The lateral and medial menisci are fibrocartilaginous structures composed of collagen, proteoglycans, glycoproteins, and cellular elements. They consist of approximately 70% water and have a crescent shape. Together, they cover about 70% of the tibial articular surface and perform essential functions such as load distribution, providing stability in all planes, and acting as stabilizers that rotate similarly to a hinge, preventing knee displacement. Additionally, they play a crucial role in shock absorption, preventing wear on the cartilage that covers the knee joints.

Meniscal Tears

Meniscal tears are one of the most common knee injuries, especially among athletes, although anyone can suffer them at any age due to acute trauma or degenerative changes associated with aging.

Tears are classified based on their appearance and the location in the meniscus where the damage occurs.

Isolated Meniscal Tears

These injuries typically occur when there are twisting forces or "sudden turns" in the knee, especially when bearing significant weight (such as landing from a jump or changing direction quickly). The menisci, which act as shock absorbers, can be damaged by these types of movements. Risk situations include positions with high degrees of flexion, such as kneeling, squatting, lifting or carrying heavy objects, and performing activities involving rapid acceleration or deceleration.

Complex Meniscal Tears

A traumatic impact on the knee can also cause tears along with the primary stabilizing ligaments, such as the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL). After the age of 40, relatively less force is required to cause a tear in people with degenerative changes in the menisci, often associated with osteoarthritis (OA).

Types of Meniscal Tears

1. Longitudinal Tear: Occurs along the length of the meniscus, usually on the outer edge.
2. Radial Tear: Extends from the inner edge outward.
3. Horizontal Tear: Often caused by wear and tear, separates an upper and lower portion of the meniscus.
4. Bucket Handle Tear: A fragment of the meniscus displaces toward the center of the knee, resembling a bucket handle. This type of tear requires surgery as it can block the joint.
5. Parrot-Beak Tear: Caused by compression and shearing forces. Depending on symptoms, it can be repaired or may require partial meniscectomy.
6. Flap Tear: A small fragment breaks off and may become trapped in the joint, causing knee locking. Generally requires surgery to remove it.

Symptoms of Meniscal Tears

Meniscal tears can cause a popping sensation in the knee at the time of injury. Most people can continue walking immediately after the trauma, but once the adrenaline subsides or with rest, symptoms of pain, stiffness, and swelling begin to appear.

Main Symptoms:

1. Pain
2. Stiffness and swelling
3. Locking or catching of the knee
4. Sensation of the knee giving way
5. Inability to move the knee through its full range of motion

Diagnosis of Meniscal Tears

McMurray Test

During this test, the patient lies down with legs extended and relaxed. Then, the specialist lifts the leg and bends it toward the chest while applying pressure on the knee and heel. The movement is repeated by rotating the knee sideways to evaluate the menisci. If there is a tear, the patient may experience pain, an audible click, or a popping sensation in the joint.

Apley Test

The patient lies face down, and the specialist flexes the knee to 90 degrees while applying pressure and rotating the foot to identify possible discomfort during rotational movement.

Thessaly Test

The patient stands on one leg, supported on the ground, while the specialist holds them with extended hands. Then, the patient flexes the knee to 5° and rotates the femur over the tibia medially and laterally three times. The test is positive if the patient feels discomfort in the joint line or perceives locking or clicking.

Ege's Test

The patient performs a sumo-style squat, with feet pointing outward, and then slowly stands up. Subsequently, they perform another squat with feet pointing inward. The test is positive if pain or clicking is felt around 90° of flexion.

Finochietto's Test

The patient lies down with the knee flexed at 90 degrees and the foot resting on the examination table. The specialist applies inward pressure using the forearm until discomfort or a jump in the joint is perceived.

Conservative Treatment or Arthroscopy? What's Better for a Meniscal Injury?

When discussing meniscal injuries, the key to deciding between conservative treatment or surgical intervention lies in the zone of the tear. If the injury occurs in the so-called "red zone"—the outer part of the meniscus with good blood flow—there's a possibility it may heal on its own. However, when the tear affects the inner two-thirds, the "white zone" with poor blood supply, the options change. Here, blood nutrients don't reach with the same intensity, so tears in this area rarely heal on their own and, in many cases, end up requiring surgery.

Conservative Treatment

Conservative treatment is usually the first option when meniscal injuries are mild, asymptomatic, or with controlled symptoms, without joint locking or effusion. This approach is ideal for tears smaller than 1 cm, injuries in the red zone, and radial meniscal tears of less

One of the most commonly used methods in sports medicine is the famous RICE (Rest, Ice, Compression, Elevation). It's a simple but effective treatment for mild to moderate tissue injuries. Here's how to do it:

Rest: Avoid any activity that could aggravate the injury. If the pain is severe, using crutches may be a good option to avoid putting weight on the knee.

Ice: Apply cold compresses for 20 minutes, several times a day. However, never place ice directly on the skin.

Compression: Use an elastic bandage to reduce swelling and prevent excessive bleeding.

Elevation: Keep the leg elevated above heart level to minimize swelling.

In addition to RICE, it's essential to maintain range of motion with isometric and isotonic exercises that strengthen the muscles without compromising the meniscus.

When to Opt for Arthroscopy?

Arthroscopy is a minimally invasive intervention recommended when the tear is more severe, there's joint locking, or the injury doesn't respond to conservative treatments.

Partial Meniscectomy: In this procedure, the damaged meniscal tissue is removed. It usually allows early weight-bearing and faster recovery, but it's important to note that the more meniscal tissue is removed, the higher the risk of long-term joint degeneration.

Meniscus Repair: If the type of tear allows it, suturing the torn portions can be an option. This approach has a longer recovery time but is key to preserving the meniscus structure and avoiding future joint problems.

Frequently Asked Questions About Meniscal Tears

Can you walk with a torn meniscus?

Yes, many people can continue walking, and even some athletes can keep competing. However, after two or three days, the knee may become stiffer and swollen.

Does the meniscus regenerate?

Injuries in the peripheral zone (red zone) have a better chance of healing due to good blood flow. In contrast, injuries in the central zone (white zone) usually require conservative treatment or surgery.

Is surgery necessary?

It depends on each case, considering factors such as the patient's age, presence of joint effusion, severity of the injury, and whether other knee structures are compromised.

The choice between conservative or surgical treatment will always depend on the location of the tear, the type of injury, and the response to initial treatment.

So, when facing a meniscal injury, it's best to consult with a specialist who can evaluate all options. What about you? Have you had any meniscal injury? How was your recovery?

If you'd like to schedule a consultation, I'll be waiting for you at my office located in the Torre Norte 2 building in Zona Río, just 10 minutes from the San Ysidro-Tijuana border.

If you're in another state, I invite you to schedule an online consultation.