Degenerative Meniscus

Someone with a degenerative meniscus may present with pain, stiffness and swelling. Catching, locking or the sensation of your knee “giving way” may also be experienced. The medial (inside) meniscus is more frequently torn, partly because of its different shape but also because of its attachment to the medial collateral ligament (inside knee ligament).

Meniscal tears often happen when you play sports, but you can also get them as a result of ‘wear and tear’ as you get older. When people talk about ‘torn cartilage’ in their knee, they usually mean a meniscus injury. They are given different grades depending on how severe an injury it is.

Depending on the symptoms you experience, conservative treatment should be the first option. Current guidelines generally discourage arthroscopy (keyhole surgery) for patients with clear evidence of osteoarthritis on X-ray ⁽⁹⁾.

Our understanding of the best way to manage degenerative meniscus problems is continually developing and unfortunately, it is not unusual for patients to be working on outdated and potentially ineffective treatment approaches. We review research on a regular basis and continually update our website to ensure we are giving the best advice by integrating current evidence with our clinical expertise.

Symptoms usually develop following a forceful rotation or twisting of the knee, such as when coming to a sudden stop. Symptoms can also develop insidiously (without known cause). It is well documented that natural ageing results in the menisci (cartilage) being more prone to tearing ⁽⁴⁾. Repetitively putting full body weight on the knee such as when kneeling, deep squatting or lifting heavy objects can also contribute to symptoms. Obesity and being overweight are also contributing factors. A person with predisposing degenerative diseases such as osteoarthritis is more likely to suffer from degenerative meniscus.

In the general population, degenerative menisci affects more than 35% of people over 50 and there is a 24% prevalence in those with no evidence of osteoarthritis on X-ray ⁽⁵⁾. It is more common in older people who are heavily involved in sport, particularly sports that require twisting and rotation of the knee such as football, tennis and basketball.

Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.

Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Magnetic resonance imaging (MRI) is currently the preferred choice for detecting meniscal injuries and planning subsequent treatment. A thorough understanding of the imaging protocols, normal meniscal anatomy, surrounding anatomic structures and anatomic variants, and pitfalls is critical to ensure diagnostic accuracy and prevent unnecessary surgery ⁽⁶⁾.

As part of your treatment, your musculoskeletal physiotherapist will help you understand the condition and what needs to be implemented to effectively manage your degenerative meniscus. This will include activity modification strategies, as well as other useful treatments aimed at reducing discomfort. Regular adherence to a condition-specific rehabilitation programme is important in the management of this condition. It should be noted that rehabilitation exercises are not always a quick fix, but if adhered to on a consistent basis (weeks to months), over time they have been shown to yield positive outcomes.

For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.

As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.

Surgery is rarely indicated with degenerative meniscal tears due to the fact that the outcomes have not been shown to be superior to conservative management. Likewise, the indication for using corticosteroids for this condition has not been proven by the research. There may be situations where these treatments are needed and these will be discussed with your orthopaedic consultant.