Meniscal tear - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Meniscal tear can result from playing sport or normal activities of daily living. The athletic population is at greatest risk, especially those who participate in pivoting or twisting sports (commonly American football, soccer, rugby, and basketball).
Common complaints include catching, locking, or buckling of the knee, knee pain, or any combination of these symptoms.
A magnetic resonance imaging scan is considered the most accurate and noninvasive method of diagnosis. Meniscal tears are mainly either traumatic or degenerative.
Small tears (<1 cm) are initially managed conservatively. Large tears (≥1 cm) and those with root involvement rarely heal spontaneously and are treated arthroscopically by meniscus repair (if torn in a clear, clean pattern) or, less commonly, partial meniscectomy (if torn in a complex pattern).
Successful outcome requires close follow-up and adherence to physical therapy.

Arthroscopic view of horizontal cleavage tear of lateral meniscus (arrow)

From the collection of Dr Kevin R. Stone

Quick Reference

History & Exam
- Key Factors
- Other Factors
More information...
Diagnostics Tests
More information...
Treatment Options
More information...

Definition

Epidemiology

Etiology

Pathophysiology

Images

Anatomical structures around the menisci
Types of meniscal tears
MRI scan demonstrating horizontal cleavage tear of medial meniscus (arrow); white horizontal line separates the inferior and superior portions of the torn meniscus
Arthroscopic view of horizontal cleavage tear of lateral meniscus (arrow)
Arthroscopic view of suture repair of lateral meniscus (arrow)

Citations

Key Articles

Kopf S, Beaufils P, Hirschmann MT, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2020 Apr;28(4):1177-94.[Abstract][Full Text]
American Physical Therapy Association. Knee pain and mobility impairments: meniscal and articular cartilage lesions, revision 2018. 2018 [internet publication].
American College of Radiology. ACR Appropriateness Criteria® acute trauma to the knee. 2019 [internet publication].[Full Text]

Referenced Articles

1. Kopf S, Beaufils P, Hirschmann MT, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2020 Apr;28(4):1177-94.[Abstract][Full Text]
2. American Physical Therapy Association. Knee pain and mobility impairments: meniscal and articular cartilage lesions, revision 2018. 2018 [internet publication].
3. Abram SGF, Beard DJ, Price AJ, et al. National consensus on the definition, investigation, and classification of meniscal lesions of the knee. Knee. 2018 Oct;25(5):834-40.[Abstract][Full Text]
4. Rodkey WG, Steadman JR, Li ST. A clinical study of collagen meniscus implants to restore the injured meniscus. Clin Orthop Relat Res. 1999 Oct;(367 suppl):S281-92.[Abstract]
5. Thorlund JB, Hare KB, Lohmander LS. Large increase in arthroscopic meniscus surgery in the middle-aged and older population in Denmark from 2000 to 2011. Acta Orthop. 2014 Jun;85(3):287-92.[Abstract][Full Text]
6. Howard DH. Trends in the Use of Knee Arthroscopy in Adults. JAMA Intern Med. 2018 Nov 1;178(11):1557-8.[Abstract][Full Text]
7. Abram SGF, Judge A, Beard DJ, et al. Temporal trends and regional variation in the rate of arthroscopic knee surgery in England: analysis of over 1.7 million procedures between 1997 and 2017. Has practice changed in response to new evidence? Br J Sports Med. 2019 Dec;53(24):1533-8.[Abstract][Full Text]
8. Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008 Sep 11;359(11):1108-15.[Abstract][Full Text]
9. Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: a 10-year study. Knee. 2006 Jun;13(3):184-8.[Abstract]
10. Ding C, Martel-Pelletier J, Pelletier JP, et al. Meniscal tear as an osteoarthritis risk factor in a largely non-osteoarthritic cohort: a cross-sectional study. J Rheumatol. 2007 Apr;34(4):776-84.[Abstract][Full Text]
11. Church S, Keating JF. Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br. 2005 Dec;87(12):1639-42.[Abstract][Full Text]
12. Snoeker BA, Bakker EW, Kegel CA, et al. Risk factors for meniscal tears: a systematic review including meta-analysis. J Orthop Sports Phys Ther. 2013 Jun;43(6):352-67.[Abstract][Full Text]
13. Englund M, Roos EM, Lohmander LS. Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. Arthritis Rheum. 2003 Aug;48(8):2178-87.[Abstract][Full Text]
14. Stärke C, Kopf S, Petersen W, et al. Meniscal repair. Arthroscopy. 2009 Sep;25(9):1033-44.[Abstract]
15. Orchard J. Is there a relationship between ground and climatic conditions and injuries in football? Sports Med. 2002;32(7):419-32.[Abstract]
16. Vandermeer RD, Cunningham FK. Arthroscopic treatment of the discoid lateral meniscus: results of long-term follow-up. Arthroscopy. 1989;5(2):101-9.[Abstract]
17. Zielinska B, Donahue TL. 3D finite element model of meniscectomy: changes in joint contact behavior. J Biomech Eng. 2006 Feb;128(1):115-23. [Abstract]
18. Farina EM, Lowenstein NA, Chang Y, et al. Meniscal and mechanical symptoms are associated with cartilage damage, not meniscal pathology. J Bone Joint Surg Am. 2021 Mar 3;103(5):381-8.[Abstract]
19. Lohmander LS, Englund PM, Dahl LL, et al. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. 2007 Oct;35(10):1756-69. [Abstract]
20. Ikeuchi H. Arthroscopic treatment of the discoid lateral meniscus: technique and long-term results. Clin Orthop Relat Res. 1982;(167):19-28.[Abstract]
21. Ford GM, Hegmann KT, White GL Jr, et al. Associations of body mass index with meniscal tears. Am J Prev Med. 2005 May;28(4):364-8.[Abstract]
22. Ferrer-Roca O, Vilalta C. Lesions of the meniscus. Part I: macroscopic and histologic findings. Clin Orthop Relat Res. 1980;(146):289-300.[Abstract]
23. Granan LP, Forssblad M, Lind M, et al. The Scandinavian ACL registries 2004-2007: baseline epidemiology. Acta Orthop. 2009 Oct;80(5):563-7. [Abstract][Full Text]
24. Stone KR, Stoller D, De Carli A, et al. The frequency of Baker's cysts associated with meniscal tears. Am J Sports Med. 1996 Sep-Oct;24(5):670-1. [Abstract]
25. Stratford PW, Binkley J. A review of the McMurray test: definition, interpretation, and clinical usefulness. J Orthop Sports Phys Ther. 1995 Sep;22(3):116-20.[Abstract][Full Text]
26. Diduch DR, Insall JN, Scott WN, et al. Total knee replacement in young, active patients: long-term follow-up and functional outcome. J Bone Joint Surg Am. 1997 Apr;79(4):575-82.[Abstract]
27. American College of Radiology. ACR Appropriateness Criteria® acute trauma to the knee. 2019 [internet publication].[Full Text]
28. Crawford R, Walley G, Bridgman S, et al. Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: a systematic review. Br Med Bull. 2007;84:5-23.[Abstract][Full Text]
29. Quarles JD, Hosey RG. Medial and lateral collateral injuries: prognosis and treatment. Prim Care. 2004 Dec;31(4):957-75;ix.[Abstract]
30. National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. Oct 2022 [internet publication]. [Full Text]
31. Allen PR, Denham RA, Swan AV. Late degenerative changes after meniscectomy: factors affecting the knee after operation. J Bone Joint Surg Br. 1984 Nov;66(5):666-71.[Abstract]
32. Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee: a preliminary report. Am J Sports Med. 86 Jul-Aug;14(4):270-5. [Abstract]
33. O'Connor JP, Lysz T. Celecoxib, NSAIDs and the skeleton. Drugs Today (Barc). 2008 Sep;44(9):693-709.[Abstract]
34. Bergenstock M, Min W, Simon AM, et al. A comparison between the effects of acetaminophen and celecoxib on bone fracture healing in rats. J Orthop Trauma. 2005 Nov-Dec;19(10):717-23.[Abstract]
35. Brignardello-Petersen R, Guyatt GH, Buchbinder R, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open. 2017 May 11;7(5):e016114.[Abstract][Full Text]
36. Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ. 2017 May 10;357:j1982.[Abstract][Full Text]
37. Skou ST, Hölmich P, Lind M, et al. Early surgery or exercise and education for meniscal tears in young adults. NEJM Evid. 2022 Jan 25;1(2).[Full Text]
38. Beaufils P, Becker R, Kopf S, et al. The knee meniscus: management of traumatic tears and degenerative lesions. EFORT Open Rev. 2017 May;2(5):195-203.[Abstract][Full Text]
39. Barber-Westin SD, Noyes FR. Clinical healing rates of meniscus repairs of tears in the central-third (red-white) zone. Arthroscopy. 2014 Jan;30(1):134-46.[Abstract][Full Text]
40. Abram SGF, Judge A, Beard DJ, et al. Adverse outcomes after arthroscopic partial meniscectomy: a study of 700 000 procedures in the national Hospital Episode Statistics database for England. Lancet. 2018 Nov 17;392(10160):2194-202.[Abstract][Full Text]
41. Thorlund JB, Englund M, Christensen R, et al. Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears: comparative prospective cohort study. BMJ. 2017 Feb 2;356:j356.[Abstract][Full Text]
42. Eijgenraam SM, Reijman M, Bierma-Zeinstra SMA, et al. Can we predict the clinical outcome of arthroscopic partial meniscectomy? A systematic review. Br J Sports Med. 2018 Apr;52(8):514-21.[Abstract][Full Text]
43. DeFalco RA, Ricci AR, Balduini FC. Osteonecrosis of the knee after arthroscopic meniscectomy and chondroplasty: a case report and literature review. Am J Sports Med. 2003 Nov-Dec;31(6):1013-6.[Abstract]
44. Waddell DD, Bert JM. The use of hyaluronan after arthroscopic surgery of the knee. Arthroscopy. 2010 Jan;26(1):105-11.[Abstract]
45. De Bruycker M, Verdonk PCM, Verdonk RC. Meniscal allograft transplantation: a meta-analysis. SICOT J. 2017;3:33.[Abstract][Full Text]
46. Pereira H, Fatih Cengiz I, Gomes S, et al. Meniscal allograft transplants and new scaffolding techniques. EFORT Open Rev. 2019 Jun;4(6):279-95.[Abstract][Full Text]
47. Zaffagnini S, Poggi A, Reale D, et al. Biologic augmentation reduces the failure rate of meniscal repair: a systematic review and meta-analysis. Orthop J Sports Med. 2021 Feb;9(2):2325967120981627.[Abstract][Full Text]
48. Xie YL, Jiang H, Wang S, et al. Effect of platelet-rich plasma on meniscus repair surgery: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2022 Aug 19;101(33):e30002.[Abstract][Full Text]
49. Migliorini F, Cuozzo F, Cipollaro L, et al. Platelet-rich plasma (PRP) augmentation does not result in more favourable outcomes in arthroscopic meniscal repair: a meta-analysis. J Orthop Traumatol. 2022 Feb 7;23(1):8.[Abstract][Full Text]
50. Insall JN, Scott WN, eds. Surgery of the knee, 3rd ed. New York, NY: Churchill Livingstone; 2001.
51. O'Connor JP, Lysz T. Celecoxib, NSAIDs and the skeleton. Drugs Today (Barc). 2008;44:693-709.[Abstract]
52. Bergenstock M, Min W, Simon AM, et al. A comparison between the effects of acetaminophen and celecoxib on bone fracture healing in rats. J Orthop Trauma. 2005;19:717-723.[Abstract]