Signs and Symptoms
Symptoms depend on the size and location of the tear. Common signs include:
- Pain along the inside or outside of the knee, often at the joint line
- Swelling that builds over the first day or two after an injury
- Pain with twisting, pivoting, squatting or deep bending
- Catching or clicking inside the knee
- Locking, where the knee gets stuck and will not straighten fully
- A feeling that the knee gives way
A knee that truly locks and cannot be straightened is a sign that a torn piece may be caught in the joint, and it should be checked soon.
What Causes It?
Each knee has two menisci: the medial meniscus on the inside and the lateral meniscus on the outside. They act as shock absorbers and help the knee stay stable.
- Acute tears usually happen when you twist or pivot on a planted foot, as in tennis, pickleball, soccer, basketball or a misstep off a curb. They can occur along with an ACL tear.
- Degenerative tears develop as the meniscus becomes less flexible with age. They can happen with simple movements, such as standing up from a squat, and often occur alongside early knee arthritis.
How We Diagnose It at POPB
Your physician will ask how the pain started and examine the knee for joint-line tenderness, swelling, range of motion and ligament stability. X-rays are taken on site to check for arthritis or other bone problems, since that changes the treatment plan.
If the exam suggests a meaningful tear, or if the knee is locking, an MRI can be done in our office to show the size, type and location of the tear. Meniscus tears are evaluated by Dr. Wolfson, Dr. Chalal, Dr. Press and Dr. Adelman. Dr. Adelman focuses on non-surgical care, including ultrasound-guided injections.
Non-Surgical Treatment Options
Many meniscus tears, especially degenerative tears in people over 40, improve without surgery. Non-surgical care may include:
- A short period of rest from twisting and deep squatting, with ice and elevation for swelling
- Physical therapy in our office to restore motion and strengthen the thigh and hip muscles, with your therapist working from the same chart as your physician
- Anti-inflammatory medication, if safe for you
- A cortisone injection to calm pain and swelling, when appropriate
- PRP (platelet-rich plasma, prepared from your own blood) in selected cases. Evidence is still developing, results vary, and insurance usually does not cover it.
Surgical Options
Surgery is usually considered when the knee locks, when a tear keeps causing catching and swelling despite therapy, or when a younger patient has a tear that may heal if repaired. Meniscus surgery is done by arthroscopy, a minimally invasive procedure using a small camera and instruments through small incisions, at one of the surgery centers where our surgeons operate.
- Meniscus repair: the torn edges are stitched together so they can heal. This keeps as much meniscus as possible and is most often an option for younger patients and tears in the outer part of the meniscus, which has a better blood supply.
- Partial meniscectomy: the unstable torn portion is trimmed away and the healthy meniscus is left in place.
Dr. Wolfson, Dr. Chalal and Dr. Press perform knee arthroscopy. If an ACL tear is present too, it is often treated in the same operation.
Recovery
With non-surgical care, many people improve over about 6 to 12 weeks. After a partial meniscectomy, most people walk the same day and return to daily activities within a few weeks. A meniscus repair takes longer because the tissue must heal: crutches and a brace are often used for several weeks, and a return to sports usually takes around 4 to 6 months. Timelines vary with the tear and your activity goals.
Physical therapy after surgery is usually done in our office, so your therapist and surgeon can adjust your plan together.
Insurance and Cost
Medicare and most commercial PPO plans generally cover office visits, X-rays, MRI, physical therapy, cortisone injections and medically necessary arthroscopy, subject to your co-pay, co-insurance and deductible. Some plans require prior authorization for MRI or surgery, so ask our team.
PRP is usually not covered by insurance. HMO and managed-care plans require a referral from your primary care physician before your visit. Work injuries are handled through workers' compensation, and we coordinate the paperwork with your employer and carrier.
When to Be Seen
Call our office if knee pain and swelling after a twist have not settled within a week or two, or if the knee catches, locks or gives way. If you cannot bear weight after an injury or the knee looks deformed, go to the emergency room or call 911.
