That is a question often heard in the clinics of orthopaedic doctors. Will my meniscus injury recover? How long will it take? Will I require surgery? Are there any meniscus tear therapies or treatments which can be done instead of surgery? To answer those questions, we should first understand how a meniscus tear happens.
First of all, how does a meniscus tear happen?
The most common mechanism of injury of a meniscus tear is when the foot is anchored on the ground (not moving), the knee is in a bent position, and there is a twisting or rotational force that is being applied to that bent knee.
This type of movement can occur during sports activities – think passing a ball suddenly while trying to avoid direct collision with another person – or even just accidentally catching your foot in a pothole and twisting your knee. The twisting motion can cause the meniscus to tear due to rotational forces directed at the knee joint.
When you have a meniscus tear, the signs and symptoms often look like:
- A popping or clicking sensation when the injury occurs
- Pain, especially when twisting the knee while the foot is on the ground
- Swelling and stiffness in the knee
- Difficulty fully straightening or bending the knee
- Feeling like the knee is ‘catching’, ‘locked’, or ‘giving way’
What are the different severities of a meniscus tear, and how long does it take to recover from a meniscus tear?
A meniscus tear has different types, and sometimes the type of tear determines the duration of recovery. They are categorised by both their shape and location when visualised on magnetic resonance imaging (MRI).
- Radial tear – Radial tears run perpendicular to both the tibial plateau and long axis of the meniscus, originating from the inner free edge of the meniscus.
- Parrot-beak tear – Parrot-beak tears are radial tears with partially detached fragments.
- Longitudinal tear – Longitudinal (vertical) tears run perpendicular to the tibial plateau and parallel to the long axis of the meniscus.
- Bucket handle tear – Bucket-handle tears are fragments of complete longitudinal tears that migrate centrally over the remaining menisci.
- Horizontal tear – Horizontal tears run parallel to the tibial plateau through the midsubstance of the meniscus. They are more likely to occur in people over 40-years-old with underlying degenerative changes, in the absence of a distinct traumatic event.
- Complex tears – Involve some combination of horizontal, longitudinal, or vertical tears.
Tears that are more ‘superficial’ or ‘shorter’, aka in the outer ⅓ vascular zone of the meniscus are considered ‘red’ tears. Shorter peripheral longitudinal or radial tears are less likely to be severely symptomatic and may heal spontaneously, within 4-6 weeks of meniscus tear treatments.
Deeper tears with central margins extending into or contained in the inner ⅔ avascular zone, ‘white’ tears, may require surgery if conservative meniscus therapies within the first 6 weeks does not show appropriate improvement. If there appears to be improvement in terms of knee function within the first 6 weeks, usually physiotherapy is continued for another additional 6 weeks to see if gradual return to sport is possible.
In general…
Recovery from a meniscus tear without surgery typically takes 6 to 12 weeks, depending on the severity and location of the tear.
The initial 4 weeks should be focused on resting the knee, reducing inflammation and swelling by ice, compression, and elevation, and also taking anti-inflammatory medication if recommended. Gradual load progression should be commenced, initially from minimal weight bearing till full weight bearing under the guidance of a physiotherapist.
If symptoms persist after 3 months of conservative treatment (aka physiotherapy), surgery may be considered, and an MRI is usually recommended if one has not been done already. Factors that can affect recovery time include the patient’s age, lifestyle, and overall health, but that’s another topic for another day!
Contact us today if you need a consultation regarding your knee, to assess if what you have looks like a meniscus injury, or something else.