Degenerative Meniscus
1. Introduction
Someone with a degenerative meniscus may present with pain, stiffness and swelling. Catching, locking or the sensation of your knee “giving way” may also be experienced. The medial (inside) meniscus is more frequently torn, partly because of its different shape but also because of its attachment to the medial collateral ligament (inside knee ligament).
Meniscal tears often happen when you play sports, but you can also get them as a result of ‘wear and tear’ as you get older. When people talk about ‘torn cartilage’ in their knee, they usually mean a meniscus injury. They are given different grades depending on how severe an injury it is.
Depending on the symptoms you experience, conservative treatment should be the first option. Current guidelines generally discourage arthroscopy (keyhole surgery) for patients with clear evidence of osteoarthritis on X-ray (9).
Our understanding of the best way to manage degenerative meniscus problems is continually developing and unfortunately, it is not unusual for patients to be working on outdated and potentially ineffective treatment approaches. We review research on a regular basis and continually update our website to ensure we are giving the best advice by integrating current evidence with our clinical expertise.
Frequently Asked Questions
- The meniscus is a C-shaped piece of tough, rubbery cartilage that acts as a shock absorber between your shinbone and thighbone. Wear and tear over time is normal but in some cases a tear can occur, particularly following a twisting movement.
- Meniscus tears are incredibly common.
- In the general population, it affects 35% of people over 50 years (1).
- No.
- Degenerative meniscus tears are very common and are seen as part of the normal wear and tear process.
- Although a meniscal tear can lead to knee osteoarthritis (OA), it can also occur in isolation and often respond well to conservative management.
- A degenerative meniscus tear is not linked to other serious pathology.
- Typically, those aged over the age of 60.
- Those with pre-existing knee osteoarthritis.
- The overall male-to-female incidence is approximately 2.5:1.
- Pain, stiffness and swelling.
- Catching or locking of your knee.
- The sensation of your knee “giving way”.
- You are not able to move your knee through its full range of motion.
- Avoid exercises involving pivoting, deep squatting and twisting.
- Try some exercises to enhance your strength and stability.
- Lose weight if overweight.
- Advice from a qualified physiotherapist will be helpful in most cases.
- This will depend upon several factors including, but not limited to, medical/lifestyle factors, stage of injury, your ability to follow your rehabilitation, etc.
- Recovery will take about 6-8 weeks if your meniscus tear is treated conservatively (without surgery).
- Current guidelines generally discourage arthroscopy (keyhole surgery) for patients with clear signs of osteoarthritis on X-ray (9).
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. Book online with us today to get a programme tailored to your specific needs.
2. Signs and Symptoms
- Sharp pain in the knee caused by even a minor movement.
- Swelling of the knee.
- Stiffness of the knee.
- The obvious presence of fluid in the knee.
- Inability to move your knee.
- Loss of balance when trying to stand.
- Locking, clicking or popping within the knee.
- Difficulty in straightening the knee.
- Piercing sensation in the inner and outer edges of the knee (3).
3. Causes
Symptoms usually develop following a forceful rotation or twisting of the knee, such as when coming to a sudden stop. Symptoms can also develop insidiously (without known cause). It is well documented that natural ageing results in the menisci (cartilage) being more prone to tearing (4). Repetitively putting full body weight on the knee such as when kneeling, deep squatting or lifting heavy objects can also contribute to symptoms. Obesity and being overweight are also contributing factors. A person with predisposing degenerative diseases such as osteoarthritis is more likely to suffer from degenerative meniscus.
4. Risk Factors
This is not an exhaustive list. These factors could increase the likelihood of someone developing degenerative meniscus. It does not mean everyone with these risk factors will develop symptoms.
- Over the age of 50 years of age – people generally have some osteoarthritis so higher risk.
- Gender – men are more prone than women.
- Being overweight – increased load on the joint.
- Taking part in sports such as football, tennis or basketball – more rotational forces applied to knees due to changes in direction.
- Sudden rise in training intensity/volume with a lack of preparation.
- Poor lower limb strength – excessive pressure on the joint.
5. Prevalence
In the general population, degenerative menisci affects more than 35% of people over 50 and there is a 24% prevalence in those with no evidence of osteoarthritis on X-ray (5). It is more common in older people who are heavily involved in sport, particularly sports that require twisting and rotation of the knee such as football, tennis and basketball.
6. Assessment & Diagnosis
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Magnetic resonance imaging (MRI) is currently the preferred choice for detecting meniscal injuries and planning subsequent treatment. A thorough understanding of the imaging protocols, normal meniscal anatomy, surrounding anatomic structures and anatomic variants, and pitfalls is critical to ensure diagnostic accuracy and prevent unnecessary surgery (6).
7. Self-Management
As part of your treatment, your musculoskeletal physiotherapist will help you understand the condition and what needs to be implemented to effectively manage your degenerative meniscus. This will include activity modification strategies, as well as other useful treatments aimed at reducing discomfort. Regular adherence to a condition-specific rehabilitation programme is important in the management of this condition. It should be noted that rehabilitation exercises are not always a quick fix, but if adhered to on a consistent basis (weeks to months), over time they have been shown to yield positive outcomes.
8. Rehabilitation
If you have a knee meniscus tear, you may benefit from a specific exercise programme to rehabilitate your knee. Working with a musculoskeletal physiotherapist can help you regain maximal knee range of movement and strength, and can help you return to your normal optimal level of activity.
Research even shows that participation in physiotherapy for a meniscus injury may help avoid surgery for your knee (7). Your musculoskeletal physiotherapist may use various methods and treatments to control your pain or knee swelling or to improve the way the muscles around your knee contract and support the joint.
9. Degenerative Meniscus
Rehabilitation Plans
Our team of expert musculoskeletal physiotherapist have created rehabilitation plans to enable people to manage their condition. If you have any questions or concerns about a condition, we recommend you book an consultation with one of our clinicians.
What Is the Pain Scale?
The pain scale or what some physios would call the Visual Analogue Scale (VAS), is a scale that is used to try and understand the level of pain that someone is in. The scale is intended as something that you would rate yourself on a scale of 0-10 with 0 = no pain, 10 = worst pain imaginable. You can learn more about what is pain and the pain scale here.
This programme focuses on maintaining a range of movement within the knee, appropriate loading of the affected joint and maintenance of lower limb strength and stability. We suggest you carry this out once a day for approximately 2 – 6 weeks as pain allows. Pain should not exceed 3/10 on your perceived pain scale.
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This is the next progression. More focus is given to progressive loading of the joint and lower limb strengthening. As with the early programme, some pain is to be expected but ideally at a low level. Pain should not exceed 4/10 on your perceived pain scale.
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This programme is a further progression with challenging progressive loading of the affected joint. Again, some pain is acceptable but ideally at a low level. Pain should not exceed 4/10 on your perceived pain scale.
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10. Return to Sport / Normal life
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
11. Other Treatment Options
Surgery is rarely indicated with degenerative meniscal tears due to the fact that the outcomes have not been shown to be superior to conservative management. Likewise, the indication for using corticosteroids for this condition has not been proven by the research. There may be situations where these treatments are needed and these will be discussed with your orthopaedic consultant.
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References
- Ehud Rath, John C Richmond. (Aug 2000). The menisci: basic science and advances in treatment.
- Martin Englund, Ali Guermazi, Stefan L Lohmander. The role of the meniscus in knee osteoarthritis: a cause or consequence? PMID: 19631077 OI: 10.1016/j.rcl.2009.03.003
- Sarjoo M Bhagia, MD Consulting Staff, OrthoCarolina (Apr 24, 2020) ; Voluntary Teaching Faculty, Carolinas Rehabilitation. . Medscape.
- Erik Hohmann, Richard Angelo, Robert Arciero , Bernard R Bach, Brian Cole, Mark Cote, Jack Farr, Julian Feller, Brad Gelbart , Andreas Gomoll , Andreas Imhoff, Robert LaPrade , Bert R Mandelbaum, Robert G Marx, Juan C Monllau, Frank Noyes , David Parker , Scott Rodeo, Nicholas Sgaglione , Kevin Shea, Donald K Shelbourne , Shinichi Yoshiya, Vaida Glatt, Kevin Tetsworth. Degenerative Meniscus Lesions: An Expert Consensus Statement Using the Modified Delphi Technique. PMID: 31901384.
- Rachelle Buchbinder, Ian A Harris, Andrew Sprowson. (Nov, 2016). Management of degenerative meniscal tears and the role of surgery.
- Jie C. Nguyen, Arthur A. De Smet, Ben K. Graf, Humberto G. Rosas. (Jul 14 2014) MR Imaging–based Diagnosis and Classification of Meniscal Tears. https://doi.org/10.1148/rg.344125202
- Jonathan Cluett, Brett Sears. ( May 2020.) Physical Therapy Exercises for a Knee Meniscus Tear.
- Silbernagel, K. G., Thomeé, R., Eriksson, B. I., Karlsson, J., Sahlgrenska akademin (2007). Institute of Clinical Sciences, .Sahlgrenska Academy. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with achilles tendinopathy: A randomized controlled study. The American Journal of Sports Medicine, 35(6), 897-906. doi:10.1177/0363546506298279
- R Siemieniuk. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1982 (Published 10 May 2017).
Other Conditions in
Knees, Orthopaedics
Patellofemoral Pain Syndrome (PFPS)
Knee pain around the kneecap usually worse in static positions, squatting or kneeling.
Patellar Tendinopathy
Knee pain at the lower border of the kneecap which is also known as ‘jumper’s knee’.
Osgood-Schlatter Disease
Pain in an area just below the knee on the shin bone, often with a lump.
Meniscus Injury
Structural knee injury, triggered either by a tear or through wear and tear.
Knee Replacement Surgery
Replacement of the knee hinge joint, typically as a result of severe osteoarthritis or trauma.
Knee Osteoarthritis
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Iliotibial Band Syndrome
Presents as pain on the outside of the knee, normally occurring because of overload due to prolonged or repeated bouts of exercise.
Femoral Nerve Radiculopathy
This is where the nerve that supplies the front of the leg is irritated and causes pain/numbess.
Fat Pad Impingement
A rare condition affecting the adipose (fat) tissue that sits under the kneecap (patella) between the joint spaces of the knee.
Bowed Knees
A condition in which the legs are bowed outwards leaving a greater space in between your knees.
Benign Joint Hypermobility Syndrome
Common age related changes to the structure of the knee joint which may be associated with pain, stiffness and loss of function.
Baker’s Cyst
Swelling in the popliteal space (space behind the knee) that causes a visible lump.
Anterior Cruciate Ligament (ACL) Injury
Injury to a major stability ligmant in the knee, normally occuring following a significant twisting injury.