Condition guide
The meniscus is a C-shaped piece of cartilage in the knee that acts as a cushion between the thigh bone and the shin bone. In young people it usually tears when the knee is twisted; after the age of 40, it usually tears through gradual wear. For tears caused by wear, studies have found exercise therapy to be as effective as surgery.
Each knee has two menisci, an inner one and an outer one. They spread the load, protect the joint and help keep the knee stable. In young people and athletes, a tear usually happens when the knee twists while the foot is planted on the ground; it can occur together with an anterior cruciate ligament injury. After the age of 40, tears that develop through wear, without any obvious incident, are more common, and they are often an early part of osteoarthritis.
A tear on your MRI does not mean that the tear is causing your pain: many people aged 50–90 who have no symptoms also have a meniscus tear.
A study in Norway of 140 people aged 35–60 with a wear-related meniscus tear compared a 12-week supervised exercise programme with arthroscopic removal of part of the meniscus (partial meniscectomy). After two years there was no significant difference between the two groups, while thigh muscle strength improved more in the exercise group.
In the ESCAPE trial in the Netherlands, involving 321 patients aged 45–70, physiotherapy was also no worse than surgery at both 2 and 5 years, and osteoarthritis progressed at a similar rate in the two groups. About a third of the patients in the physiotherapy group later chose to have surgery.
A guideline from an international panel of experts, published in the BMJ in 2017, strongly recommends against arthroscopic surgery for wear-related knee problems (including meniscus tears). Tears that appear after a sudden injury, and cases where the knee locks and will not straighten, are assessed separately by an orthopaedic specialist.
Exercises at home
You may feel some mild, bearable pain during exercise; if the pain and swelling are no worse the next day, carry on. In the first few days after a new injury, do the movements gently, without forcing them.
Lie on your back and place a rolled-up towel under your knee. Press the back of your knee down into the towel to tighten the muscle at the front of your thigh; hold for 5 seconds, then relax. You can do this during painful spells too.
10 reps, 3 times a dayLie on your back and bend your other knee. Tighten your thigh and, keeping your knee straight, lift your leg up to the level of your other knee; hold for 2–3 seconds, then lower it slowly.
10 reps, 2–3 setsSit up straight on a chair. Slowly straighten your knee, tightening the muscle at the front of your thigh; hold for 3 seconds, then lower it slowly. As it gets easier, you can add a light weight at your ankle.
10 reps, 2–3 setsLie on your back with your knees bent and feet on the floor. Squeeze your buttocks and slowly lift your hips, hold for 2–3 seconds, then lower.
10 reps, 2 setsLean your back against a wall with your feet one step out from it. Slide your back down the wall, bending your knees no further than a half squat; hold for a few seconds, then come back up. If the pain increases, bend less.
8–10 reps, 2 setsHolding on lightly to the kitchen counter, stand on one leg with your knee slightly bent. As it gets easier, hold on less.
30 seconds, 3 times on each legVideo
From the YouTube channel of US physical therapists Bob Schrupp and Brad Heineck.
The first steps of rehabilitation after a meniscus tear.
A non-surgical approach to wear-related knee problems.
Usually not. Meniscus tears are very common on MRI after the age of 50, and more than half of these people have no knee symptoms at all. For wear-related tears, studies have found exercise therapy to be as effective as surgery. The decision is based on your symptoms and an examination, not on the MRI image.
Only the outer edge of the meniscus has a blood supply; small tears in this area can heal, but tears in the inner part usually do not heal on their own. Even if the tear remains, though, pain and function often improve considerably with exercise.
A brief catching sensation is common and often eases with exercise. If the knee gets stuck in one position and cannot be straightened, however, this may be because a torn fragment is caught inside the joint. In that case, see an orthopaedic specialist.
Once pain and swelling are under control and the strength of your thigh muscles is close to that of your other leg, you can gradually return to sport. Start with low-impact activities such as walking, cycling and swimming; leave sports that involve jumping and sudden turns until last.
See a doctor without delay if you have any of the following:
Sources
İhsan Eren