One of the most common things we see in our clinic is knee pain. Acute knee injuries are usually swollen, warm, stiff, painful. It may be difficult to put weight on your knee or bend it. We often are asked whether the knee injury means surgery is needed and what the prognosis is for the knee pain resolving over time. The purpose of this blog post is to go over one of the most common knee injuries we see – meniscal tears – and what you can expect as someone who has a meniscal tear.
What is the Meniscus?
The meniscus is a piece of fibrous cartilage between the joint surfaces of the femur and tibia. It has a high water content, and its composition and shape changes over time. It it thought to help absorb shock between the two bones and has a bit of a stabilizing effect on the knee.
Is a Meniscal Tear a Serious Injury?
Thankfully, meniscal tears are usually not serious injuries, although they can seriously hurt! Sudden meniscal tears can occur when twisting on your knee or squatting deeply. The episodes of pain and swelling afterward should go away with time. In fact, a 2020 study showed that 97% of people without symptoms at all had abnormalities in the meniscus when they had an MRI of their knee (Horga et al, 2020). Large bucket-handle tears are more stubborn, but were also present in those without any knee pain. If your knee locks in place and you have to manually straighten it, this may indicate a meniscal tear that might require more intervention.
Does a Meniscal Tear Require Surgery?
Again, in most cases, no. Meniscal tears, especially degenerative meniscal tears that become inflamed, do not require surgery. In fact, current guidelines recommend against surgery in knees with a meniscal tear when osteoarthritis is present. In that scenario, surgery is often unsuccessful and often leads to a second knee surgery to replace the knee. It is tempting for experts to override these recommendations when they think they can really help the patient, but research actually shows that experienced orthopedic surgeons did no better than chance at predicting who would benefit from surgery for degenerative meniscal tears.(van de Graf et al, 2020)
How Does Physical Therapy Help Improve My Knee Pain from a Meniscal Tear?
Physical therapy can be a good option for someone with knee pain after a meniscal injury. As you can see, if meniscal tears are common in people without pain, you shouldn’t need to “fix” the meniscus surgically in order for the knee pain to improve. Treatment in physical therapy often consists of education to reduce the swelling and learn how to move your knee to ensure it doesn’t stiffen. This may include manual therapy techniques such as joint mobilization. Your physical therapist may also begin to gradually teach you how to load your knee and improve the strength of muscles around your knee over time.
Horga LM, Hirschmann AC, Henckel J, Fotiadou A, Di Laura A, Torlasco C, D’Silva A, Sharma S, Moon JC, Hart AJ. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020 Jul;49(7):1099-1107. doi: 10.1007/s00256-020-03394-z. Epub 2020 Feb 14. PMID: 32060622; PMCID: PMC7237395.
van de Graaf VA, Bloembergen CH, Willigenburg NW for the ESCAPE Research Group, et al
Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey of 194 orthopaedic surgeons who made 3880 predictions
British Journal of Sports Medicine 2020;54:354-359.