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    Move Forward Guide

    Physical Therapist's Guide to Meniscal Tear

    Meniscal tears are common injuries to the cartilage of the knee that can affect athletes and nonathletes alike. These tears can be either “acute,” meaning they happen as a result of a particular movement, or “degenerative,” meaning they happen over time. Your physical therapist can help you heal a meniscal tear and restore your strength and movement. If surgery is required, your physical therapist can help you prepare for the procedure and recover following surgery.


     

    What is a Meniscal Tear?

    The meniscus is a cartilage disc that cushions your knee. Each of your knees has 2 menisci (plural of meniscus); one on the inner (medial) part of the knee, and the other on the outer (lateral) part of the knee. Together, they act to absorb shock and stabilize the knee joint.

    Meniscal tears can be classified in 2 ways: acute or degenerative. An acute meniscal tear typically is caused by twisting or turning quickly on a bent knee, often with the foot planted on the ground. This mechanism of injury often produces related injuries, such as an ACL tear. Degenerative meniscal tears occur over time, due to repetitive stress being put on the knee, such as in a job or sport that requires a lot of squatting.

     

    How Does it Feel?

    When you tear the meniscus, you might experience:

    • A sharp, intense pain in the knee area
    • A "pop" or a tearing sensation in the knee area (acute injury)
    • Swelling within the first 24 hours of injury
    • Difficulty walking or going up or down stairs because of pain or a "catching or locking" sensation in the knee
    • Difficulty straightening or bending the knee fully
     

    How Is It Diagnosed?

    Your physical therapist will:

    • Conduct a thorough evaluation that includes a detailed review of your injury, symptoms, and health history.
    • Perform special tests to measure the range of motion (amount of movement) in your knee and determine which specific movements and positions increase your symptoms.
    • Use a series of tests that apply pressure to the meniscus to determine whether it appears to be damaged.

    The results of these tests may indicate the need for further diagnostic tests—such as magnetic resonance imaging (MRI)—or a referral to an orthopedic surgeon for consultation.

     

    How Can a Physical Therapist Help?

    Meniscal tears can often be managed without surgery. A short course of treatment provided by a physical therapist can help determine whether your knee will recover without surgery. Your physical therapist can help control pain and swelling in the knee area and work with you to restore full strength and mobility to your knee. Your treatment may include:

    Manual therapy. Your physical therapist may apply manual therapy—hands-on treatment that may include massage, stretching, or joint mobilization—to help reduce swelling and stiffness, and restore muscle function around the knee.

    Icing. Your physical therapist will apply ice packs to the knee to help control any pain and swelling, and may instruct you to apply icing at home. Swelling is an important "guide" during your rehabilitation and can indicate your level of ability and recovery. If you experience an increase in swelling, your physical therapist will modify your treatment program or activity level to ensure your safest, most effective recovery.

    Compression. Your physical therapist may recommend the use of compression bandages, stockings, or pumps to assist in the reduction of or prevent further accumulation of edema (swelling). Your physical therapist may include them as part of your regular treatments and teach you and your family how to use them at home.

    NMES. Your physical therapist may use a treatment called neuromuscular electrical stimulation (NMES). NMES uses electrical current to gently stimulate/contract the muscles around your knee to help improve their strength.

    Assistive devices. It may be necessary to use assistive devices such as crutches, a cane, or a walker in the short term. Your physical therapist will make recommendations about which device is best for you and will instruct you in how to use it properly.

    Strengthening exercises. Your physical therapist will design exercises to build and maintain your strength during recovery and help restore full movement to the knee. You will be given a home program of exercises that are specific to your condition. Strengthening the muscles around the knee and throughout the leg helps ease pressure on the healing knee tissue.

    Fitness counseling. As you recover, your physical therapist will advise you on ways to improve and maintain your fitness and activity levels, and will help you decide when you are ready to return to full activity.

    If Surgery Is Required

    Patients with more serious meniscal tears, or those who don’t respond to a course of physical therapy, may need surgery to repair the injured knee. Surgically removing the torn cartilage (a procedure called a meniscectomy) usually is a simple procedure that requires a course of physical therapy treatment following surgery. Many people are able to return to their previous level of activity, including sports, after approximately 4 months of treatment.

    Meniscus removal. Following a simple meniscectomy, your rehabilitation will likely be similar to that for nonsurgical meniscal injuries. Your physical therapist may use ice and compression to control pain and swelling and will show you how to use these treatments at home. The focus of your treatment will be on helping you get back your strength and movement through a series of exercises performed in the clinic and at home, as well as with hands-on treatment (manual therapy). Initially, it is likely that you will need to use crutches or a cane for walking. Your physical therapist will help guide you in gradually placing your weight on the knee to stand or walk, to allow the meniscus and other tissue in the knee joint to slowly adjust to increased pressure.

    Meniscus repair. Sometimes your surgeon will decide that the torn meniscus can be repaired instead of removed. Research studies show that if a meniscal repair is possible, it can reduce the risk of arthritis developing later in life. Rehabilitation following a meniscal repair is slower and more extensive than with meniscal removal because the repaired tissue must be protected while it is healing. The type of surgical technique performed, the extent of your injury, and the preferences of the surgeon often determine how quickly you will be able to put weight on your leg, stop using crutches, and return to your previous activities.

    Following surgery for meniscal repair, your physical therapist will:

    • Help you control pain and swelling
    • Guide you through progressive reloading of weight to the knee to allow the cartilage to slowly adjust to increased compressive stress and pressure
    • Help restore your knee and leg range of motion
    • Teach you exercises to help restore your muscle strength

    Return to Activity

    Whether your torn meniscus recovered on its own or required surgery, your physical therapist will play an important role in helping you return to your previous activities. Your physical therapist will help you learn to walk without favoring the leg and perform activities like going up and down stairs with ease.

    Return to work. If you have a physically demanding job or lifestyle, your physical therapist can help you return to these activities and improve how you perform them.

    Return to sport. If you are an athlete, you may need a more extensive course of rehabilitation. Your physical therapist will help you fully restore your strength, endurance, flexibility, and coordination to help maximize your return to sports and prevent reinjury. Return to sport varies greatly from one person to the next and depends on the extent of the injury, the specific surgical procedure, the preference of the surgeon, and the type of sport. Your physical therapist will consider these factors when designing and adjusting your rehabilitation program, and will work closely with your surgeon to help decide when it is safe for you to return to sports and other activities.

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    Can this Injury or Condition be Prevented?

    There is little research at this time to support exercise or other interventions such as bracing for prevention of meniscal injuries. However, you can make choices to help improve your overall fitness and keep your knees as strong and as healthy as possible. Practices that can help keep your knees strong include:

    • Regular exercise to help strengthen the muscles that support your knees
    • Staying physically active to prepare your body for the demands of a sport or strenuous activity
    • Avoiding twisting or turning quickly while your foot is planted on the ground, to help prevent stress to the knee that can cause a meniscal tear

    If you already have knee problems, your physical therapist can help you develop a fitness program that takes your knees into account. Some exercises are better than others for those with a history of knee pain. Many exercises can be modified to fit your specific needs.

     

    Real Life Experiences

    Beau is a college sophomore who plays on his intramural lacrosse team. During a recent practice game, Beau twisted his left knee while performing a sharp turn to make a catch. He immediately heard a “pop” and felt pain in his knee joint. He was helped off the field by teammates and led back to his room, where he applied ice and rested for the rest of the evening.

    The next morning, Beau felt pain when he put weight on his leg to get out of bed, and found he had difficulty walking; he also noticed some swelling on the inside of his knee. His roommate is in the physical therapy program at his university; he suggested Beau see a physical therapist.

    Beau’s physical therapist gets his medical history and asks him to describe what happened in the game to get a sense of what might have happened to his knee. She then performs some tests that include movements that selectively stress the tissues of the knee to see if the symptoms can be provoked. She tells Beau that his symptoms may indicate a meniscal tear. She recommends that he consult with an orthopedic surgeon, who orders magnetic resonance imaging (MRI). The surgeon confirms a diagnosis of a medial meniscal tear. After consultation with the surgeon, Beau chooses to have the tear “cleaned up,” and have a small piece of the meniscus removed—a procedure called a meniscectomy.

    Prior to surgery, Beau works with his physical therapist, who prescribes exercises and manual therapy to reduce the swelling, improve the knee range of motion, and restore muscle function around the knee—treatments that have been shown to improve surgical outcomes.

    Following his surgery, Beau’s physical therapist controls the swelling around the knee joint with ice, and shows Beau how to ice his knee at home. She applies electrical stimulation to speed the recovery of the quadriceps muscle. She teaches him range-of-motion exercises and tells him how often he should be doing them at home. She teaches him how to use crutches to avoid putting pressure and weight on the knee while its tissues heal.

    After 1 week, Beau is able to walk without his crutches, but has difficulty bending his knee fully or straightening it when he walks. His physical therapist works with him on improving his walking pattern, and continues to address his knee range of motion, strength, swelling, and pain. His exercises are adjusted as he heals to continue to challenge him and move his recovery forward.

    After 3 weeks, Beau has full range of motion and increased strength in his involved leg. He has good balance and no pain while walking. His physical therapist guides him as he returns to jogging and then running. She gives Beau feedback on how much he should be running, how running should feel, and what to do to ensure a symmetrical running pattern to keep his knee and his other joints safe.

    At 4 weeks, Beau’s treatment progresses to sports-related rehabilitation activities, which include moving quickly from side to side and learning how to safely turn to field a catch. His physical therapist provides guidance and training to help Beau avoid reinjury. Beau reports his leg muscles have gained strength, and he feels more stable as he executes his movements.

    After 6 weeks of treatment, Beau rejoins his team for a playoff game and, with newfound confidence, sets up his teammate for a winning goal!

    This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.

     

    What Kind of Physical Therapist Do I Need?

    All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:

    • A physical therapist who is experienced in treating people with orthopedic (musculoskeletal) problems or sports injuries.
    • A physical therapist who is a board-certified orthopaedic clinical specialist or who completed a residency or fellowship in orthopedic physical therapy or sports physical therapy has advanced knowledge, experience, and skills that may apply to your condition.

    You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

    General tips when you're looking for a physical therapist:

    • Get recommendations from family and friends or from other health care providers.
    • When you contact a physical therapy clinic for an appointment, ask about the physical therapist's experience in helping people with a meniscal tear.

    During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

     

    Further Reading

    The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

    The following articles provide some of the best scientific evidence related to physical therapy treatment of meniscal injuries. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are listed by year and are linked either to a PubMed* abstract of the article or to free access of the full article, so that you can read it or print out a copy to bring with you to your health care provider.

    Beaufils P, Pujol N. Management of traumatic meniscal tear and degenerative meniscal lesions: save the meniscus. Orthop Tramatol Surg Res. 2017 September 2 [Epub ahead of print]. doi: 10.1016/j.otsr.2017.08.003. Article Summary in PubMed.

    Moses MJ, Wang DE, Weinberg M, Strauss EJ. Clinical outcomes following surgically repaired bucket-handle meniscus tears. Phys Sportsmed. 2017 May 23 [Epub ahead of print]. doi: 10.1080/00913847.2017.1331688. Article Summary in PubMed.

    Skou ST, Lind M, Holmich P, et al. Study protocol for a randomised controlled trial of meniscal surgery compared with exercise and patient education for treatment of meniscal tears in young adults. BMJ Open. 2017;7(8):e017436. Free Article.

    Hare KB, Stefan Lohmander L, Kise NJ, et al. Middle-aged patients with an MRI-verified medial meniscal tear report symptoms commonly associated with knee osteoarthritis. Acta Orthop. 2017 August 8 [Epub ahead of print]. doi: 10.1080/17453674.2017.1360985. Free Article.

    Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368:1675-1684. Article Summary in PubMed.

    Logerstedt DS, Snyder-Mackler L, Ritter RC, Axe MJ. Knee pain and mobility impairments: meniscal and articular cartilage lesions. J Orthop Sports Phys Ther. 2010;40(6):A1-A35. Free Article.

    Heckmann TP, Barber-Westin SD, Noyes FR. Meniscal repair and transplantation: indications, techniques, rehabilitation, and clinical outcome. J Orthop Sports Phys Ther. 2006;36:795-814. Article Summary in PubMed.

    Lowery DJ, Farley TD, Wing DW, et al. A clinical composite score accurately detects meniscal pathology. Arthroscopy. 2006;22:1174-1179.  Article Summary in PubMed.

    Fitzgerald GK, Piva SR, Irrgang JJ. A modified neuromuscular electrical stimulation protocol for quadriceps strength training following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther. 2003;33:492-501. Article Summary in PubMed.

    *PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI).  PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

     Authored by Christopher Bise, PT, DPT, MS. Reviewed by the MoveForwardPT.com editorial board.