Meniscal Tear

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A meniscal tear is one of the most frequent injuries of the knee, which I treat daily at my practice. It concerns young athletes after a sports injury, but also middle-aged and older adults in whom the tear appears from degenerative wear, without necessarily any clear traumatic episode. The correct treatment of a meniscal tear is critical for the long-term health of the knee.

Knee pain with a simultaneous feeling of mechanical locking is one of the most typical symptoms of a meniscal tear. Timely evaluation by a specialised Orthopaedic Surgeon is critical for avoiding secondary damage to the articular cartilage and preventing early arthritis.

As an Orthopaedic Surgeon specialised in arthroscopic knee surgery, my aim through this guide is to explain to you with clarity what the role of the meniscus is, how the tear occurs, how you will recognise it, and what the modern, effective therapeutic options are that can rid you of pain and return you to normal activity.

It is important to know that the treatment of meniscal tears has evolved dramatically in recent years. The old notion of “total removal” of the torn meniscus has been abandoned, as medical science has demonstrated that the meniscus is critical for the long-term health of the knee. Today, our philosophy is the maximum possible preservation of the meniscal tissue, either with suture or with targeted removal only of the damaged part. This modern approach leads to better long-term outcomes and prevents the early development of arthritis. At my practice, I treat such cases daily with modern techniques and a personalised approach.

What is the Meniscus and why is it so Important

In every knee there are two menisci: the medial meniscus (on the inner side of the joint) and the lateral meniscus (on the outer side). They are two C-shaped or crescent-shaped fibrocartilaginous structures, placed between the femur and the tibia. Despite their small size, they have an extremely important functional role for the long-term health of the joint.

The Functions of the Meniscus

They function as natural “shock absorbers” of the joint, absorbing the loads that the knee receives.
They increase the contact surface between the femur and the tibia, reducing the pressure on the articular cartilages.
They secondarily stabilise the joint, assisting the ligaments.
They contribute to the lubrication of the joint and the distribution of the synovial fluid.
They protect the articular cartilage from premature wear.
They participate in the proprioception of the knee.

When the meniscus suffers a tear and the damage remains untreated, the articular cartilage is exposed to excessive loads, resulting in the early development of osteoarthritis. For this reason, the preservation of as much of the meniscus as possible is a priority during surgical treatment.

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How a Meniscal Tear Occurs

We distinguish two large categories of meniscal tears, with different pathogenesis, picture, and therapeutic approach.

Traumatic Tears

They appear mainly in young, sporting individuals. The mechanism is usually rotational: the patient has the foot firmly on the ground and performs a sudden rotation of the body. They often accompany an anterior cruciate ligament tear in sports injuries. Other causes include a deep squatting position, sudden flexion of the knee, or descent from stairs with a twist.

In 50–70% of sports injuries, a meniscal tear coexists with an anterior cruciate ligament tear, a condition that requires integrated treatment of both injuries in the same operation.

In traumatic tears, the report of the injury is clear: the patient can identify the exact moment when the pain appeared. They often report a sensation of “snapping” or “popping” in the interior of the knee, followed by intense pain and progressive swelling within hours.

Degenerative Tears

They appear in people over 40–50 years of age. The meniscus has undergone progressive degeneration with the passage of time, and the tear may occur even after a simple movement, such as when the patient bends to pick something up, rises from a seated position, or gets out of the car.

In degenerative tears, there is usually coexisting incipient or established knee arthritis. Treatment is different from that of traumatic tears, as many cases respond excellently to conservative therapy.

In these cases, the correct distinction between a degenerative meniscal tear and knee arthritis is critical for the correct therapeutic approach, as often the tear is secondary to the arthritic process.

Symptoms of a Meniscal Tear: How You Will Recognise It

The symptoms vary depending on the size, position, and type of the tear. The most characteristic are:

Pain: It is usually located on the inner or outer part of the knee, depending on the affected meniscus. It is worsened by flexion, rotation, and the use of stairs.
Swelling: It usually appears within the first hours or days after the injury and recurs with exertion.
Locking: This is the most characteristic mechanical symptom. A portion of the torn meniscus intervenes between the femur and the tibia, resulting in the patient being unable to fully extend the knee.
Sensation of “clicking” or “catching”: The patient reports that something “catches” within the knee in certain movements.
Difficulty with full flexion or extension: The range of motion of the joint is restricted.
Feeling of instability: Less frequent than in ligament tears, but it may present in large tears.
Pain during deep squatting position: It is one of the early symptoms, particularly in tears of the posterior horn.

Diagnosis: The Importance of a Correct Evaluation

The diagnosis of a meniscal tear begins with a detailed history-taking. The way symptoms develop, the previous traumatic episode (if any), and the progression of the pain constitute valuable information for the diagnostic approach.

Clinical Examination

The clinical examination follows. I use specific tests of high diagnostic value, the main ones being the McMurray test, Apley’s test, the Thessaly test, and the careful palpation of the joint space. In experienced hands, the clinical examination has a diagnostic accuracy approaching 85–90%.

Imaging Assessment

Magnetic Resonance Imaging (MRI) is the examination of choice for the definitive confirmation of the tear. It provides excellent information about:

The position of the tear (anterior horn, body, posterior horn of the meniscus).
The type of the tear (vertical, horizontal, oblique, root, “bucket-handle” tear).
The extent and depth of the damage.
The presence of concomitant injuries (ligaments, cartilage).
The condition of the rest of the knee.

Digital X-rays also offer useful information, as they rule out coexisting bony injuries or advanced arthritis that may mimic the clinical picture of a meniscal tear.

Modern Therapeutic Management

The ideal treatment of a meniscal tear is strictly personalised. I take into account many factors: the age of the patient, the level of activity, the type and position of the tear, the presence of mechanical symptoms, and the condition of the rest of the knee. Modern thinking dictates the preservation of as much of the meniscus as possible.

Conservative Treatment

It is appropriate for small, stable tears without mechanical symptoms, particularly of the degenerative type. It includes analgesic and anti-inflammatory drugs, brief rest, targeted physiotherapy with emphasis on strengthening the periarticular muscles, and, in certain cases, a targeted injection within the joint (cortisone, hyaluronic acid, or PRP).

Arthroscopic Surgical Treatment

It is the definitive solution for tears that cause persistent symptoms or risk of further damage to the knee. It is a minimally invasive operation, which is performed through two very small openings of 3–4 millimetres. With the help of a special high-resolution camera and micro-instruments, I treat the damage in two ways:

Meniscal repair (suture): It is always my first choice, provided that the tear is located in the vascularised area of the meniscus and its type allows suture. Thus the entire meniscal structure is preserved, while the articular cartilage is protected in the long term.
Partial meniscectomy: When the tear is not repairable, we remove only the damaged portion of the meniscus, preserving as much healthy tissue as possible. This modern “conservative” technique has replaced the old practice of total removal, which led to early arthritis.
Combination of techniques: In certain cases, both techniques are combined for the optimal outcome.

The choice between suture and partial removal is made based on many factors: the position of the tear (the peripheral zone of the meniscus has good blood supply and heals better, while the inner zone does not have blood supply and does not heal), the type of the tear (vertical peripheral tears are ideal for suture), the age of the patient (in younger people, suture is almost always preferable), the level of activity, and the condition of the rest of the knee. The final decision is often taken during the arthroscopy, when I can directly evaluate the condition of the meniscus with the camera. In every case, my aim is the maximum possible preservation of the tissue.

Learn in detail about knee arthroscopy, the stages of the operation, and the advantages offered by the modern minimally invasive technique compared to older open surgical methods.

Advantages of Arthroscopic Surgery

The arthroscopic treatment of a meniscal tear, in the modern form applied today, offers significant advantages compared to older open techniques:

Minimal surgical trauma (two openings of 3–4 millimetres).
Excellent aesthetic result without visible scars.
Hospitalisation usually same-day (one day surgery).
Rapid recovery and return to daily activities.
Minimal postoperative pain.
High success rates (>90%).
Possibility of simultaneous treatment of concomitant injuries.
Faster return to sports compared to open techniques.

Cost and Price of the Arthroscopic Operation

A frequent question of patients concerns the cost and price of the arthroscopic operation for a meniscal tear. Although knee arthroscopy is a minimally invasive operation, the specialisation required and the modern equipment determine the final cost.

The cost and price are shaped by various factors:

The type of operation (partial meniscectomy or meniscal repair).
The clinic or hospital where it will be performed.
The days of hospitalisation (usually same-day or 1 overnight stay).
The materials that will be used (special sutures and suture systems for meniscal repair).
The presence of concomitant injuries that need simultaneous treatment.
The involvement of your insurance provider (EOPYY or private insurance).
The cost of anaesthesia and the surgical environment.

The accurate estimate of the cost is made only after a full appointment, during which I will examine the findings of your MRI scan, evaluate your case, and we will discuss in detail the optimal therapeutic option. Our aim is full transparency and correct information before any decision.

Postoperative Course and Recovery

Recovery after arthroscopic treatment of a meniscal tear depends mainly on the type of operation performed.

Recovery After a Partial Meniscectomy

Rehabilitation is particularly fast. The patient walks with full weight-bearing from the very same day of the operation and returns to office work in 5–10 days. Driving is usually allowed after 1–2 weeks. The full return to sports is placed at 4–6 weeks, depending on the sport and the progress of physiotherapy.

Recovery After a Meniscal Repair

Rehabilitation is more gradual, as protection of the healing is required. Usually, partial weight-bearing with crutches for 4–6 weeks is needed, while the return to sports is completed at 4–6 months. This longer duration is absolutely worth it, as the integrity of the meniscus is preserved and the knee is protected in the long term from the development of arthritis.

In every case, the physiotherapy programme is personalised and strictly adhered to, with gradual strengthening of muscle groups and recovery of the full range of motion.

The Importance of Choosing the Right Surgeon

Having served as a permanent Consultant in Orthopaedics in Great Britain (NHS) for 10 years and with a clinical record that exceeds 9,000 arthroscopic and open operations, arthroscopic knee surgery, and especially the treatment of meniscal tears, constitutes one of the most important pillars of my clinical activity.

My extensive further training (fellowships) at top international centres enables me to apply the most modern techniques, with particular emphasis on the preservation of as much of the meniscus as possible. Every patient is treated as a unique case, with the aim of a comprehensive and lasting solution. More information can be found at drpolyzois.gr.

Take Care of Your Knee in Time

A meniscal tear, however small it may initially seem, can significantly affect your quality of life and lead to secondary damage if left untreated. With modern diagnosis and specialised treatment, full recovery is a realistic and immediate goal. Modern orthopaedics offers excellent results with minimal postoperative trauma and rapid return to normal life.

Contact our practice today through the website drpolyzois.gr to schedule a diagnostic appointment. I will evaluate your case with care, answer all your questions, and together we will design the appropriate therapeutic strategy for your rapid and safe return to daily life.

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Συχνές ερωτήσεις

Must I always have surgery for a meniscal tear?

No. Many small or degenerative tears, without serious mechanical symptoms, can be treated conservatively with excellent results. The decision depends on the symptoms, the type of tear, and the overall condition of the knee.

How long do I need to recover after the arthroscopy?

In a partial meniscectomy, the return to daily activities takes place in 7–14 days and to sports in 4–6 weeks. In a meniscal repair, the time is longer (4–6 months for full return), but the long-term benefits are significant.

When is a meniscal repair done, and when is a removal?

A repair is always the preferred option, but requires certain prerequisites: the tear must be located in the vascularised area of the meniscus, be relatively recent, and the tissue must be in good condition. I assess the possibility of repair both preoperatively (with MRI) and during the arthroscopy.

Can a meniscal tear heal on its own?

Rarely, and only in very small tears in the peripheral, vascularised zone of the meniscus. The majority of tears do not heal automatically, as the meniscus has a limited blood supply, particularly in its inner portion.

Will I be able to play sports again after the surgical operation?

Yes, in the overwhelming majority of cases. Patients return to their previous levels of activity safely, provided they follow the rehabilitation programme. Even professional athletes return to the very highest level.

If I leave a meniscal tear untreated, what are the consequences?

A meniscal tear that remains untreated and causes symptoms progressively leads to wear of the articular cartilage and to the early development of osteoarthritis. Furthermore, mechanical symptoms such as locking can lead to falls and other injuries. For this reason, timely diagnosis and treatment are critical.

Is hospitalisation necessary after the arthroscopy?

In most cases, knee arthroscopy for a meniscal tear is a same-day operation (one-day surgery). This means that the patient enters the clinic in the morning, undergoes the operation, and returns home on the same day, a few hours later. Only in special cases (meniscal repair with a complex technique, concomitant injuries, medical history requiring it) is an overnight stay needed. Early mobilisation in the friendly environment of home accelerates recovery.

Can a meniscal tear recur after the surgical treatment?

After a partial meniscectomy, recurrence of the tear in the same portion is not possible (since this part has been removed). However, in cases of degenerative changes in the rest of the meniscus or in patients with established arthritis, a new tear in another portion may develop over time. After a meniscal repair, the success rates are very high (over 85–90%), but in some cases (e.g., extensive tears, poor tissue quality), the repair may not heal completely. In every case, my goal is to choose the technique that offers the best long-term outcome.

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