allow you to exercise. Corticosteroid injections may provide temporary relief if suitable.

Scans: the same leaflet says an MRI scan will not usually be required because degenerative meniscal tears occur in most people over 40. It also says episodes of knee pain often settle naturally over weeks or months even without treatment, which is important to know before considering surgery. The NHS Tayside referral guide for clinicians says degenerative tears are managed conservatively unless there is a large unstable fragment with a good history of true locking, citing evidence that surgery is no better than leaving it alone, and recommends routine referral to MSK physiotherapy.

The NHS Tayside guide advises urgent referral when the knee is locked, which may reflect a displaced bucket-handle tear, or in a young patient under 30 with a good history of an acute tear, such as getting up from squatting. It says bucket-handle tears and unstable large peripheral tears are typically treated surgically, and that peripheral undisplaced tears may be considered for repair, particularly if recent and in younger patients, although the effect of repair on the natural history is not known.

For unstable flap tears with clicking, catching or giving way but no locking, the same guide suggests a trial of conservative management, around six months, because the flap can be cleaved off over time with resolution of symptoms. It also notes that pain alone may not be a good indication for surgery and may be due to secondary effects rather than the tear itself.

The NHS says physiotherapy may be recommended to reduce pain and improve movement and strength, and that if damage is severe you may need arthroscopy (keyhole) surgery to repair or remove the damaged cartilage. South Tees Hospitals says surgery may be needed, especially if you have locking and giving way regularly (mechanical symptoms), or persistent pain or swelling where non-surgical treatments have been tried, and that surgery may not be helpful if arthritis is present on your X-ray.

Whether a tear is repaired or trimmed depends on its pattern, location and your age and activity, and your surgeon will explain the choice. After any surgery, rehabilitation with a physiotherapist is part of recovery. If you are considering a private orthopaedic opinion, ask whether non-operative treatment has been tried, what scan findings mean for you and what benefit is realistic.