A knee meniscus tear is a relatively common injury/diagnosis in both the general population and in the sporting population.

In younger (20-30 year old) ball sports players like rugby, football, netball etc, a meniscus tear tends to occur from a sudden twisting movement with a foot planted on the ground. So the upper body rotates, the foot stays still, the knee twists, and the meniscus tears. This causes a sudden sharp pain and quite a lot of swelling within 20-30 minutes of the injury occurring.

In the 40+ year old population these knee injuries tend to be diagnosed more as a “degenerative meniscus” with symptoms that have come on relatively gradually and without any specific twisting incident. They can still be swollen and painful, but are usually slightly easier to manage than the sudden acute tears.

What is a meniscus?

The menisci (plural of meniscus) are crescent-shaped wedges of fibrocartilage that provide increased stab

How do you treat/fix a meniscus tear?

10 years ago the standard medical treatment process was to get an MRI scan, and if it confirmed a meniscus tear then arthroscopic surgery was recommended to remove the torn part of the meniscus. Nowadays, more often than not, a surgeon will opt to treat it conservatively with rest, physio and rehab for up to 6 months or more before considering operating on it.

I have had both of my knees operated on for meniscal tears. One in 2006 and one in 2018, both with great results. So although I agree that a conservative approach is the best initial approach, I am certainly open to suggesting arthroscopic surgery if a conservative treatment approach hasn’t worked. Especially if your knee pain is bad enough to prevent you from being able to run.

Signs and Symptoms:

The normal symptoms of a meniscus tear are:

  • Swelling (inside the actual knee joint so the whole knee looks and feels a bit puffy)
  • Pain on the inside of the knee joint (the part of your knee joint that would be touching if you were to press your knees together)
  • Difficulty getting into a full squat position (like our Hunter Gatherer Squat stretch)
  • Pain with any sort of twisting movement
  • Increased swelling and pain during and after impact exercise
To Operate or Not to Operate:

Most degenerative-type meniscal tears do eventually settle down. Every knee is different, so it is very hard to put a time frame on it, but with a combination of reducing impact activities, stretching quads, calves and hamstrings, foam rolling quads and doing some strength exercises (like squats and deadlifts with relatively heavy weights, and single leg stability exercises like single leg squats and single leg deadlifts with lighter weights) they usually do settle down allowing you to get back into full running training.

If you have an acute meniscal tear, caused by a sudden and sharp incident, then I think the recovery is less predictable and these types of injury are more likely to need surgery.

My Surgery Litmus Test:

This is not a black and white test so please don’t use it as your sole decision making tool , but I think it can give some indication as to the severity of your injury and the likelihood of it settling down with a conservative approach.

The Hunter-Gatherer Squat Test. If you can squat right down on your haunches and your knee feels tight, but not painful through the inside of the joint, then I think you have a good chance of it settling down with the right rehab regime. If you can’t get right down into a full squat because it is too painful, even after a week or two of rest, then I think it is more likely that you have a flap of meniscus or a tear which is irritating the joint and more likely to need to be surgically removed.

This is something that can change over time, so keep monitoring it to help gauge your progress.

What is an arthroscopy?

The operation required  to “fix” a meniscus tear is a keyhole surgery procedure called an arthroscopy. To do this, a surgeon will cut two small incisions in the front of your knee and insert a couple of tubes about .5cm – 1cm thick. One has a camera and the other some tools. The aim is usually to chop a smooth margin around the meniscal tear getting rid of any torn fragments and especially any flaps of meniscus which might be sticking up and irritating the joint.

I put “fix” in inverted commas because this procedure can improve your symptoms significantly, but it involves removing part of your knee’s natural shock absorption mechanism, so it may come at the potential price of an increased chanced of developing osteo-arthritic changes in your knee in the future. However, and I think this is very important to understand, if you have a torn meniscus that is constantly making your knee swell up and causing pain, then this is equally or even more likely to cause you arthritic changes in the future.

How/When do you choose to operate?

You need to think about this holistically in terms of your whole quality of life. My first knee arthroscopy was in 2006. One of my knees went pop when I was out running one day. It was painful, but manageable, and I was training for an Ironman at the time, so I thought I would try and manage it through a 5 month training block. I could run for up to an hour, it would swell a bit, but usually settle within 24-36 hours. I could ride and swim with no problems, so this was enough to keep pushing on with training. 1 month before the Ironman I did a 1/2 ironman race as part of the training block. The run for this was a half marathon and that caused my knee to blow up like a balloon, and that was the end of my ironman aspirations.

Because my knee had already been problematic for 5 months, I opted to have surgery, and was running pretty much normally again 3 months post surgery, albeit at a reduced volume just to be cautious. Since 2006 I have run tens of thousands of km’s and my knee has been pretty much perfect. In the last couple of years (following a 100 mile race) it has been a bit grumpy again, but I can manage it with stretching, rolling and strength, and it isn’t preventing me from running, nor affecting my training volume. I can still do a hunter-gatherer squat, so I am hoping/intending to avoid further surgery.

My right knee went pop in 2018 when I was squatting down and twisting to lift something. It felt very similar to when I had done my left knee, so this time I went down the surgery route after 6 weeks of rest and rehab proved not to be working.

For most runners I know, every aspect of their life is better when they are running. They make better diet choices and lifestyle choices, they are fitter, healthier, happier and stronger. So if you have been diagnosed with a meniscal tear and a medical professional (or anyone else) has told you not to run because your knee is going to wear out quicker, then you need to think pretty seriously about the implications this may cause.

I have absolutely loved my last 18 years of running. It has helped to keep me fit, healthy, strong and sane. Even if now my knees were becoming problematic enough to limit my running I would not regret my decision to have had surgery, and certainly wouldn’t regret my decision to have kept running.