What is the Knee Meniscus?
Before you can learn about meniscus tear recovery, you need to know about the meniscus. The knee meniscus is a figure-8 shaped structure that sits between the thigh and leg bone in the knee and acts as a shock absorber to protect cartilage. There is one part of the figure 8 on the inside (medial) that attaches to the leg bone in the middle at the meniscal root. There’s another part on the outside (lateral) that also attaches in the middle. In the image here, the medial meniscus is highlighted red and the lateral meniscus is highlighted yellow. Both structures mix in the ACL ligament in the knee, which is why it’s common to see a medial meniscus injury go along with an ACL injury.
There are many different types of meniscus tears that may or may not impact meniscus tear recovery. The first thing you need to know is that tears on the outside of the meniscus are more likely to heal based on the better blood supply in the outer 1/3 of the meniscus. This is called the “red-red zone”. Tears in the middle area that have some blood supply will likely only heal in younger people, and this zone is called red-white. Then there’s the inside 1/3 which is called the white-white zone which has no blood supply, so tears are unlikely to heal.
The image here shows many different types of meniscus tears in red. While your MRI report will likely tell you the type of tear you have, it’s also important to realize that these tear types may not be as important as we once thought, especially in patients 35 and over. As you’ll read below, in that age group, meniscus tears are as common as wrinkles and many people have no idea that they have them, meaning many don’t cause symptoms.
Watch my video below to learn how to read your MRI:
Can a Meniscus Tear Heal on its Own? Can You Walk Around with a Torn Meniscus? How Long Does Meniscus Tear Recovery Take Without Surgery?
The short answer is that tears toward the outer third tend to heal on their own with time. Other tears may not, but as I describe below, it may not be a big deal whether the tear heals, as you may have had it for years without ever knowing about it. Meniscus tear recovery without surgery can take 6-12 weeks. To maximize meniscus tear recovery, you may want to purchase or get an unloader brace that can take the weight off of that side while the area heals. Remember, that only works if the tear is in the outside third of the meniscus. These braces are widely available on Amazon and can also be obtained via a doctor’s prescription. The braces are differently configured for the medial or lateral compartments, and left and right, so be careful when ordering.
Are Meniscus Tears a Big Deal?
By the time we’re in our mid-thirties, many of us have tears in our meniscus. Most of us don’t know it (9). Why? Because they are as common and wrinkles and about as important, meaning most don’t hurt. For the ones that do hurt, surgery is often considered. Does it work?
Does Meniscus Surgery Work?
If you fail meniscus tear recovery on your own, the next step is often surgery. The most common surgery performed on the meniscus is an arthroscopic partial meniscectomy (APM). In this surgery, the doctor removes the part of the meniscus that is torn. The New York Times puts the APM procedure into its “useless” category. Why?
A study conducted in 2013 showed us that APM results couldn’t beat a simple physical therapy program (1). Then research later that year demonstrated that APM wasn’t any better than fake or sham surgery (2). Finally, research in 2016 put the final nail in the proverbial coffin of arthroscopic partial meniscectomy when it discovered that the procedure didn’t beat a faked surgery for patients with locking symptoms due to a torn meniscus (3).
Want to Get Back to What You Love, Without Surgery and Medication?
There is also research showing that the surgery may harm the knee joint. For example, research shows us that APM alters the normal way a knee moves (4). Other research has shown that the procedure may cause more lost cartilage (5). Finally, knee arthritis is much more common in patients who have had APM when compared to the non-operated knee (6).
In a recent 5-year study in patients who were over 45 years of age, researchers looked at how many patients went on to get a knee replacement (7). Patients either got physical therapy or a partial meniscectomy to treat a meniscus tear. In the end, the meniscus surgery group was about 2 1/2 times more likely to get a knee replacement than those patients who had just had physical therapy!
Are There Newer Meniscus Injection Techniques that Can Help?
Can meniscus tear recovery be helped along without surgery? I can answer that question with the story of a local patient who is a chiropractor, Evan Katz. He injured his meniscus and ACL while exercising and had significant knee pain. He normally would have had APM surgery at that point, but he knew the research showed that it didn’t work despite surgeons still commonly offering the procedure.
What did Evan Katz do? We performed a Percutaneous Meniscus Trephination procedure using high-dose platelets (8). What’s that? We used precise ultrasound guidance to locate the tear and injected his own healing platelets that we had concentrated in the lab. We also performed a Perc-ACLR procedure with x-ray guidance. How did it work? Here’s a text I got from Evan:
The upshot? Meniscus tear recovery can happen naturally, especially if the meniscus is injured in the outer third. In addition, tears are very common as we age and oftentimes about as important as wrinkles. Also, surgery is really not the answer. Finally, newer techniques are available that can help patients avoid surgery.
(1) Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis [published correction appears in N Engl J Med. 2013 Aug 15;369(7):683]. N Engl J Med. 2013;368(18):1675–1684. doi:10.1056/NEJMoa1301408
(2) Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL; Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013 Dec 26;369(26):2515-24. doi: 10.1056/NEJMoa1305189.
(3) Sihvonen R, Englund M, Turkiewicz A, Järvinen TL; Finnish Degenerative Meniscal Lesion Study Group. Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial. Ann Intern Med. 2016 Apr 5;164(7):449-55. doi: 10.7326/M15-0899.
(4) Netravali NA, Giori NJ, Andriacchi TP. Partial medial meniscectomy and rotational differences at the knee during walking. J Biomech. 2010 Nov 16;43(15):2948-53. doi: 10.1016/j.jbiomech.2010.07.013.
(5) Cohen SB, Short CP, O’Hagan T, Wu HT, Morrison WB, Zoga AC. The effect of meniscal tears on cartilage loss of the knee: findings on serial MRIs. Phys Sportsmed. 2012 Sep;40(3):66-76. doi: 10.3810/psm.2012.09.1983.
(6) Longo UG, Ciuffreda M, Candela V, Rizzello G, D’Andrea V, Mannering N, Berton A, Salvatore G, Denaro V. Knee Osteoarthritis after Arthroscopic Partial Meniscectomy: Prevalence and Progression of Radiographic Changes after 5 to 12 Years Compared with Contralateral Knee. J Knee Surg. 2019 May;32(5):407-413. doi: 10.1055/s-0038-1646926.
(7) Katz JN, Shrestha S, Losina E, Jones MH, Marx RG, Mandl LA, Levy BA, MacFarlane LA, Spindler KP, Silva GS; MeTeOR Investigators, Collins JE. Five-year outcome of operative and non-operative management of meniscal tear in persons greater than 45 years old. Arthritis Rheumatol. 2019 Aug 20. doi: 10.1002/art.41082.
(8) Kaminski R, Maksymowicz-Wleklik M, Kulinski K, Kozar-Kaminska K, Dabrowska-Thing A, Pomianowski S. Short-Term Outcomes of Percutaneous Trephination with a Platelet Rich Plasma Intrameniscal Injection for the Repair of Degenerative Meniscal Lesions. A Prospective, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study. Int J Mol Sci. 2019;20(4):856. Published 2019 Feb 16. doi:10.3390/ijms20040856
(9) Risberg MADegenerative meniscus tears should be looked upon as wrinkles with age—and should be treated accordinglyBritish Journal of Sports Medicine 2014;48:741. https://bjsm.bmj.com/content/48/9/741?sid=1bb96744-600b-45df-9ad5-735ce7be1beb