Meniscus Tear

A traumatic tear happens in a specific twisting injury, usually in a younger person, often with immediate swelling and sometimes with the knee locking. A degenerative tear develops gradually in a knee that already has wear, and is frequently found incidentally.

Meniscal tears are common on scans of people with no knee pain: in a population study of 991 adults aged 50 to 90, 61% of those whose MRI showed a tear had had no knee pain, aching or stiffness in the previous month 3. Finding one alongside pain does not establish that it is the cause.

Multiple randomised trials have found that arthroscopic partial meniscectomy for degenerative tears produces outcomes no better than exercise therapy, and no better than placebo surgery, at one and two years 1 2.

This is one of the better-replicated findings in orthopaedics and it has changed guidelines. It has changed practice more slowly, which is why it is worth knowing before consenting to an arthroscopy.

A knee that is truly locked and cannot be fully straightened. A displaced bucket-handle tear. A traumatic tear in a young active person, particularly a repairable peripheral tear where preserving the meniscus matters for the long term.

Catching or occasional locking on its own is a weaker reason than it sounds: in a sham-controlled trial, partial meniscectomy relieved these symptoms no better than a placebo operation 4.

Progressive quadriceps and hip strengthening, range restoration, and graded return to loading. Twelve weeks of consistent work is the usual trial period before any surgical decision in degenerative tears 2 6.

After surgery, the protocol depends on whether the meniscus was trimmed or repaired — a repair needs months of protection where a trim does not. We ask the surgeon for it in writing.

Randomised trials comparing arthroscopic partial meniscectomy with exercise therapy, and with placebo surgery, have found no meaningful advantage to the operation for degenerative tears without mechanical locking, and a 2022 Cochrane review rated the evidence of little or no benefit over placebo surgery as high certainty 5.

That evidence changed guidelines internationally and it has not reached most patients. Where a scan shows a degenerative tear and the knee does not lock, exercise is the first-line treatment rather than a delay before surgery.

It depends on whether the torn part was removed or repaired. In a 2026 meta-analysis of studies in athletes, return to sport took an average of 2.1 months after partial meniscectomy and 5.8 months after repair, and similar proportions got back to their pre-injury level, 84.4% and 81.3% 7. These are averages across studies, not a timetable for an individual knee.

The quicker return after removal has a longer-term cost: clinical and radiological outcomes years later are worse after partial meniscectomy than when the meniscus is preserved 8. That is why a European consensus puts preservation first wherever the tear allows it, and advises that a needed repair be done as early as possible 8.