Meniscal tears are among the most common types of injury to the knee anyone can get, amounting to about 12-14% of the population. And, in the U.S. alone, 10-20% of all orthopedic surgeries are done to the meniscus. But, what happens if you leave a torn meniscus untreated?
Well, since menisci are important to both the structure and stability of your knee, leaving them damaged can compromise the immediate and long-term integrity of the joint. So, generally, you should want a professional managing your meniscus tears.
This, however, doesn’t always mean surgery. In fact, in certain cases, conservative treatment options are better.
So, let’s dive deeper into what your options might be, when surgery is at the top of the list, as well as if you can just leave your meniscus to heal on its own. Let’s start with the latter.
Can A Meniscus Tear Heal On Its Own?
Well, yes and no. Needless to say, though, minor tears are more likely to heal on their own but there are other things that also need to be considered.
For one, where the tear is located is vital to healing.
Anatomically, your meniscus is a c-shaped cartilage that’s divided into 3 zones, and where the tear is in these zones determines its healing possibilities.
- Red zone – This is the outer third of your meniscus that’s rich with blood supply. Healing is very likely here. (Also called the red-red zone.)
- Red-white zone – The middle third of the meniscus with minimal blood supply. Healing is possible but may depend on the type/shape of the tear.
- White zone – The innermost third of the meniscus without any direct blood supply. Healing is unlikely. (Also called the white-white zone.)
So, essentially, the deeper your tear goes into these zones, the less likely it is to heal.
How your body responds to the tear is also another factor.
Some types of tears are just way too much of a nuisance to your daily life. For example, a tear could prevent you from putting any significant weight on your knee without buckling, or you can’t straighten or bend your knee through its full range of motion, or if it’s just excessively painful all the time.
It’s these types of tears that, if they don’t get better over time with conservative treatment, your doctor will probably recommend surgery because it’s taking too long to heal (or that it won’t heal enough to a point that’s comfortable).
Lastly, how you tore your meniscus might also determine its healing capacity.
In essence, there are 2 ways you can think about this:
- Traumatic/acute meniscus tears – When you can point to an exact moment where you suffered an injury (e.g. during a tennis match, or yesterday’s basketball game, or when you swung your golf club, etc).
- Degenerative tears – These are tears that mostly happen without your knee experiencing any type of trauma. They’re a normal part of the aging process (according to the NHS) but they do happen to younger folk every once in a while.
As previously stated, traumatic or acute meniscal tears that are in the red zone can heal on their own or with conservative treatment.
Degenerative tears, however, are unlikely to regain their normal shape but they can feel and function better with exercise therapy ger and surgery (we will talk more about both later on).
How long does it take for a torn meniscus to heal without surgery?
Generally, meniscus tears take anywhere from 6-12 weeks to heal. Some even heal faster at just 4 weeks, depending on the size of the tear and where it is.
That being said, recovering from a torn meniscus, with/without surgery, doesn’t mean you get to laze around for a few weeks.
Rather, your doctor or physical therapist will have you perform exercises and stretches that’ll help you get back to your regular activities safely and quickly while helping you reduce the risk of reinjury.
What treatment options are available for a meniscus tear?
Before anything else, I think the question “how are meniscus tears treated?” is something you should thoroughly discuss with your doctor and/or therapist. I say this because while there is a general protocol for handling these injuries, they may have something more specific in mind for your case.
That being said, here are a few treatments they may recommend:
An acronym for Protect, Rest, Ice, Compress, and Elevate, the PRICE method is generally used for fresh injuries to help control inflammation without hampering the initial stages of healing.
In particular, protecting and resting your knee joint inherently prevents further injury (this might involve using crutches when walking). Ice, compression, and elevation, on the other hand, help with circulation so blood and other fluids don’t pool at the site of injury.
You basically have 2 options here:
- Over-the-counter (OTC) drugs – You can get them without needing to see your doctor. These include acetaminophens and non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen but you might also find relief from topical pain relievers like gels and creams.
- Prescription meds – Obviously, you’d need your doctor’s help with these types of drugs. These are mostly corticosteroids which are more powerful pain relievers and anti-inflammatory agents.
While these are indeed helpful, I highly suggest that you don’t use them whenever they’re not necessary. But, if you do decide to take them, make sure not to go over the limits your doctor set as both OTC and prescription drugs can have significant side effects when they’re abused.
Others might also call this “exercise therapy” and, as a physical therapist myself, I say rightfully so (though they technically aren’t the same) just because I firmly believe that you get the most out of your sessions if it involves controlled movements.
This, of course, includes recovering from a meniscus tear.
With that said, rehab for these types of medical injuries often includes strengthening the muscles of the hips and legs, gradually stretching the knee joint back to its full range of motion, as well as working on balance and skills specific to your sport.
For example, if you’re a tennis player and you tore your meniscus after pivoting, your therapist would probably tailor your exercises towards improving how your pivot foot rotates as well as how the rest of your body moves throughout the rotation.
Or, if it’s a basketball injury that happened after a rebound, your training would probably include improving how you jump and land.
There are 2 ways to about meniscus surgery:
- Meniscectomy, and
- Meniscus repair
Meniscectomy is just a fancy medical term for removing the damaged parts of your meniscus. And, again, there are 2 options:
- Partial meniscectomy, and
- Total meniscectomy
Partial meniscectomy, of course, refers to when your surgeon only takes part of the meniscus. This surgery is often done when only a small part of the meniscus needs to be taken out, preserving the rest of the cartilage.
Total meniscectomy, on the other hand, is done when you might benefit more from having all of your meniscus removed. However, this type of surgery is rarely done as recent studies have proven how partial meniscectomy has a far greater success rate over the long run.
One such study (Mordecai et al.) says that partial meniscectomy has an 80% success rate over 2 years. In contrast, another study (Ahmed and Burke) shows that total meniscectomy drastically alters pressure distribution which suggests long-term repercussions, like osteoarthritis.
Now, you might be wondering:
When is knee surgery the best option?
Ultimately, surgery will only be considered if your doctor thinks that none of the conservative treatments I just mentioned will work or if their effectiveness will be inferior to surgery.
That means he/she will take a good look at the size of the tear, what zones are affected by it, and what type of tear it is.
Generally, small tears on the outer third of the meniscus (red zone) can heal on their own, so surgery likely won’t be necessary. However, larger tears that extend to the inner two-thirds (white zone and red-white zone) is where it gets a little complicated.
Here are some more details on what types of tear may require you to go under the knife:
Otherwise known as intersubstance injuries, incomplete tears are often early signs of wear and tear to the meniscal cartilage but it’s also a stable type of injury that, generally, doesn’t need surgery.
This is the type of tear where the damage runs along the circumference of the meniscus. It is, perhaps, also the type of tear with the best prognosis after surgical repair with one study showing a success rate of up to 85%.
However, this still depends on where the tear is located (with tears in the red zone having the best chance of healing).
Bucket handle tear
This is essentially a more severe horizontal tear, meaning that it also runs along the circumference of the meniscus but at a much larger degree.
The sheer size of the tear may cause the frayed parts to block the normal movement of the knee which makes surgery crucial for recovery.
The type of surgery could either be repair or meniscectomy depending on what zones are affected.
These are tears that happen within the inner two-thirds of the meniscus, or the zones with little to no blood supply and healing ability. They, therefore, cannot be surgically repaired.
Unfortunately, these are also the most common types of meniscal tears. So, when the injury does require surgery, the most probable option would be to trim out the damaged parts (i.e. partial meniscectomy).
Similar to a bucket handle tear, a flap tear may block the normal movement of your knee which, in turn, may require surgery. Partial meniscectomy is often done here to remove the piece of tissue blocking your joint.
It is, however, more uncommon to have this type of injury.
Complex tears can be a combination of any of the injuries I previously mentioned or none of them. The most common combo, however, are patterns belonging to horizontal and radial tears, making both repair and meniscectomy possible.
What happens if you leave a meniscus tear untreated?
Well, that, again, depends on the type and severity of the injury.
In some cases, like tears that limit how your knee moves or ones that cause significant pain, leaving them untreated can severely hamper your quality of life. Not only will you be limited in what sports and exercises you can do but so will other essential activities, like walking or taking the stairs for instance.
Moreover, you may run the risk of causing even more damage.
For one, a supposedly repairable tear with minimal symptoms may get worse if you abuse it. Renowned orthopaedic surgeon Dr. Simon Moyes says that the edges of the tear may wear away, block the movement of your knees, and potentially cause more knee pain and swelling.
Another reason you should not leave meniscal tears untreated is that they may develop into arthritis.
To be sure, get yourself an appointment with your area’s orthopaedic physicians.
Will walking on a torn meniscus make it worse?
Unless pain increases with activity and you get the feeling of your knees sort of locking in place, it’s likely (not absolutely) a minor tear that you can walk with. Still, remember to take it easy on your knees while it’s still recovering.
Do all meniscus tears need surgery?
No, not all tears will need arthroscopic surgery. As a matter of fact, a good deal of torn menisci heal on their own.
However, a tear in the inner two-thirds of the cartilage may need to be trimmed. Larger tears on the outer third may also require surgical action except that preserving all of your menisci is possible with arthroscopic repair.
How Are Meniscus Tears Treated?
- PRICE – Short for Protect, Rest, Ice, Compress, and Elevate. It’s generally the first treatment of choice in sports medicine to help control swelling.
- Medicine – These are mostly for managing knee pain and can either be OTC or prescription drugs.
- Physical therapy – Essentially controlled exercises coupled with therapeutic modalities that help you get back to normal shape, if not better.
- Surgery – This can either be repair (through stitching) or removal. The former is usually done when the injury is capable of healing whereas the latter is done when it can’t and removing the damaged parts is the only treatment option that improves symptoms.
When you leave a meniscus tear untreated, it can either get better or get worse.
It can get better if it’s a relatively smaller tear in the area of the cartilage with a rich blood supply, given that you don’t abuse your knee joint.
On the other hand, a torn meniscus that’s in the avascular region of the cartilage, or even larger tears in the red zone, can get worse to a point where it severely limits the things you can do. These types might even put you at a higher risk for developing arthritis.
So, if there’s anything you should take away from this article, it’s that you should get yourself a doctor’s appointment and talk about your treatment options.