Meniscus tears

The menisci are two wedge-shaped cartilage structures that distribute load across the knee and add stability. Because they protect the joint surface, preserving meniscal tissue matters for the long-term health of the knee.

Tears occur in two broad patterns: acute tears in younger knees, often with a twisting injury or alongside an ACL tear, and degenerative tears that develop gradually in knees with early wear. These behave differently and are treated differently.

Meniscus symptoms often centre on one side of the knee and are provoked by loading the knee in a bent, rotated position.

In younger knees, tears typically occur with a twisting injury on a planted foot, often in sport and frequently alongside an ACL tear. In knees over about forty, the meniscus becomes less resilient and can tear with a routine movement such as standing from a squat, sometimes without a memorable injury at all.

A knee that locks, cannot be straightened, or gives way should be evaluated promptly, as should a knee that swells repeatedly after a twisting injury. Persistent joint-line pain that limits work, sport or sleep after several weeks of rest and activity modification is also worth assessing.

Assessment includes a focused examination of the joint line, ligaments and patellofemoral joint, weight-bearing x-rays to evaluate joint space and alignment, and MRI when it will change the plan. MRI findings are always interpreted against the examination, because meniscal signal changes are common in knees that are not symptomatic from them.

For most degenerative tears without locking, the first course is a structured physical therapy program addressing quadriceps and hip strength, load tolerance and movement mechanics, combined with activity modification. A corticosteroid injection can settle a reactive knee enough to make therapy productive, and viscosupplementation or PRP may be an option where arthritis is a factor.

This approach is given a fair trial and then reassessed honestly. If symptoms remain mechanical and limiting, arthroscopy is discussed.

Meniscus repair uses sutures to bring the torn edges together so the tissue can heal, and is favoured for tear patterns in the vascular portion of the meniscus, particularly in younger patients and alongside ACL reconstruction. It asks more of the patient during recovery: restricted weight-bearing and motion for a period, and a longer path back to sport.

Partial meniscectomy trims the unstable fragment causing mechanical symptoms. Recovery is quicker, but tissue is removed permanently, which is why it is reserved for tears that cannot be repaired.

After a partial meniscectomy, most patients walk comfortably within a couple of weeks and return to low-impact activity soon after, with sport following once strength and control return. After a repair, weight-bearing and deep bending are restricted for a period to protect healing, and full return typically takes several months.

Written rehabilitation protocols are provided so you and your therapist are working from the same plan.

Dr. Horner is a board-certified orthopedic surgeon with fellowship training in sports medicine and shoulder surgery at Rush University Medical Center. Meniscus preservation is prioritized whenever the tear pattern allows, and non-operative care is offered honestly when surgery is unlikely to help.

Patients are seen at Oak Brook on Mondays, Little Village on Wednesdays and St. Charles on Thursdays.