Medial Meniscus Tears Made Easy

Assisting the efficient joint relationship in the knee, two cartilaginous menisci rest on the flat surface of the larger lower leg bone (tibia). The inner (medial meniscus) and outer (lateral meniscus) have a flat under surface that sits on the tibia bone and the concave (depressed) overlying surface of the menisci houses the convex (rounded) end of the thigh (femur) bone.

Both of the menisci act as shock absorbers for weight-bearing by providing extra protection to the articular cartilage of the femur and the tibia. It also helps distribute forces throughout the knee while adding stability to the entire knee joint.

An injury to either of the menisci can be both painful and difficult to bear.

The medial meniscus, located in the inner side of the knee, is by far more prone to be injured compared to it lateral (outer) counterpart. This is due to its direct attachment to other structures of the knee such as the medial collateral ligament and the medical capsule of the knee joint.

The “unhappy triad” injury is a common injury in contact sports involving resulting in damage to the medial meniscus, medial collateral ligament and the anterior cruciate ligament.

Meniscus Repair

Only the peripheral zone of the meniscus cartilage is well supplied with blood while the remaining central region of the meniscus lacks a direct blood supply. Therefore, meniscus injuries affecting the central zone do very little healing.  Only if the meniscal tear is on the peripheral edge is a meniscal repair possible.  If a meniscus repair is not an option, a meniscectomy or a meniscus trimming is a surgical option if necessary.

How to Tear a Meniscus

Common causes of medial include direct forces to the outer knee, aggressive knee twisting, overuse trauma, hyper flexion with rotation and excessive birthdays. These factors can result in thinning and tears of either the medial or lateral meniscus.

Injuries to the medial collateral ligament and anterior cruciate ligament will stress the medial meniscus and result in a medial meniscus tear (MMT). Degenerative conditions predispose the medial meniscus to injury. This is a painful injury initially accompanied by swelling and tenderness.

Signs & Symptoms of Medial Meniscus Tear

  • Knee joint line pain which can be increased with twisting and grinding movements.
  • Swelling and tenderness usually accompany the inflammation along the medial joint line.
  • Possible joint locking and “catching” from the tears and loose piece of the meniscus and/or articular cartilage.
  • Range of motion for both bending and straightening of the knee joint may be compromised.
  • Difficulty bearing weight with the involved knee.

Professional Treatment for Medial Meniscus Tear

The severity and type of tear sustained will guide the proper treatment approach to medial meniscal injuries.

  • Seek clinical evaluation of the injury. Improperly diagnosed and managed meniscal injuries can result in problems that you don’t want to experience.
  • RICE – rest, ice, compression & elevation to minimize the inflammation and decrease the symptoms.
  • Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
  • Knee braces and sleeves will assist in supporting the knee and reducing the excessive motion that will increase the medical meniscus symptoms.
  • Maintain knee range of movement as early as possible.
  • ·Progressive resistive strengthening exercises for the quadriceps as early as possible maintain dynamic knee stability.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Is this injury related to my biomechanics?
  2. Exactly what structures in my knee are damaged?
  3. Do I need an MRI to assess what exactly my knee hurts so much?
  4. Do I have any articular cartilage damage in any of the three (3) compartments of my knee? If so, do I have arthritis and where?
  5. What kind of exercises do I need to avoid?
  6. Are there any long-term complications with this MMT?
  7. Do I need to visit a physical therapist?

Elite Sports Medicine Tips from Mike Ryan

  • Be Smart Now – Resting early on for 3-5 days can prove to pay off if the MMT quiets down quickly.
  • It’s Not About Medications – Avoid pain medications for pain unless you REALLY need them.
  • Quads Are MCL Guards – If your quad are strong, your MCL will recover fast and with better results. It’s that simple.
  • Avoid Bending With Twisting – That’s a common way to tear a meniscus so avoid this movement combo whenever possible.

Tackling a Lateral Meniscus Tear of the Knee


Understanding a Lateral Meniscus Tear

“I tore my cartilage” is the term most athletes use to describe the possible source of their knee joint line pain.  About 40% of the time, they’re correct.  Now ask them to identify culprit, aka “the cartilage”, in a police lineup and they’ll probably have the look of a cow staring at a fence.

The medial (inner) and lateral (outer) menisci are made up of very resilient cartilage.  Their design and cellular structure allows them to assist in the stability of the distal femur (thigh bone), distribute body weight forces across the joint surfaces and absorb compressive forces as we move.

Injuries to the menisci can significantly impair knee functions. Because of their relationship with other structures in the knee joint, the lateral meniscus is less prone to injury when compared with the medial meniscus. The lateral meniscus has less direct attachments to other structures in the knee. However, the long-term impact of a lateral meniscal injury is more concerning due to the high weight-bearing forces in the lateral compartment of the knee.  In other words, if you have a lateral meniscal injury, your likelihood of needing to have it addressed surgically increases and the presence of accelerated arthritic damage rises with time when compared to the medial meniscus.
The types of injuries to the lateral meniscus vary in location and severity, ranging from splitting into two segments to tearing around its more “C” shaped borders. Over time, meniscal micro trauma can result.

The lateral meniscus has minimal blood supply around its periphery.  With no direct blood supply to its central region, one can typically expect minimal healing with injuries involving this region of the lateral meniscus.

The two most common causes for meniscus tears are direct trauma and degenerative conditions. More often, the traumatic injuries involve twisting of the knee with the knee in a bent position.  This is commonly seen in contact sports. With this mechanism of injury, the foot is fixed to the ground resulting in a stretching of the meniscus. A direct blow to the inner part of the knee joint can also injure the lateral meniscus.

The degenerative damage is more commonly seen in the older population and is often associated with underlying arthritic changes. As the meniscus lose significant blood supply and weakens, it becomes more prone to injury. In this population, simpler twists and forces associated with daily activities may prove to be the cause of a meniscal injury.

Signs & Symptoms of Lateral Meniscus Tear

  • Excruciating pain and swelling immediately or up to 3 days after the activity in question.  Lateral joint line pain increases with rotation of the knee and weight-bearing.
  • Difficulty walking, bending or rotating the knee against resistance due to lateral knee pain.
  • The knee joint may become locked or “catch” if the loose piece of the meniscus is in a position of pain within the joint.  This flipping of the flap or unstable section of the cartilage will typically prevent full extension more often than it will limit full flexion.
  • Joint stiffness and tenderness around the outer edge and back ridge of the lateral joint line.
  • A general sense of insecurity with the knee with increased activity contributing to what older athletes tend to refer to as a “trick knee” due to its unpredictability.

Professional Treatment for Lateral Meniscus Tear

The best treatment is often a treatment of the symptoms and not the injury itself due to the limited healing capability of the meniscal tissue.

  • Ice the knee at least 4 times per day and immediately after all athletic activities.
  • Utilize the latest physical therapy modalities and rehabilitation equipments to control the pain, swelling and tenderness in the in and around the joint.
  • Strengthen the muscles directly influencing the knee joint. Strengthening exercise should be mostly pain-free. Muscles of the thigh, quads in front and the hamstrings in back, should be the main focus along with the hip rotators and the calves.
  • Soft tissue massage and stretching of the surrounding muscles and fascia needs to be included. This encourages the muscles to stay pliable which will accelerate the recovery time.
  • Surgery?  Let the doctor and YOU determine the answer to this question.  Closely monitor your symptoms and your activity level before you decide to “go under the knife”.  If unsure, gradually test your knee with functional activities along with the watchful eye a sports medicine specialist.
  • Eat right and drink right.
  • Be cautious of activities that twist the knee to avoid aggravating the injury.
  • Rest as needed.

Asking the Right Questions Like a Pro

Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:

  1. Is this injury related to my athletic activities?
  2. What structures in my knee are damaged?
  3. Do I need further diagnostic test like an MRI?
  4. Do I need to have a knee scope and/or a micro fracture surgery?
  5. What kind of exercises do you recommend?
  6. Are there any long-term complications that we should discuss now?

Elite Sports Medicine Tips from Mike Ryan

  • Train With “Training” Specifications: Train smarter.  You can be aggressive and keep your knee pain-free by minimizing the twisting motions during your training.
  • Surgery is Just One Option on the Menu:  Many doctors may tell you otherwise but here is the truth: Just because you have a meniscal tear does not necessarily mean you need to have surgery.  The location of your injury, your pain level, the present knee limitations and your past medical history are the most important factors in determining whether you need to be walking around the surgical center trying to look cool in one of those drafty Johnnies!
  • Grocery Choices: You know when it’s junk or healthy. Help yourself to a healthy diet if you’re serious about getting back to competing like you did 10 years ago.
  • Ride Your Way Up: Don’t play “hero” on day #1 with your agility drills and running.  Bike riding is a great way to get your range of motion back and to start the leg strengthening process the smart way.  It’s time to change your mindset and getting on the bike and in the swimming pool is a great way to start.
  • Employ Proper Techniques: You accidentally did something wrong to incur the meniscal tear so now your focus should be to doing it right. Proper techniques and progression are the keys along with getting in with the right physical therapist.