Degenerative meniscus, December 2023 1
Degenerative meniscal tears: Information and
advice for patients
This leaflet gives advice and exercises to patients who have been diagnosed
with a degenerative meniscal tear. If you have any questions or concerns,
please speak to your physiotherapist.
What are the menisci?
The menisci are C-shaped tissues inside the
knee joint. They help to cushion the thigh bone
(femur) and the shin bone (tibia). There is one
on the inside of the knee (medial) and one on
the outside of the knee (lateral).
The meniscus play several important functions:
• They work as a shock absorber and help
spread the weight of your body evenly across
the knee joint.
• They help with joint lubrication
• They help increase joint stability
The outer parts of the meniscus have a good
blood supply but the middle and inner parts have
a poor blood supply. Because of the effect the
blood supply can have on healing, the location
of a tear will affect treatment options.
Cross section of the knee showing the anatomy
Anterior cruciate ligament
Medial meniscus
Posterior cruciate ligament
Transverse ligament
Lateral meniscus
Posterior
meniscofemoral
ligam
ent
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How are the menisci injured?
The menisci are commonly injured parts of the knee joint. They can be injured in two ways:
• Acute meniscal tears: usually due to a specific injury, e.g. in sports such as football, rugby
or skiing, where menisci can be torn from twisting movements while weight-bearing through
the knee joint. The meniscus can be partially or fully torn.
• Degenerative meniscal tears: not due to a specific injury. These can occur at any age,
although are more common in middle age or older people. There is usually no specific injury
or incident, but are probably an early sign of osteoarthritis (the normal ageing process of
joints), rather than a completely separate diagnosis. They gradually come on and can get
worse. They can also be pain free, as the changes within the menisci are perfectly normal
age-related changes and responses that happen within the knee as we get older. The knee
pain if present, is often difficult to pinpoint. Research shows that it is more difficult to heal a
tear caused by deterioration than one from an acute trauma that can occur earlier in life.
What can contribute to someone developing a degenerative meniscal tear?
There are several factors that may increase the risk of developing degenerative meniscal tears:
• Weight: Being overweight can significantly increase the chances of developing knee pain, as
the knee joint has to carry the extra weight. For every pound lost, the knee feels three to four
pounds less stress.
• Cardiovascular fitness: Being unfit is closely associated with degenerative meniscal tears.
Good cardiovascular fitness is important for good health and helps you to carry out daily
tasks and leisure activities with less strain on our bodies.
• Load tolerance: Our joints adapt to a person’s usual level of activity, developing a baseline
level of load (weight) that the knee is comfortable with (load tolerance level). Increased
loading or a rapid increase in load can make your knee more sensitive but rarely causes
serious damage.
• Strength: Your thighs muscles (quadriceps) help to support your knee and weakness of
these muscles can have a big impact on your knee function. If you also have weak hip and
bottom muscles (glutes), single leg activities such as climbing stairs and walking can become
more difficult to control and make your knee more sensitive.
• Altered biomechanics: While having strong muscles is important, these muscles also need
to be able to control movements above, at and below the knee efficiently. If they are unable
to do this, your knee may become more sensitive.
• Flexibility: It is important to keep your knee flexible, as tight or restricted movements can
reduce the range of movement at your knee and affect how your knee copes with the loads
being transferred through your knee.
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Symptoms
Symptoms of a degenerative meniscal tear vary and some patients may not have any at all.
Symptoms may include:
• Pain: Pain is the most commonly associated symptom of a meniscal tear. Intensity may vary
from mild to severe, to aches and sharper pains. Pain may be aggravated with twisting
movements, impact activities, squatting and kneeling movements.
• Swelling: This often develops within a day or two of the tear. Some swelling may last up to
several months.
• Altered function of the knee: Straightening the knee may cause pain, and people may
experience difficulty with walking. If fragments from the torn meniscus interferes with the
normal movement of the knee, some people may also experience ‘locking’ of the knee.
• Some people also report a clicking sound when they walk. You may be unable to straighten
the knee fully. In severe cases you may not be able to walk without a lot of pain. On the other
hand, activities such as going down the stairs may result in giving way of the knee joint.
Self-help / management
Some people only ever have mild symptoms that do not worsen. Many people are able to
manage their degenerative menisci themselves and with simple management may be able to
reduce the pain, increase their activity and function, and reduce their need for painkillers.
The following may be helpful.
Exercise
Joints need to be exercised regularly to remain healthy. Whatever your fitness level, exercise
can help the knee cope with normal daily activities again.
• Exercise can help to strengthen the muscles around your knee, improve your posture and
help you lose weight; all of which will help to reduce your symptoms.
• Maintain joint stability and movement. Non-weight bearing exercises will help to build up the
muscles so that the stress is reduced on the joint and surrounding soft tissues and can help
to maintain the range of movement. This could include cycling outside or on a static bike.
Ensure that the saddle is correctly adjusted and not too low. Avoid lots of hills as the extra
stress may aggravate your knees. Do your exercises daily, 10-15 minutes is all that is
needed.
• Exercises in weight bearing positions can also be included if your symptoms are not
aggravated by them. They can be incorporated into your activities of daily living, e.g. squats
climbing stairs etc.
• Aerobic exercise (any exercise that increases your heart rate and makes you a little short of
breath) should also be included. It is good for your general health and well-being and can
reduce pain by stimulating the release of endorphins (pain relieving hormones). It can also
make you sleep better. You should aim to do 2 hours and 30 minutes of aerobic exercise a
week. You do not need to do this all in one go.
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• Swimming and exercises in water can help your joints as the water helps to support the
weight of your body and reduces the stresses on your knees but allows you to keep moving.
Be careful with breaststroke as the twisting action may aggravate your knee.
• Avoid long periods of standing. If unavoidable, shift the weight from one leg to the other.
Sitting for long periods may cause stiffness. Try to get up and walk around or change your
position regularly, e.g. every 20-30 minutes. Remain as active as you can and find the right
balance between exercise and rest for your knee.
Weight management
• Avoid becoming overweight as this can lead to increasing stress on the knee and increased
pain.
• If overweight, losing weight can help. For every one pound in weight lost, there is a 3-4
pounds reduction in the load exerted on the knee for each step taken during daily activities.
• There is no special diet that will help but if you need to lose weight you should follow a
balanced, reduced calorie diet combined with regular exercise. Your GP should be able to
advise you regarding diets and exercise that may help.
Reducing the stress on your knee
There are also a number of ways that can help you to avoid unnecessary stress on your knees:
• Pace your activities – don’t tackle all your physical jobs at once. Break the harder jobs into
smaller chunks and do something lighter in between them. Keep using your knee even if it is
slightly uncomfortable but rest before it becomes too painful.
• Avoid long, hilly walks on hard ground. Be careful and slow down when walking on uneven
ground.
• Where possible, avoid carrying heavy loads. Balance loads between both hands and
decrease the loads by increasing the number of journeys if you are able.
• Avoid twisting the knee, move the whole body and feet as one.
• Wearing a knee support may help your symptoms but ideally should not be worn long term.
You can purchase these off the shelf from many pharmacies, or ask your physiotherapist for
advice. A simple Tubigrip support may help to provide some relief and a feeling of stability to
the knee.
• Use a stick to reduce the stress on the joints when walking or standing for long periods.
• Try to wear sensible shoes that support your feet and have low heels.
Pain relief
Pain relieving medication can be used to help ease pain and stiffness caused by degenerative
menisci but they will not prevent or cure the condition itself.
Some of the medications that you can try include:
• Painkillers – simple over the counter painkillers such as Paracetomol may help but your
doctor can prescribe stronger painkillers if necessary.
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• Non-steroidal anti inflammatories (NSAIDs), e.g. Ibuprofen. A short course may help to
reduce any pain, inflammation and swelling in your knee.
• Capsicum cream – a pain relieving cream made from the pepper plant. This is available on
prescription and may help if rubbed into the painful area.
• Intra-articular steroid injections – may provide short term pain relief .The effects can last
between a few weeks and a few months but will need to be discussed with your health care
provider to see if they are suitable.
Other things which may help with pain relief are:
• Ice – for 15 – 20 minutes. Place a dampened cloth over the knee and apply the ice pack over
this to prevent an ice burn. Wrap the knee in a towel if necessary to keep the ice pack in
place. Packets of frozen peas or crushed ice in a bag are the most convenient and re-usable
although re-usable gel packs are also available.
If you are taking over the counter medications make sure you are taking them safely as directed
by your doctor or the patient information leaflet included with the drug. Make sure that whoever
is treating you knows all the medication you are taking.
Can surgery help?
Surgery will not help with degenerative meniscal tears. In the rare cases where this may be
considered, funding will need to be applied for and is often rejected as surgery is not a
recommended treatment option. It is important to note that in middle aged and older people,
research studies have shown that the outcomes from arthroscopy surgery (keyhole surgery) on
degenerative meniscal tears were no better than those who opted to self-manage.
Surgery to the meniscus (which acts as a shock absorber) will expose the bone that can
eventually increase the risk of earlier onset osteoarthritis. However, surgery may be undertaken
if there are clinical symptoms of “caching” or “locking” and / or localised knee pain. These
symptoms are more likely to be associated with an acute meniscal tear. Removal of the tissue
(known as a ‘partial meniscectomy’) may be considered where as little tissue as possible is
removed. The goal is to improve the function and range of movement of the knee.
How will physiotherapy help?
This is only one part of your treatment. It will help to identify the main contributory factors for
your pain and give you a specific targeted rehabilitation programme.
Exercises to increase the muscle power in the muscles at the front of your thigh, to help
support the knee joint and to maintain range of movement are one of the most important
treatments for degenerative meniscal tears. They may help to alleviate pain and stiffness.
Exercises targeted at the bottom muscles (glutes) can improve the control of single leg
movements e.g. climbing stairs and walking.
It is important to continue with your exercises even if your knee starts to feel better. Stopping or
reducing the amount of exercise you do could cause your knee symptoms to come back. Try to
build them into your daily routine.
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How long will it take to get better?
How long it takes for your knee to settle can vary. With regular exercises, we would expect to
see a difference in 3-6 months. With continuation of the exercises, this benefit may be
maintained and further improvements seen.
Do I need an MRI scan or x-ray?
MRI (Magnetic Resonance Imaging) scans give a very detailed picture of the knee and may
form part of the assessment process. However, as already mentioned, there is poor correlation
between MRI findings of degenerative meniscal tears and level of pain experienced by patient.
The best way to understand your symptoms is a detail assessment by your physiotherapist, GP
or consultant.
Degenerative meniscus tears commonly exist in people without knee pain, so it is important that
treatment deals with your contributory factors and not just the picture generated from the MRI
scan. It is important to treat the person rather than the picture of the scan because many
images show incidental findings.
An X-ray may be helpful to determine whether there is any significant level of osteoarthritis
within the knee. This is important as if this is the case and keyhole surgery is being considered,
it is often ineffective in relieving pain in the long term and may speed up the arthritis process
due to loss of the meniscus.
How do I manage ongoing pain?
With degenerative meniscal tears, sometimes a flare up of symptoms can occur without
warning. These flare ups are often associated with changes in activity or load. During a flare up,
exercises and daily activities should be modified to decrease the load on the knee. As the
symptoms settle, exercises and normal activities should be gradually built up again.
Home exercises
1. Sitting with your back supported and your legs out
straight in front of you.
• Bend your knee as far as possible. Gently bend
your knee a little more.
• Hold for 10 seconds.
• Repeat 10 times.
• To help bend your knee, you may put a towel
around your foot, or help bend your knee with your
hands around your thigh.
• Try to do this exercise 2-3 times a day.
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2. Lying on your back or sitting with your back
supported and your legs out straight in front of
you.
• Place a rolled towel under your ankle.
• Pull your feet up towards you. Push your knee
down firmly so that your thigh muscles tighten.
• Try to touch the floor with the back of your knee.
• Hold for 10 seconds.
• Repeat 10 times.
• Try to do this exercise 2-3 times a day.
3. Lying on your back or sitting with your back
supported and your legs out straight in front of
you.
• Pull your feet up towards you. Push your knee
down firmly so that your thigh muscles tighten.
• Keeping your knee straight, lift your leg up to just
clear the bed.
• Hold for 10 seconds and lower slowly.
• Repeat 10 times.
4. Lying on your back or sitting with your back
supported and your legs out straight in front of
you.
• Place a rolled up towel or cushion under your
knee.
• Push your knee down hard and straighten your
leg.
• Hold for 10 seconds. Repeat 10 times.
5. Lying on your back or sitting with your back
supported and your legs out straight in front of
you.
• Bend your knee to 45 degrees.
• Pull your toes up towards you, and dig your heel
into the bed.
• You should feel the muscles of the front and back
of your thigh tighten.
• Hold for 10 seconds.
• Repeat 10 times.
↓
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6. Lying on your
back with your knees bent and feet
hips width apart.
• Draw in your abdominals and tighten your buttocks.
•
Tilt your pelvis backwards and lift your pelvis up.
Only lift as high as you are able while maintaining
your pelvis position. Do not let your back arch.
• Hold for 5-10 seconds
• Lower your pelvis down in a controlled manner.
• Repeat 10 times
7. From a sitting position, try to stand up from the
chair without using your hands.
• Slowly lean forwards and stand up, then slowly sit
down again.
• You may need to use your arms to help at first. Try
not to drop into the chair but try to control the
movement.
• This can be made easier and more difficult by
changing the height of the chair.
• Try to avoid letting your knees roll in to touch each
other. It may help to place a resistance band
around your legs to encourage you to keep your
knees apart.
• Repeat 10 times.
8. Stand in front of a table or chair, holding on to the
support with both hands.
• Slowly crouch down, keeping your back straight
and your heels on the floor.
• Stay down for approximately 30 seconds and feel
the stretching in your buttocks and the front of your
thighs.
• Repeat 10 times.
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9. Stand up straight and try to balance on one leg.
• If you are unsteady rest your hand lightly on a
nearby surface.
• Try to hold this position for 5- 10 seconds.
Gradually increase the time up to 30 seconds as it
becomes easier.
• You can make this exercises more difficult by:
o Closing your eyes
o Using a folded towel or cushion to stand on
o Tapping the toes of your non weight wearing
leg around the numbers of an imaginary clock
face. Allow your weight bearing leg to bend
slightly.
• Repeat 5-10 times.
10. Start by standing in front of a step or at the bottom
of the stairs.
• Step up onto the step and straighten the hip and
knee.
• Do not let your knees roll in keep good hip knee,
ankle alignment.
• Step down again.
• Repeat x 5-10 times on each leg. Repeat 2-3 sets.
11. Stand on your affected leg on a step facing down.
• Slowly lower yourself down by bending your knee
to 30 degrees.
• Try to keep the knee of your affected leg over your
2
nd
/3
rd
toes.
• This can be made more difficult by bending your
knee more so that the heel of your unaffected leg
touches the ground and/or by increasing the height
of the step and doing the exercise more slowly.
Additionally a small weight could be held in each
hand.
• Repeat 5-10 times.
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In the gym
If you have access to a gym and they have a leg press machine and /or knee extension and
hamstring curl machines, then these are also good exercises to do to strengthen your leg
muscles.
Start with lower loads and gradually build up.
Speak to your physiotherapist if you have any questions regarding using these machines.
You should wait until your knee is not swollen, is pain free and has full range of movement
before attempting to return to impact type activities e.g. running, jumping and hopping. These
activities should then be returned to slowly and reduced should any of your symptoms recur.
Please note: During the previous exercises, you should not push into pain but mild discomfort
is acceptable. They are designed to stretch, strengthen and stabilise your knee.
As is usual with any new exercise, your muscles may ache and you may experience new aches
and pains for a few days, these should settle. If they do not, try to establish the aggravating
exercise and leave this out of your exercise programme for a few days and then try again. Carry
on exercising even if your symptoms ease as this can help stop them coming back.
Exercise pictures © Physio Tools Ltd.
Contact us
RBFT Physiotherapy Department
0118 322 7811 or 7812
To find out more about our Trust visit www.royalberkshire.nhs.uk
Please ask if you need this information in another language or format.
Debbie Burden, Orthopaedic Physiotherapy Specialist, RBFT Orthopaedic Physiotherapy
Produced: December 2023
Next review due: December 2025
