A meniscal tear is one of the most frequent knee injuries, especially among athletes and active individuals. However, it can also affect older adults due to natural wear and tear in the knee joint. Whether the tear results from a sudden twist or gradual degeneration, early care and proper rehabilitation are key to recovery.
What Is a Meniscal Tear?
The meniscus is a crescent-shaped cartilage that lies underneath the thigh bone (femur) and above the shin bone (tibia), basically present between the knee joint. There are two menisci in each knee, one on the inner or medial side and one on the outer or lateral side which usually help with shock absorption, load distribution, and joint stability.
A meniscal tear occurs when this cartilage gets damaged, either from injury or long-term stress. Depending on the location and type of tear, symptoms can vary from mild discomfort to severe pain and restricted motion.
Symptoms
- Sharp pain either in the inner or the outer side of the knee
- Swelling that may develop within a day of injury
- Difficulty fully straightening or bending the knee
- Locking or catching sensation in the joint
- Knee giving way during movement
Causes
Meniscal tears can happen in different ways:
- Sudden injury – twisting the knee mistakenly while bearing heavy weight, very common in sports
- Squatting or deep knee bending under load
- Degeneration – age-related thinning and fraying of the cartilage
- Previous knee injuries or instability
Types of Meniscal Injuries (Tears)
Meniscal tears are classified based on their pattern, location, and severity. Common types include:
- Longitudinal Tear
A vertical tear along the length of the meniscus, often on the inner (medial) side. If not treated on time, it can further develop into a bucket handle tear. - Bucket Handle Tear
A displaced form of a longitudinal tear where a portion of the meniscus flips into the joint space, causing locking or restricted movement. - Radial Tear
Starts from the inner edge of the meniscus and moves outward. This tear disrupts load transmission and often requires surgical trimming. - Horizontal Tear
It splits or breaks off the meniscus into upper and lower parts, often due to degeneration. Fluid may collect inside, forming a cyst. - Flap Tear
An irregular-shaped tear where a small portion of the meniscus becomes loose, often causing catching or irritation during movement. - Complex Tear
A combination of different tear patterns, usually found in degenerated menisci or a severe knee injury. It’s harder to repair and often managed conservatively or with partial meniscectomy.
Treatment Options
Conservative (Non-surgical) Management:
- Rest, ice & elevation in the early stage
- Activity modification to avoid aggravating movements
- Use of knee support or brace if needed
- Anti-inflammatory medications for pain relief
- Physiotherapy to restore function
Surgical Treatment:
If the tear is large, causing locking or not healing with conservative care, arthroscopic surgery may be advised. The torn portion may be either repaired or trimmed depending on the location and blood supply.
Physiotherapy Management of Meniscal Tear
Pain Management:
- Accelerated Healing Therapy: Advanced electrotherapy solution for better healing and pain relief.
- Cold therapy: Best suggested for reducing swelling around the joint.
Rehabilitation
1. Acute Phase (0–2 weeks)
Goals: Reduce inflammation, protect the joint, and prevent stiffness
Physiotherapy Focus:
- Rest and protection: Advise limited weight-bearing with crutches (if needed)
- Cold therapy: Ice packs 3–4 times daily to control swelling
- Compression and elevation to reduce joint effusion
- Pain-free range-of-motion (ROM) exercises:
- Heel slides
- Passive knee flexion and extension
- Isometric muscle activation:
- Quadriceps setting
- Hamstring co-contractions
2. Subacute Phase (2–6 weeks)
Goals: Regain mobility, initiate strengthening, and begin weight-bearing
Physiotherapy Focus:
- Progressive weight-bearing with or without assistive devices
- Active ROM exercises to restore full flexion and extension
- Muscle strengthening:
- Closed kinetic chain exercises (e.g., mini squats, step-ups)
- Resistance band exercises for quads, hamstrings, glutes
- Neuromuscular re-education:
- Proprioception drills using balance boards, single-leg stands
- Patellar mobilization if indicated to prevent stiffness
3. Strengthening & Functional Phase (6–12 weeks)
Goals: Enhance muscle endurance, improve stability, and regain confidence in movement
Physiotherapy Focus:
- Advance strengthening:
- Lunges, wall squats, bridges, hamstring curls
- Leg press
- Gait training: Normalize walking pattern
- Core and hip stability training to support proper knee mechanics
- Sport-specific drills: For athletes, incorporate running, jumping
4. Return to Activity/Sports Phase (After 12 Weeks or as Guided by Ortho Protocol)
Goals: Full function, dynamic knee control, and safe return to high-level activities
Physiotherapy Focus:
- Plyometrics and agility drills: Jump-landing, ladder drills, cone drills
- Endurance conditioning: Cycling, swimming
- Movement pattern correction: Emphasize proper knee alignment during all activities
- Education: Injury prevention strategies and home exercise continuation
Final Thoughts
Meniscal tear can lead to long-term issues like joint instability or early-onset arthritis if it’s not taken seriously. However, with timely diagnosis and a guided rehabilitation plan, most people recover well and return to their normal activities without surgery.
If you’re dealing with persistent knee pain or clicking sounds during movement, consider seeing a physiotherapist for assessment and a customized recovery program.
