If you have experienced your knee locking up with pain and then loosening after some movement, or if you find it difficult to fully straighten your leg (especially when twisting or bending), you may be suffering from a meniscus tear.
A meniscus tear is a common knee injury often due to twisting motions or overused joints, particularly among older adults. It is estimated to affect 12% to 14% of the population, with approximately 61 cases per 10,000 people yearly (Knadmin, 2022). In this blog, we will discuss the role of the meniscus, the common causes and symptoms of meniscus tears, and how it is diagnosed and treated.
The Meniscus: What It Is and What It Does
The Meniscus: What It Is and What It Does
The meniscus is a small but essential piece of cartilage that acts as a little cushioning between your knee joints. Each knee has two menisci: the medial meniscus found on the inner inside and the lateral meniscus on the outer side. The wedge-shaped soft cartilage helps the knee move smoothly and bear weight more effectively.
The meniscus serves several important functions because of its rigid and flexible structure. It stabilises the joint, distributes body weight evenly, and absorbs shock during movement. Most importantly, it protects the hyaline cartilage that lines the ends of the thigh bone and shin bone.
When the meniscus is damaged or torn, it can compromise the joint’s function. Without the menisci, the knee becomes more prone to arthritis, pain, and structural damage over time.
Why the Meniscus is Vulnerable
The meniscus is prone to injury due to several factors. Its limited blood supply, the complex movements of the knee joint, and the repetitive forces it must withstand all contribute to its vulnerability.
Research shows that only 10% to 30% of the medial meniscus and 1% to 25% of the lateral meniscus receive a direct blood supply (Fox et al., 2011). This limited vascularity significantly affects the meniscus’s ability to heal independently after injury. Tears in the outer vascular regions may heal with conservative treatment. However, tears in the inner, avascular areas often require surgical intervention, as they lack the necessary blood flow to support natural repair.
The hinge-like movement of the knee joint plays a role in the vulnerability of the meniscus (Bumrungrad International Hospital, 2023). While it provides stability, it also limits flexibility, making the joint more prone to injury from twisting, especially when the knee is bent. Sudden changes in direction (common in sports like football, tennis, and basketball) can place high stress levels on the menisci.
What Causes Meniscus Tears
Meniscus tears can range from mild discomfort to serious injuries requiring extended recovery, therapy, or surgery. These injuries are typically caused by:
- Trauma during sports or strenuous work
- Heavy lifting
- Movements that strain a bent knee
In younger, active individuals, meniscus tears often result from sudden, forceful knee movements like twisting or rotating while the foot remains planted. For example, a basketball player making a quick pivot may put intense pressure on the meniscus, leading to an acute tear.
As we age, the meniscus gradually weakens. The cartilage in the knee thinks and becomes less resilient, making it more prone to tearing even with simple movements. Even light recreational activities, such as dancing, can strain the knee joint enough to result in a tear, especially when movements are repetitive or poorly aligned.
Ultimately, meniscus tears can happen to anyone. Whether from athletic exertion or regular daily movement, improper technique or excessive pressure on the knee can significantly impact joint health.
Know the Signs
A meniscus tear can be tricky, but recognising symptoms early can help prevent further damage. The symptoms can change based on how bad the tear is and where it is. Spotting these signs, even if they do not have a clear diagnosis, is an important first step. Here are four key symptoms to help you understand a meniscus tear:
Knee Pain
Pain is usually felt around the area where the knee bends, often in the centre of the joint. It can also occur at the front, back, or sides of the knee. Unlike general cartilage damage, the pain is more focused and can worsen with movement or pressure.
Clicking/Popping Sensation
If you hear or feel a click or pop in your knee when bending or straightening it, especially if it happens consistently at a specific angle, it may signify a meniscus tear.
Catching or Locking of the Knee
Sometimes, the knee may suddenly get stuck in a bent or straight position and become difficult to move. This locking happens when a torn meniscus flap gets caught in the joint, preventing it from moving freely. It can take several minutes or specific movements to unlock the knee.
Swelling
Swelling may appear soon after the injury or following a locking episode. Activities that pressure the knee, like standing for long periods, can worsen the swelling. Since the meniscus supports body weight, ongoing strain can cause inflammation to persist.
Diagnosis & Imaging
When diagnosing a meniscus tear, doctors consider both the pattern and location of the tear as these factors help determine the suited treatment for you. The blood supply to the torn area is also important because tears in well-supplied regions tend to heal more easily.
Diagnosis typically involves a physical examination and imaging tests. During the physical exam, your doctor may:
- Observe how you walk.
- Press around your knee to check for tenderness or swelling.
- Assess your knee’s range of motion.
- Ask about your symptoms and recent physical activities.
Specific tests may be used, such as Thessaly test and McMurray or Meniscus Grind test. Thessaly test is when you stand on one leg while slightly bending your knee, then twist side to side. If this causes pain, it may suggest a tear.
On the other hand, the Meniscus Grind test is done while lying down and your doctor bends and rotates your leg while applying pressure to the knee. Pain or a clicking sound can likewise indicate a torn meniscus.
For imaging, your doctor may recommend an X-ray or an MRI, depending on your symptoms. Since meniscus tears are made of cartilage, an X-ray cannot show them. However, they help rule out potential causes of knee pain, such as osteoarthritis or bone alignment issues that may require connection.
An MRI provides detailed images of soft tissues, allowing your doctor to check for other injuries and confirm the presence of a meniscus tear. It also helps identify the tear’s location, severity, pattern, and whether it’s in an area with good blood supply. Based on these findings, your doctor can determine if the tear is best treated through surgery or non-surgical options.
Meniscus Injury Management & Treatment in Singapore
A/Professor Andrew Quoc Dutton is a Harvard Fellowship-trained orthopaedic surgeon with over 20 years of experience. He specialises in hip and knee surgery and provides expert care in treating complex joint conditions, including meniscus tears, combining recently developed, industry-forward surgical techniques with personalised treatment plants.
If you are experiencing symptoms of meniscus tear, don’t wait — call (+65) 6836 8000 to book a consultation and receive professional orthopaedic care today.
References:
- Knee ligament surgery – NHSMeniscal Injuries Milwaukee, Madison, WI | Sports Injuries Waukesha, Brookfield. (n.d.).
- Meniscus Tears & Sprains – Types of meniscus injuries | Massachusetts General Hospital. (n.d.). Massachusetts General Hospital.
- TikTok – Make your day. (n.d.).
- El Paso Manual Physical Therapy. (2021, June 8). Top 4 causes of Knee meniscus tears [Video]. YouTube.
- Fox, A. J. S., Bedi, A., & Rodeo, S. A. (2011c). The basic science of human knee menisci. Sports Health a Multidisciplinary Approach, 4(4), 340–351.
- Knadmin. (2022b, January 6). Meniscus Injuries of the Knee | PM&R KnowledgeNow. PM&R KnowledgeNow.
- Bumrungrad International Hospital. (2023b, August 22).
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