The meniscus is the wedge-shaped cartilage pad that sits between the femur and tibia in the knee. Tears to the meniscus are among the most common knee injuries and can result from either acute trauma or chronic degeneration. Treatment is guided by tear type, location, and patient factors, with repair prioritized over removal whenever the tear allows, because preserving meniscal tissue preserves long-term knee function.
What Is a Meniscus Tear?
The knee has two menisci: the medial meniscus on the inside and the lateral meniscus on the outside. Each is a C-shaped structure of firm, durable fibrocartilage that distributes load across the knee, absorbs shock, and contributes to stability.
The meniscus has a limited blood supply. The outer one-third (the red zone) is vascular and has the potential to heal. The inner two-thirds (the white zone) is avascular and relies on joint fluid for nutrition, with little ability to heal on its own.
Tear patterns include:
- Vertical and longitudinal tears, often repairable, especially when located in the vascular zone
- Bucket-handle tears, a large longitudinal tear in which the inner fragment displaces into the joint, producing mechanical locking
- Radial tears, extending from the inner rim outward, disrupting the circumferential fibers that allow the meniscus to distribute load
- Horizontal cleavage tears, a degenerative pattern common in middle-aged and older patients
- Root tears, avulsion of the meniscus at its attachment to the tibia, functionally equivalent to total meniscus loss if not repaired
Tear pattern, location, size, and the patient’s age and activity level together drive the treatment decision.
Causes and Risk Factors
- Acute traumatic tears from twisting or pivoting on a loaded knee, often in sport
- Degenerative tears from gradual wear of the meniscus over years, often without a specific injury event, common over age 40
- Associated with ACL injury (approximately 50 percent of ACL tears have an associated meniscus tear)
- Occupations involving frequent squatting or kneeling
- Prior meniscus surgery on the same knee, which predisposes to further tears
- Early osteoarthritis, since degenerative meniscus tears often coexist with cartilage loss
Symptoms
- Pain along the joint line, on the inside or outside of the knee depending on the meniscus involved
- Swelling that develops over hours to a day after injury (slower than ACL swelling)
- Catching, clicking, or locking with knee motion
- Sensation of the knee giving way, particularly with twisting
- Difficulty with deep squatting or kneeling
- Pain with pivoting
Diagnosis
Dr. Chudik’s evaluation includes the mechanism of injury and activity pattern, a detailed physical examination with joint line palpation, McMurray and Thessaly tests, and assessment of knee range of motion and associated ligament stability. X-rays evaluate joint space, alignment, and any arthritic changes. MRI is the imaging study of choice and characterizes tear pattern, location, size, and associated cartilage status. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical management is appropriate for degenerative tears without mechanical symptoms, for stable tears that may heal, and for lower-demand patients. It includes activity modification, physical therapy, anti-inflammatory medication, and occasional corticosteroid or hyaluronic acid injection. Many degenerative tears improve with this approach, particularly when early arthritis is the actual driver of symptoms.
Surgical treatment is indicated for mechanically symptomatic tears (catching, locking), for tears in active patients that do not respond to non-surgical care, and for root tears that functionally behave like total meniscus loss. Dr. Chudik performs:
- Arthroscopic meniscus repair, using suture fixation to restore a healable tear. Dr. Chudik prioritizes repair over removal whenever the tear pattern and location allow.
- Arthroscopic partial meniscectomy, trimming the torn fragment when the tear is not repairable
- Meniscus root repair, reattaching the meniscal root to the tibia when it is avulsed
- Meniscal transplantation, replacing the meniscus with a cadaveric graft in younger patients who have lost most of their meniscus
Recovery and Outcomes
Recovery depends on the procedure. After partial meniscectomy, weight-bearing begins immediately and return to sport is typically four to six weeks. After meniscus repair, weight-bearing may be restricted or the range of motion protected for four to six weeks to allow healing, with return to sport at four to six months. Root repair and transplantation have longer recoveries of six to nine months or more.
Long-term outcomes favor preservation of meniscus tissue. Patients who undergo meniscus repair have lower rates of subsequent arthritis than those who undergo removal. This is why Dr. Chudik’s approach prioritizes repair whenever the tear allows.
When to See Dr. Chudik
Schedule an evaluation after a knee injury with swelling, pain along the joint line, or catching and locking symptoms, or if prior treatment has not resolved knee symptoms. Call 630-324-0402 or request an appointment online.