This article will be your guide to meniscus tear recovery and hopefully provide some clarity on this common knee issue.  We’ll start with an easy understanding of the meniscus and what it does. Then we’ll help you identify potential issues and what research says about the most current treatment options.

The first note is that not all meniscus tears are the same and management will likely look a bit different for each case.  Nonetheless, with a better understanding of your meniscus, you can help navigate the best treatment option for you.

The Meniscus Picture

As we reviewed in The Quick Guide to Understanding How Your Knee Works, the knee bends and straightens like the hinge on a door.  Inside the hinge are two “C” shaped cartilage rings called the meniscus.  

 

It’s easily termed medial meniscus for the inner ring, and lateral meniscus for the outer ring.  Together they create a bowl for the femur to sit.  It helps provide stability for the knee and disperses loads evenly throughout the joint. It also reduces friction and adds padding to protect the bones from rubbing against each other.

 

When the doc says “bone-on-bone,” they’re trying to explain that the meniscus padding (along with other cartilage) is missing.  But the impression that the body is worn out like old brake pads on a car isn’t accurate and may do more harm than good.

It implies there is no way to fix the issue without a repair and the problem will only get worse.  Yet for many issues, including meniscus tears, a plan of exercise and rest often works well and is an ideal first approach (ref).

How Your Meniscus Becomes Damaged

Meniscus tears can occur in nearly any individual— ranging from elite athletes to older adults. Despite the different demands, abuse to the meniscus usually comes from landing and changing directions.

To help explain this, think of the meniscus as a wet paper towel squished between two rocks. If you merely compress the towel between the rocks nothing will happen. However, if you squish and twist the rocks, you can imagine how it would like the tear the paper towel. 

For older adults, tears develop with much less force. Think of the same wet paper towel analogy, but using a thin towel rather than a thick super-absorbent one. The thinner towel won’t take as much force to tear. Depending on the quality of the meniscus, walking stairs, or sitting or standing from a chair, could be enough force to tear the meniscus.

All of this makes the meniscus seem all too fragile— but it’s far more robust than a wet paper towel. It’s thick and rubbery, built to take a beating. Thus, not everyone with knee pain has a meniscus tear, nor does a tear even mean you’ll have pain. 

When Things Go Wrong 

Depending on the type, degree, and location, people experience different symptoms.  Below you will see the most common types of meniscus tears.  The upper row is a milder version than the more progressed version under it.

 

Additionally, a traumatic tear in a young soccer player will feel and recover much different than general wear and tear that’s common in people over the age of 40.

 

Yet, the common symptoms associated with a meniscus tear include:

• Pain with Clicking*
• Swelling that progressively increases over 24 hours 
• There may be limited ability to straighten the leg completely or bend it all back all the way depending on the location of the tear.

(*Important Note- Many people have clicking in their knees that means nothing, so don’t freak out over the little creaks and pops you get in your joint.)

The gold standard for diagnosing a meniscus tear is by MRI. There are also clinical tests that can hint at a tear, which you can check out one in the video below. You can see it’s an aggressive test that could further your issue, so this is best left to a trained professional.

Acute vs. Chronic Meniscus Tears

The initial question a medical professional will often have about your injury is, “How did it happen?”  

For many tears, it occurs from a sudden or specific event such as a hard cut or land, and many report hearing a pop.  Despite the nature of the injury, most are still able to keep moving and many athletes will continue to compete in their event.  It’s not until later when they notice swelling, pain, or tightness, do they realize there is an issue. 

Meniscus tears due to accident or injury may also involve damage to other stabilizers as well.

“The unhappy triad” is the unfortunate, yet common situation, where the meniscus, anterior cruciate ligament (ACL), and medial collateral ligament (MCL) are torn during a fall, hit, or twist.  It usually occurs with force moving from the outside of the leg inwards with the foot fixed on the ground. All three structures are critical components to the stability of the knee, thus it’s a different issue altogether than just a damaged meniscus.

The other type of meniscus tear is more chronic in nature, without a cause or explanation.  These tears are more likely in people who have arthritis in the joint already. We’ll get more into treatment later, but many times chronic tears don’t make good surgical candidates due to complications from underlying arthritis in the joint (ref).  

Blood Flow

Meniscus tears also differ based on their location within the ring.  The “red-red” zone is the outermost part of the ring and has the best blood flow.  This allows for increased nutrients and metabolites to give the tissue the best opportunity to heal.  The middle section is the “red-white” zone and does not have direct blood flow, but is close enough to the red-red zone to get some trickle over. The white-white zone is the innermost portion of the meniscus ring and has the least amount of blood flow.  Tears in this area can heal, but it’s much less likely.

 

 

Treating Your Meniscus Tear

The good news is many meniscus tears will heal on their own.  Based on what we currently know, the location of the damage in either the red-red zone vs. white-white zone is most telling for the tear’s ability to heal.

Yet some factors make surgery a necessary option.  Sometimes a meniscus tear can act like a hangnail, constantly getting caught up and aggravating things.  Other times, the tear may not be severe, but in a location that gets extra abuse. Like the neverending cut on the finger that’s constantly getting bent, bumped, and reopened 

The Conservative Approach

The difficulty is that you won’t know your opportunity for rehab success without giving it a try.  A physician can make an educated guess, based on imaging and your history, but this is no guarantee.

Acute and or painful tears usually start with a period of rest to allow things to calm down,  followed by physical therapy for 4-6 weeks to improve strength and range of motion.

Some patients will find that their tear won’t afford them the option of conservative treatment.  For example, for a big flap that’s causing locking and severely limiting the range of motion point to surgery as the only option.

Other Potential Aids (That Aren’t Surgery)

Cortisone is a steroid injection into the location of the tear. Cortisone will NOT heal the meniscus, but reduces pain for 3-6 months for more effective stretching and strengthening. 

It’s helpful for taking the sting out of the issue, but won’t likely have any lasting effect without strengthening.  And the most significant trouble with cortisone is the lack of short and long term research on its use.  

PRP (Platelet-rich plasma) is a newer treatment option and a hot-button topic.  The short story is a mixture of your own blood cells is injected into the injury location to promote the healing process. 

Studies on PRP for the meniscus have been promising but not definitive (ref).  The red-red zone appears to be an effective target for PRP, while treatment in the white-white zone seems to be less effective. Again, the red-red zone heals the best because it has the best blood flow to the area. 

Ultimately PRP needs more research. We currently don’t have a great answer for who it works for, making it a system of guess and check.  Insurance is not reimbursing for it yet either, but if you’ve got a couple of hundred dollars lying around, it may be worth it.

Surgical Options

If the conservative options don’t work, there are two surgery types to help correct the issue.

Surgical Removal

One option, called debridement, involves the surgical removal of the torn area of the meniscus.  This is a minimally invasive procedure using a small camera and tools inserted into the joint via keyhole incisions. Typically individuals return to their desired activities between 6-8 weeks. 

Surgical Repair 

Or it’s possible to repair the meniscus rather than cutting out.  This is an arthroscopic procedure as well, using a small stitch to connect the meniscus back to itself.  

Although, this is a delicate process that needs careful management afterward.  Some surgeons describe the procedure as sewing tissue paper back together.  

Depending on what research you are reading, the recovery for this process can take anywhere from 3 months to full year, but the big take-home is that it’s much lengthier than simply cutting it out.

Moving Forward with Your Meniscus Tear Recovery

At this point, this is what many of you are thinking…

I can give rehab a try, but won’t know if it will work for several weeks.

Or, I could have it stitched back together, and be out up to one year.

Or, I could have a doctor cut it out, and go right back to my activities in just a couple of months. 

While the third option probably sounds the most appealing, looking past the 6-8 week recovery, there are long term consequences to consider for removing a piece of the meniscus.

Going back to the original function of the meniscus, its job to help disperse loads within the knee. Removing rather than repairing a torn meniscus leaves more contact of bone to bone, which increases the chance of developing arthritis later in life.

Ultimately it’s worth the time investment if the meniscus can be saved (ref). 

Initially, try conservative management—and I mean seriously try—where you give your knee the best chance to rest and recover properly. Even if it’s not the ultimate fix for your knee, you only lost a few weeks and set yourself up to come back better and stronger after your procedure.

If you decide on the surgical route, it’s worth discussing with your surgeon about debridement vs. repair, and how it will change your rehabilitation process and the long term health of your knees.

Conclusion

Getting past a torn meniscus is not a one-size-fits-all solution. There are many options for managing a meniscus tear.  Hopefully, this laid out some of the information to help you make a more informed decision going forward!

(Flato R, Passanante GJ, Skalski MR, Patel DB, White EA, Matcuk GR Jr. The iliotibial tract: imaging, anatomy, injuries, and other pathology. Skeletal Radiol. 2017;46(5):605–622.)

It’s a thick band of fascia, that intertwines with other fascia starting along the crest of the hip. It then runs along the outside of the leg where it finally attaches to the outer portion of the knee. Along the way, it’s a connecting place for the tensor fasciae latae, or TFL for short, on the front side, and the gluteus maximus muscle on the backside.

It covers a lot of distance, spanning both the hip and knee joint, leading many to assume any pain along the outside of the hip or thigh is some form of IT Band Syndrome. But those are different problems.

IT Band Syndrome a condition tied to a pinpoint spot outside the knee where the IT Band runs over a bony place called the lateral femoral condyle. The long-held belief is that irritation was coming from the IT band rubbing over this bony notch, but now we aren’t so certain (ref).

A 2006 study introduced evidence that the IT band is anchored down too well to roll around and get hung-up on things. Instead, they believed the irritation was more likely from a fat pad, a bursa, or other connective tissue getting compressed under the IT band (ref).

A later study partly refuted this. Saying the IT band does roll along the outside of the knee but didn’t conclude either way if it was an issue of friction or compression (ref). Surprisingly this is where we stand on the IT Band after more than a decade of research.

Regardless of the underlying problem, unless you’re looking to cut something out, you’ll approach it the same way.

Diagnosis

Before we get too carried away, it’s a good idea to determine if IT Band Syndrome is what you’re dealing with.

It’s usually a straightforward diagnosis rarely requiring imaging or even special tests. Pain in the right spot, paired with a recent increase in activity, and no injuries to the knee, point to IT band syndrome. But there are other issues, like the strains to the LCL or a meniscus tear, that may present as an IT band issue.  Our Red Flag Screen is a good evaluation of these other major issues.  Reach out at support@crossoversymmetry.com and we’ll walk you through it.

Unfortunately, the treatment may be lengthy, but with active participation— things like activity modification, stretching and strengthening— most are able to navigate the issue without any advanced treatment.

IT Band Syndrome Treatment

Here’s your game plan to help treat IT band Syndrome.

Rest

I’m sorry to say…this will require rest. It’s the four-letter word that every endurance or workout junkie hates to hear. They also happen to be the ones who will get IT band syndrome.

The unfortunate truth is that stopping provocative activities, like running and cycling, is the most important criterion to calm it down. An interesting side note related to rest and chronic use injuries like IT band syndrome is that many times surgical procedures work simply because it forces the issue of rest.

Start with a timeline of 2-weeks off from running, biking, or anything else that involves repeated flexion and extension of the knee. If you’re looking to get your cardio fix, give swimming a try. Or some runners find that they can bike without provoking symptoms.

After 2-weeks off evaluate the progress and your ability to move forward.

The downtime is relatively easy to navigate and fill with other activities. The real problem and where many hit setbacks is the return to activity.

The usual story is a dedicated runner starts struggling with knee pain. They take time off and do all the rehab stuff, then excitedly wake up one morning feeling better than ever. The happy ending is then ruined when they pick up right where they left off and piss off their knee again.

It’s important to return to activity through graded exposure. After 2-weeks off, take another 2-weeks as an on-ramp to getting back to where you once were. This helps reacclimate the tissues to stress and helps you gauge what you’re truly ready for. Just hit the eject button if you feel things get worse.

Pain Management

Most people with IT band syndrome have mild discomfort throughout the day. Simply backing off activity is probably the best way to deal with the pain issue.

Still, some might find it restricts them from activities and disrupts their rest. In this case, NSAIDs may be useful to fight off pain. But when returning to activity, logic would say it’s best to see how the body responds without any pain inhibitors.

Then for the last resort, corticosteroid injections may be considered, and that’s really only if visible swelling is present.