Meniscus Tear Treatment and Recovery: Evidence Based Physiotherapy, Surgery, and Rehab Explained
- endurancehealthlab
- May 5
- 8 min read
Updated: May 6
This article explores the causes of meniscus injuries, compares surgical vs conservative treatment approaches, and outlines the latest evidence-based rehabilitation strategies to help meniscus tear recovery.
What Is a Meniscus Tear?
The meniscus is a fibrocartilaginous structure in the knee that provides shock absorption, load transmission, and joint stability. Each knee contains a medial and lateral meniscus. Tears can result from:
Trauma: Often seen in younger, athletic populations during cutting, pivoting, or rapid deceleration movements
Degeneration: Common in adults over 40 due to cumulative loading, decreased joint hydration, and thinning cartilage
Repetitive Stress: Long-term repetitive loading without sufficient recovery
Common Symptoms
Pain along the joint line (usually medial or lateral)
Swelling and stiffness
Clicking, catching, or locking of the knee
Difficulty fully bending or straightening the knee
Recognising the mechanism of injury and the typical presentation of meniscus tears is essential to determining whether a traumatic or degenerative process is at play. This distinction influences treatment choices and prognosis.
How Are Meniscus Tears Diagnosed?
Diagnosing meniscal injuries involves a combination of clinical examination and imaging when appropriate.
Physiotherapy Assessment
Physiotherapists use a detailed subjective history followed by specific special tests to assess for meniscal involvement:
Joint Line Tenderness: Localised tenderness along the medial or lateral joint line is one of the most sensitive indicators.
McMurray’s Test: The knee is taken through flexion and extension with tibial rotation to provoke a clicking sensation or pain.
Thessaly Test: Performed at 20° of knee flexion, the patient rotates on a single leg. Pain or locking may indicate a meniscal tear.
Apley’s Compression Test: Downward pressure is applied to the heel while rotating the tibia. Pain suggests meniscal damage.
These tests are more reliable when combined rather than used in isolation. A systematic review by Hegedus et al. (2007) supports the use of test clusters to improve diagnostic accuracy, with positive likelihood ratios increasing substantially when multiple tests are positive.
Imaging
MRI (Magnetic Resonance Imaging): The gold standard non-invasive tool to confirm meniscal tears, with reported sensitivity of approximately 85% and specificity of 90% (Oei et al., 2003).
X-rays: Useful for excluding bony pathology or joint space narrowing in degenerative knees but not diagnostic for meniscus.
However, imaging should be reserved for cases where:
Mechanical symptoms are present
Diagnosis remains unclear after clinical exam
The patient is not progressing with conservative care
A thorough clinical assessment remains the cornerstone of diagnosis, with imaging used judiciously. Special tests help identify the presence of a tear, while MRI provides confirmation when needed. Over-reliance on imaging without clinical correlation can lead to unnecessary intervention.
Classification of Meniscus Tears
Meniscus tears can be classified not only by shape and location but also by grade, which refers to the severity of tissue disruption seen on MRI. One of the most widely used systems is the Stoller Classification, which helps clinicians interpret MRI findings and make treatment decisions accordingly.
Stoller Grading System (MRI-Based Classification)
This grading system categorises meniscal tears based on MRI signal characteristics:
Grade 0: Normal meniscus (homogeneous low signal)
Grade 1: Small intrameniscal focal high signal (does not reach articular surface)
Grade 2: Linear intrameniscal high signal (also does not reach articular surface)
Grade 3: High signal intensity that reaches at least one articular surface — indicative of a true meniscal tear
Grade 1 and 2 represent intrasubstance degeneration and are usually managed conservatively. Grade 3 is consistent with a definitive tear, which may be symptomatic and require further intervention based on symptoms and function.
Supporting Research:
Stoller et al. (1987) demonstrated that Grade 3 lesions on MRI had a strong correlation with arthroscopically confirmed tears, providing reliability to guide diagnosis and treatment.
De Smet and Tuite (2006) reinforced the validity of the grading system and its high specificity for ruling in meniscal pathology when used with clinical findings.
The Stoller grading system offers a standardised, validated framework to assess meniscal injury severity on MRI. It helps differentiate between degenerative signal changes and actual tears, ensuring patients receive appropriate management - whether conservative or surgical.
Types of Meniscus Tears
Tears can be classified by shape and location:
Longitudinal (bucket-handle): Often repairable in younger populations
Radial tears: Compromise load transmission capacity
Horizontal cleavage tears: Seen in degenerative changes
Complex tears: A combination of the above
The pattern, vascularity of the tear zone, and patient factors (age, activity level) influence treatment decisions. Preserving meniscal tissue through repair (when possible) is associated with better long-term joint health and lower rates of osteoarthritis (Paxton et al., 2011).
Understanding the tear type helps guide treatment strategy. Repairs offer long-term joint protection, especially in younger individuals with traumatic injuries, while complex and degenerative tears may respond better to structured rehabilitation.
Conservative vs Surgical Management: What Does the Research Say?
Historically, partial meniscectomy (arthroscopic removal of the damaged segment) was the go-to treatment. However, robust clinical trials and meta-analyses have questioned its benefit in many cases.
Degenerative Meniscal Tears in Middle-Aged Adults
A systematic review by Thorlund et al. (2015) showed no clinically meaningful difference in pain or function between arthroscopic surgery and conservative therapy in degenerative meniscus tears. Supporting this, a landmark RCT by Sihvonen et al. (2013) involving 146 patients found no advantage of partial meniscectomy over sham surgery at 12 months.
Younger, Athletic Populations with Traumatic Tears
Conversely, in young athletes with traumatic tears, surgical repair may offer joint preservation benefits. Paxton et al. (2011) reported that meniscal repair, compared to removal, led to better long-term outcomes and reduced risk of degenerative joint disease. Eberbach et al. (2017) supported this notion and concluded that meniscal repair leads to favorable sport-specific outcomes and a high rate of return to sports in both recreational and professional athletes.
The evidence therefore indicates the decision making process differs based on presentation. For degenerative tears in older adults, physiotherapy is equally effective and safer than surgery. In young, active patients with traumatic tears, timely surgical repair can protect the joint and restore stability. Tailoring treatment to the patient’s profile and tear type yields the best outcomes.
Best-Practice Meniscus Tear Recovery
Phase 1: Acute Symptom Management
This phase focuses on reducing inflammation and maintaining joint mobility. Initial strategies include heel slides, isometric quadriceps sets, and straight leg raises, alongside ice and compression. Beaufils et al. (2009) stress that early motion promotes synovial fluid circulation and supports meniscal healing in non-surgical cases.
Early conservative management that addresses pain and stiffness lays a strong foundation for progression. Avoiding early overloading reduces risk of further meniscal irritation.
Phase 2: Strength and Control
Strengthening the surrounding musculature and restoring neuromuscular control is essential. Kise et al. (2016) demonstrated that a 12-week supervised exercise program offered equivalent improvements to surgery in middle-aged patients with degenerative tears. Exercises such as bodyweight squats, glute bridges, and balance drills help rebuild stability.
A targeted strengthening program is not only safe but effective in restoring function without surgery. Neuromuscular training improves joint control, reducing risk of future injury.
Phase 3: Return to Activity
Once strength and motion are restored, functional and sport-specific drills are introduced. Noorduyn et al. (2022) found that even at 24-month follow-up, patients treated non-operatively reported similar function and pain outcomes as those undergoing surgery. Criteria for progression include pain-free full range of motion, resolved swelling, and near-equal strength.
Gradual return to sport or activity, guided by functional milestones rather than time alone, ensures a safer and more durable recovery. Long-term outcomes from conservative care continue to match or exceed surgical pathways in non-obstructive tears.
When Is Surgery Warranted?
Surgical intervention remains appropriate in specific cases:
Mechanical locking of the knee
Failure of conservative rehab over 12+ weeks
Young, athletic individuals with large, repairable tears
Importantly, meniscal repair is now favoured over removal to protect long-term knee integrity, preventing OA development and achieving better functional outcomes and quality of life post-treatment. (Hurmuz et al., 2024).
How Endurance Health Lab Can Help
Meniscus tears can be frustrating, but they are also manageable. For the majority of non-locking, non-traumatic tears, high-quality rehabilitation is just as effective - if not better - than surgery.
At Endurance Health Lab, we offer evidence-based assessment and rehab plans tailored to your knee, your goals, and your timeline. Whether you're a recreational runner, weekend footy player, or just want to walk without pain, we're here to help you recover fully and stay strong.
📅 Book an Assessment Today or Email us to address your knee pain and get back to doing what you love!
Located in Chatswood, 2067
📚 References
Beaufils, P., Hulet, C., Dhénain, M., Nizard, R., Nourissat, G., & Pujol, N. (2009). Clinical practice guidelines for the management of meniscal lesions and isolated lesions of the anterior cruciate ligament of the knee in adults. Orthopaedics & Traumatology: Surgery & Research, 95(6), 437–442.
De Smet, A. A., & Tuite, M. J. (2006). Use of the "two-slice-touch" rule for the MRI diagnosis of meniscal tears. AJR. American Journal of Roentgenology, 187(4), 911–914.
Eberbach, H., Zwingmann, J., Hohloch, L., Bode, G., Maier, D., Niemeyer, P., Südkamp, N. P., & Feucht, M. J. (2018). Sport-specific outcomes after isolated meniscal repair: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 26, 762–771.
Hegedus, E. J., Cook, C., Hasselblad, V., Goode, A., & McCrory, D. C. (2007). Physical examination tests for assessing a torn meniscus in the knee: A systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy, 37(9), 541–550.
Hurmuz, M., Ionac, M., Hogea, B., Miu, C. A., & Tatu, F. (2024). Osteoarthritis development following meniscectomy vs. meniscal repair for posterior medial meniscus injuries: A systematic review. Medicina, 60(4), 569.
Kise, N. J., Risberg, M. A., Stensrud, S., Ranstam, J., Engebretsen, L., & Roos, E. M. (2016). Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle-aged patients: Randomised controlled trial with two year follow-up. BMJ, 354, i3740.
Noorduyn, J. C. A., van de Graaf, V. A., Willigenburg, N. W., Reijman, M., Meuffels, D. E., & Bierma-Zeinstra, S. M. A. (2022). Effect of physical therapy vs arthroscopic partial meniscectomy in people with degenerative meniscal tears: Five-year follow-up of the ESCAPE randomized clinical trial. JAMA Network Open, 5(7), e2220394.
Oei, E. H., Nikken, J. J., Verstijnen, A. C., Ginai, A. Z., & Hunink, M. G. (2003). MR imaging of the menisci and cruciate ligaments: A systematic review. Radiology, 226(3), 837–848.
Paxton, E. S., Stock, M. V., & Brophy, R. H. (2011). Meniscal repair versus partial meniscectomy: A systematic review comparing reoperation rates and clinical outcomes. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 27(9), 1275–1288.
Sihvonen, R., Paavola, M., Malmivaara, A., Itälä, A., Joukainen, A., Nurmi, H., Kalske, J., & Järvinen, T. L.; Finnish Degenerative Meniscal Lesion Study (FIDELITY) Group. (2013). Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. New England Journal of Medicine, 369(26), 2515–2524.
Stoller, D. W., Martin, C., Crues, J. V., Kaplan, L., & Mink, J. H. (1987). Meniscal tears: Pathologic correlation with MR imaging. Radiology, 163(3), 731–735.
Thorlund, J. B., Juhl, C. B., Roos, E. M., & Lohmander, L. S. (2015). Arthroscopic surgery for degenerative knee: Systematic review and meta-analysis of benefits and harms. BMJ, 350, h2747.
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