Meniscus Tears: What They Are and How We Manage Them

Meniscus tears are one of the most common injuries seen across all sports. Despite how common they are, meniscus injuries and their management are often misunderstood. There are numerous types of meniscus tears and the symptoms related with these differ from person to person. The good news is that many athletes return to full performance without surgery. However, to get the best outcome we need high quality rehabilitation tailored to suit the athlete and the demands of their sport. 

What Is the Meniscus? 

The knee is made up of two menisci, a medial (inside) and lateral (outside). They are C-shaped pieces of cartilage that sit between the femur and the tibia. Their primary role is shock absorption and to evenly distribute forces throughout the knee joint. During sport, they are essential for absorbing high impact forces, providing stability during change of direction and protecting cartilage from repetitive loading.  

How Do Meniscus Tears Happen? 

Meniscus tears generally fall into two broad categories; traumatic and degenerative tears. Common mechanisms involved in traumatic tears include twisting/pivoting on a planted foot, sudden deceleration or change of direction and direct contact or tackling. Degenerative tears are more common in those over 40 but can also occur in younger athletes. These tears develop gradually from repetitive stress to the meniscus. 

Types of Meniscus Tears 

Meniscus tears are often described using specific terms on MRI. While these labels can sound alarming, it’s important to remember that the type of tear does not automatically dictate symptoms, management option or rehabilitation timeframes. Function and response to loading matter more than the name alone. 

Surgical vs Conservative Management 

Research shows that structured physiotherapy can be just as effective as surgery for many meniscus tears, particularly in the absence of mechanical symptoms. Surgery is usually considered when the tear causes the knee to repeatedly lock and/or give way or if symptoms persist despite appropriate rehabilitation. Regardless of what option is chosen, high-quality rehabilitation and hard work is essential for a safe and effective return to sport. 

Physiotherapy Management 

Here at Game Time our goal is not just pain relief, it’s to return you to your sport stronger, more resilient and confident. The most important starting point is for us to take an in-depth history of both the athlete and the injury and decide on the most suitable management option. Both surgical and conservative options follow a similar framework. An example of what your meniscus rehab may look like at Game Time is outlined below:  

1. Protection Phase:  

• Prevent any further injury or damage to the knee 

• Minimise symptoms such as pain and swelling 

2. Reload Phase: 

• Restoring full pain-free range of motion and function 

• Early loading of quadriceps, hamstrings and other surrounding muscles 

• Building capacity required to progress into the strength phase 

3. Strength Phase: 

• Progress into the gym with a program tailored to the injury and demands of the athlete’s sport 

• Regain muscle symmetry (quadriceps, hamstrings, calves, glutes, adductors) 

• Begin plyometric and ballistic exercises 

• Prepare the knee for running 

4. Power Phase: 

• Maximise power output while maintaining strength gains 

• Build running load in preparation for a return to training 

• Exposure to change of direction and contact 

5. Return to Training: 

• Progressive reintegration into training to avoid pain flare ups or reinjury 

• Continuing to maintain hard work in the gym alongside training sessions 

• Exposing the knee to the high demands involved with sport (change of direction, contact, acceleration and deceleration) 

6. Return to Performance: 

• Individualised strength and conditioning aimed at decreasing risk of reinjury and continuing athlete development 

• Pushing the athlete to perform at a higher level than pre-injury 

Return to sport is a criteria-based process, not just a timeline. Progression through each stage is based on test results not time! 

If you’re an athlete dealing with a suspected or diagnosed meniscus tear, early assessment and targeted rehabilitation can make the difference between ongoing frustration and a confident return to sport. Book in with one of our experienced physiotherapists today for only $99 to start your meniscus rehabilitation. Claim offer here!

References 

Abram, S. G. F., Beard, D. J., & Price, A. J. (2019). Arthroscopic meniscal surgery: A national society treatment guideline and consensus statement. Bone & Joint Journal, 101-B(6), 652–659. https://doi.org/10.1302/0301-620X.101B6.BJJ-2019-0126.R1 

Beaufils, P., Becker, R., Kopf, S., Englund, M., Verdonk, R., Ollivier, M., & Seil, R. (2017). Surgical management of degenerative meniscus lesions: The 2016 ESSKA meniscus consensus. Knee Surgery, Sports Traumatology, Arthroscopy, 25(2), 335–346. https://doi.org/10.1007/s00167-016-4407-4 

Englund, M., Guermazi, A., Gale, D., Hunter, D. J., Aliabadi, P., Clancy, M., Felson, D. T. (2008). Incidental meniscal findings on knee MRI in middle-aged and elderly persons. New England Journal of Medicine, 359(11), 1108–1115. https://doi.org/10.1056/NEJMoa0800777 

Katz, J. N., Brophy, R. H., Chaisson, C. E., de Chaves, L., Cole, B. J., Dahm, D. L., Levy, B. A., Mandl, L. A., Martin, S. D., Marx, R. G., Miniaci, A., Reinke, E. K., Richardson, B. E., Rome, B. N., Safran-Norton, C. E., Skoniecki, D. J., Solomon, D. H., & Wright, J. G. (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. New England Journal of Medicine, 368(18), 1675–1684. https://doi.org/10.1056/NEJMoa1301408 

Logerstedt, D. S., Snyder-Mackler, L., Ritter, R. C., Axe, M. J., & Godges, J. J. (2018). Knee pain and mobility impairments: Meniscal and articular cartilage lesions. Journal of Orthopaedic & Sports Physical Therapy, 48(2), A1–A50. https://doi.org/10.2519/jospt.2018.0301 

Sihvonen, R., Paavola, M., Malmivaara, A., Itälä, A., Joukainen, A., Nurmi, H., Kalske, J., Järvinen, T. L. N. (2013). Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. New England Journal of Medicine, 369(26), 2515–2524. https://doi.org/10.1056/NEJMoa1305189 

van de Graaf, V. A., Noorduyn, J. C. A., Willigenburg, N. W., Butter, I. K., de Gast, A., Mol, B. W., Poolman, R. W., & ESCAPE Research Group. (2018). Effect of early surgery vs physical therapy on knee function among patients with nonobstructive meniscal tears. JAMA, 320(13), 1328–1337. https://doi.org/10.1001/jama.2018.13308