Can a torn meniscus heal without surgery?

What is the meniscus?

Each knee has two C-shaped pieces of cartilage, the menisci, sitting between the thigh bone and the shin bone. They act as shock absorbers, spread load across the joint and help stability. The medial meniscus is on the inner side of the knee and the lateral meniscus is on the outer side.

The outer part of the meniscus has a blood supply and can heal, while the inner part has little blood supply and heals poorly. This is one reason why the location and type of tear influence treatment.

What kinds of tears are there?

Traumatic tears usually happen in younger, active people during a twisting movement with the foot planted, often in sport, and may occur together with ligament injuries such as an ACL tear. Degenerative tears develop gradually as the meniscus changes with age and are common in people over 40, sometimes without any clear injury.

Many degenerative tears are found on MRI in people who have no knee pain, so a tear on a scan does not always explain symptoms.

Is surgery better than exercise for degenerative tears?

A randomised, double-blind trial of 146 people aged 35 to 65 with a degenerative medial meniscus tear and no knee osteoarthritis compared keyhole partial meniscectomy with sham surgery 1. At 12 months, improvement in the Lysholm knee score was 21.7 points after meniscectomy and 23.3 points after sham surgery, with no significant difference in any primary outcome 1.

Another randomised trial of 140 adults with a mean age of 49.5 years compared 12 weeks of supervised exercise therapy with partial meniscectomy 2. At two years, there was no clinically relevant difference in knee scores, thigh strength improved more with exercise at three months, and 19 per cent of the exercise group later chose surgery, with no additional benefit 2.

What does rehabilitation involve?

A clinical practice guideline on meniscal and cartilage lesions supports progressive exercise to restore knee movement, thigh and hip strength, balance and neuromuscular control 3. Programmes often run for around 12 weeks and progress from gentle movement and muscle activation to strength training, step and balance work and, where relevant, running and sport-specific drills.

Temporary modification of activities that provoke pain, such as deep squatting, twisting and kneeling, helps symptoms settle while strength improves.

When is surgery recommended?

Surgery is more likely to be considered for a knee that truly locks, meaning it becomes stuck and cannot straighten, which may indicate a displaced fragment of meniscus. It may also be considered for traumatic tears in younger people that are suitable for repair, tears combined with ligament injuries, and persistent mechanical symptoms despite rehabilitation.

Meniscus repair, stitching the torn meniscus together, aims to preserve the cartilage and requires a longer, more protected recovery than removal of part of the meniscus.

What is recovery like after meniscus surgery?

After a partial meniscectomy, where the torn part is trimmed, most people walk soon after surgery and progress through rehabilitation over several weeks. After a meniscus repair, recovery is slower because the repaired tissue needs to heal, and weight-bearing and deep knee bending may be restricted for a period.

In both cases, rehabilitation focuses on reducing swelling, restoring movement and rebuilding strength and control. Return to sport depends on the procedure, the surgeon's advice and progress in strength and function.

What symptoms need prompt assessment?

A knee that locks and cannot be straightened, rapid swelling within hours of an injury, inability to bear weight, or a knee that repeatedly gives way should be assessed promptly.

A hot, red, swollen knee with fever needs urgent medical attention, as it may indicate infection.

Frequently asked questions