edge blog

Tales of A Torn Meniscus… Do they all need surgery?

Tales of a torn meniscus from a physiotherapist who has one!

Let me tell a tale of a torn meniscus from a person who is fortunate to get to help people with them every day. Let me previse this article with the notion that not all meniscus tears are the same. Rather, it is my intentions to share a personal story that will help some of you understand why some knees require surgical intervention while others do not.

I will not speak of percentages, but I will instead share some insight into my own personal clinical reasoning as to who needs an MRI, who does not, who needs rehabilitation and who needs surgery. I am one of the fortunate individuals who have not needed surgery and am able to perform almost all tasks that I ask of my knee, including soccer, water skiing and even squash.

The Back Story

15 years ago I was injured playing rugby. My knee was bridged across another players body when a larger individual, we call them “props” in rugby, fell onto my knee causing it to hyperextend. I immediately sensed that something was wrong, but was able to carry my own weight off of the field. In fact, despite some swelling, I was able to finish the season without any treatment.

Fast forward 5 years, and while doing some work around our home that required me to climb a ladder repetitively, I began to get sharp pain on the inside of my knee. At this point I realized that my rugby days would never be forgotten.

What complaints will suggest that I have a tear?

There are a few tell-tale signs of meniscus damage that I look for while taking a history from a patient. One of them is localized pain on the inside of the knee, something we refer to as medial joint line pain which is what I was getting. It can also be localized pain in the back and outside of the knee, referred to a posterior lateral knee pain.

The pain may be sharp or instead it can just be a constant dull ache sensation. It usually hurts more when bending the knee deeply or straightening it fully. It can also hurt when twisting on the knee with your foot fixed on the ground. These locations and natures of pain may indicate meniscus damage. In my case, at around this time my knee began to lock, especially when I was squatting to the floor or kneeling onto my heels. Locking in the knee is when it literally gets stuck. If this is happening to you, you may very well have a torn meniscus.  Clicking in the knee is not the same as locking and can be very benign.

What findings during assessment indicate a torn meniscus?

At this time, I underwent an assessment from a colleague to confirm what I was quite sure was a torn meniscus. When assessing a knee, we perform certain tests. These tests are mostly provocative, meaning that we are trying to cause or reproduce the pain that you are getting. One test is called a bounce test. We take your knee and let it hyperextend just using the weight of the knee itself. This causes a pain on the inside of the knee and may also cause the knee to spring once it is bounced. This test in my opinion simply indicates that there is something within the joint that is evoking pain. The next test that I utilize is called McMurray’s exam. The knee is compressed, flexed (bent) and rotated all at once and throughout the range of motion. A positive exam is again one that reproduces pain and can even sometimes reproduce locking. Apley’s exam is the third test I use. Laying on your stomache, the knee is placed at a 90 degree bend and the examiner pushes down through the heel and rotates the leg. Again, we are looking for pain. Finally, I use a test called the swipe test. This exam will provoke a pocket of swelling to appear in the location of the tear after swiping the knee with our hand.

These tests are usually pretty reliable.  However, the absence of positive findings does not mean that there is not a tear, and when the knee pain, dysfunction and swelling persist, a MRI may be indicated to confirm the presence of a tear.

These exams are brought together to give a clinical picture. In my case, all of these examinations are positive. My knee also locks but I have not needed surgery… so far anyway.

In my opinion, a diagnosis of torn meniscus is not an indication for surgery.

Certain tears can be quite inconsequential. Even major tears that are found on MRI do not necessarily require surgery. In these cases, you may have an episode of swelling, pain and even locking that with treatment resolves within a window of 2 to 3 months. In my opinion, all tears should be treated first with physiotherapy and not just because I am a physiotherapist. Often, with treatment aimed at reducing swelling, inflammation and increasing ROM and functional strength, your knee can function normally.

So I have learned that the result of treatment (rehabilitation) over time is one of the best indicators of the necessity for surgery. If the swelling and or pain persists or if the pain and swelling return again once rehab has finished, then it is likely that surgery will be required.  If the knee pain and swelling persistently keep one from work or activity, again over time, then surgery may be required.

If not, then in my opinion a knee with torn cartilage is better than one with removed cartilage.  Not to mention that despite the skill of our orthopedic surgeons, surgery is in itself another trauma and recovery is not guaranteed.  Please note that this is based on my experience to date and I believe that there will be research results forthcoming that will support this notion.
In my case, my knee still locks and will intermittently get sore. I am able to play all of the sports that I enjoy and I have no swelling. I have a significant tear but I will avoid surgery for now.

Conversely, I have some patients who have minor tears and unfortunately their knee pain and swelling persist. Their knee may or may not lock, but they have difficulty with everyday activity or enjoying the sports that they want to play. This has persisted for a period greater than a year.  If this is you, then surgery may be your best option.

In conclusion, it appears to me that the irritability of the tear, the nature of your work or sport and the ability for you to enjoy activity is what may make surgery necessary.  Just don’t rush to it!

In Health,  Grant Fedoruk

This information is not meant to replace the advice or treatment of a qualified physician or physiotherapist.  It is meant for information only.  Please seek an assessment and discuss your treatment options with your caregiver prior to making a decision about your treatment path.


does my meniscus need to be repaired, knee injury, knee pain, knee pain edmonton, knee pain st. albert, meniscus tear, torn meniscus

62 comments on “Tales of A Torn Meniscus… Do they all need surgery?”

Leave a Reply

Your email address will not be published.

  • James says:

    Cutting away part of the meniscus is not a solution at all(Menisectomy) But it is what surgeons are trained to do and its their cash mobile. Its what they suggest if the tear wont heal. In fact this only exacerbates the problem in the years to come,eventually leading to a knee replacement.

    The way forward is through Stem Cell Therapy. Having surgery to cut out a torn meniscus will be a thing of the past in less than 10 years time. There is lots of clinical research and trials currently taking place around the world using stem cell technology that has shown great promise in animal models and can heal acute tears in the meniscus.

    Right now certain high profile stem cell companies in America claim they can heal tears using stem cells. But they have no real evidence to back up there claims through scientific means or research journals.Its a money making racket and they are making false and exaggerated claims about there treatment outcomes. The fact is when you get an injection of stem cells into the tear the majority of the liquid solution is t simply washed away. The cells require a seeded matrix to hold them in place in the joint defect.This is being solved through the use of stem cell seeded hydro-gels and this is how meniscus tears can be healed in the not so distant future. If you have a tear in your meniscus and its stable and you can live with it for now hold onto your meniscus.The medical technology to heal it using non invasive methods is very close.

  • Matthew says:

    May 2015 I’m kind of worried. I had woke up in the middle of the night and my right leg was asleep from knee down. I tried to step and my knee gave out and I fell to ground. After about 30 seconds feeling started coming back to my leg and foot. However I feel as though I tore something. I can walk fine and when I sit or stand on not affected leg I can straighten the affected leg with no problem. But when I try and stand on the hurt leg and lock my knee it hurts. Any advice.

  • alaina says:

    I think my niece has a torn meniscus but she doesn’t have any swelling it’s just that she has a hard time straightening and bending it, she can walk on it but it just hurts. Is it normal not to get swelling and still be In pain?

  • Space Nhlapo says:

    Dec 2013

    I felt a sharp pop on the right side of my knee when I landed from a jump to head the ball during a soccer match. I dropped to the grass immediately, in pain and in shock, I think my heart skipped beat. My mind didn’t just feel this sharp pop but instead it felt like I had literally severed the neural connection between my right knee, as well as my brain.

    Now it is April 2015

    Never got surgery, knee is functioning, it pops all the time when I kick hard, or apply pressure because it isn’t comfortable when I don’t pop it. I still get the warm sensation from time- to- time, especially after a long walk, or skateboarding. The same pain I felt “recovering” from injury returns every time I do the latter.

    My worry is my stature, and proportion, I don’t feel the same anymore and this has had emotional complications too because I’m always sad as I am constantly thinking about my ticking time- bomb. My physique has been compromised and this said, my lifespan is in jeopardy because my course of life has been artificially altered.

    Basically, I feel like dying, I feel like I’m not the same anymore, mentally or physically because of this one injury I wish I never got. The sad part being that I can not afford to go see a doctor nor get acquainted with a MRI scan, not when you’re a below average South African with shit public hospitals and a shit president.

  • George says:

    I am scheduled for meniscus surgery in 5 days and am wondering if I need to have it done. My knee hurt but I could get through everyday activities well enough but when I started working out my knee really started bothering me, so much so I couldn’t workout or get up from the floor without bracing my self with my arms. I stopped working out and it improved and to the old level of pain/discomfort.
    My question is should I get the surgery and if so should I insist on attempting a repair first and only if that doent work then try partial removal of the torn area?


1 3 4 5 6 7 11