Degenerative meniscal lesion
A degenerative meniscal tear develops gradually, often without any specific trauma. It can cause pain on the inside or outside of the knee, discomfort when walking, or swelling after exertion. It may also be discovered on an MRI scan without being the primary cause of symptoms.
Treatment depends on the pain level, examination of the knee, the patient's activities, and the condition of the cartilage. In most cases, a gradual approach is considered before discussing surgery.
UNDERSTANDING DEGENERATIVE MENISCAL INJURY
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This is the area located on the inner side of the knee and is the most frequently affected by osteoarthritis. Its wear and tear can cause internal pain and gradually lead to leg deformity.
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Located on the outer side of the knee, this compartment is less frequently affected. Its wear and tear can cause lateral pain and gradually alter the leg's alignment.
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This joint is located between the kneecap and the femur. When it is affected, pain often appears when climbing stairs, squatting, or after sitting for a long time.
RECOGNIZING THE SYMPTOMS
The symptoms of a degenerative meniscal tear often develop gradually. Their intensity varies, and they can also be related to cartilage wear or another cause of knee pain.
- Localized pain : it is often located on the inner or outer side of the knee, especially during walking, bending movements or changes of position.
- Discomfort during certain movements : squatting, kneeling or pivoting can become uncomfortable, especially when the knee is already painful.
- Swelling The knee may swell after activity or a period of strain. The swelling may appear gradually.
- Stiffness or a feeling of grip The knee may feel less flexible or produce a sensation of mechanical discomfort. These sensations alone do not prove that a piece of the meniscus is displaced.
Symptoms can fluctuate: some days the knee is only slightly painful; at other times, a longer walk or unusual activity triggers the discomfort. An MRI scan alone cannot determine whether a meniscus tear is the cause of the symptoms.
Prompt consultation is recommended in cases of severe knee swelling, significant pain following an injury, inability to bear weight, or persistent locking that prevents straightening or bending the knee. In cases of significant pain and swelling following an injury, the service SOS Knee Geneva for a knee assessment can be contacted.
WHY DOES A DEGENERATIVE MENISCAL LESION OCCUR?
The meniscus is a fibrocartilaginous tissue that helps distribute forces between the femur and tibia. Over time, its structure can become less resistant. A tear can then appear gradually, sometimes following ordinary movement, without any major injury.
A gradual weakening
Unlike a traumatic tear occurring during a sudden movement, a degenerative lesion generally develops on a meniscus that has gradually weakened. It can be associated with changes related to age and the overall condition of the joint.
Repeated constraints
Repetitive stress, certain professional or sporting activities, the alignment of the lower limb, and the characteristics of the joint can all contribute to the stresses placed on the meniscus. These factors alone are not sufficient to predict the occurrence of an injury.
A possible association with osteoarthritis
A degenerative meniscal tear can coexist with cartilage wear. Symptoms can then originate from several structures simultaneously. The doctor considers the pain, the examination, and the imaging to determine the respective contribution of each element. Learn more about knee osteoarthritis.
MAKE THE RIGHT DIAGNOSIS
The diagnosis is not based solely on the MRI. It is necessary to verify whether the visible lesion corresponds to the location of the pain and the discomfort experienced.
01 — CIRCUMSTANCES AND SYMPTOMS
The doctor will determine how long the pain has been present, where it is located, which movements trigger it, and whether it appeared after an injury or gradually. They will also ask about the patient's activities, medical history, and daily limitations.
02 — THE CLINICAL EXAMINATION
Gait, mobility, swelling, stability, and tender areas of the knee are examined. Certain movements can put stress on the menisci, but no single test is sufficient to confirm the cause of the symptoms.
03 — X-RAYS IN CHARGE
X-rays, when indicated, allow for the assessment of leg alignment and the condition of the joint spaces. They help to detect associated osteoarthritis, which should not be overlooked after an MRI.
04 — MRI: IF IT IS USEFUL
An MRI can provide a clearer picture of the meniscus and look for other damage, particularly to the cartilage or ligaments. It is interpreted in conjunction with the physical examination and symptoms, as a visible tear is not always the cause of the pain.
A meniscal image should always be interpreted in light of what the patient feels and the examination of the knee.
THE FIRST STEPS TO RELIEVE KNEE PAIN
The initial approach aims to reduce discomfort while avoiding unnecessary immobilization. It is tailored to the severity of symptoms and the patient's activities.
Temporarily adapt efforts
When certain movements clearly trigger pain, it can be helpful to temporarily reduce their intensity or duration. This does not necessarily mean stopping all activity.
Managing pain and swelling
In case of swelling, relative rest and applying cold with a protective covering to the skin may provide temporary relief. Pain relievers or anti-inflammatory medication should only be considered after taking into account the patient's medical history and any potential contraindications, and with the advice of a healthcare professional.
Resume the movement gradually
Gentle mobility and tolerated activities are generally preferable to prolonged complete rest. Crutches are only useful in certain situations, for example, if pain makes weight-bearing difficult; they are not always necessary.
In case of significant swelling, acute pain after a twist, or locking of the knee, a Specialized knee assessment by SOS Genou Genève may be relevant.
TREATING A DEGENERATIVE MENISCAL DAMAGE WITHOUT SURGERY
Surgery is not always necessary. Conservative management is often the first-line approach, particularly when the pain remains compatible with activities and there is no persistent mechanical blockage.
Physiotherapy
Physiotherapy can help maintain mobility, strengthen thigh muscles, and improve movement control. Exercises are tailored to the patient's pain level and abilities, and then progress based on the knee's response.
Adapting activities
The patient can maintain well-tolerated activities and temporarily modify those that trigger symptoms. Progression is based on the evolution of pain, swelling, and function.
Monitoring and reassessment
Follow-up care allows us to check if the pain is decreasing and if mobility and activities are improving. If symptoms persist, worsen, or become very limiting despite appropriate management, the diagnosis and treatment options can be reassessed.
SURGERY: AN OPTION RARELY INDICATED FROM THE START
For a degenerative meniscal tear, arthroscopy is generally not the first option. The presence of a tear on MRI, a click, or intermittent mechanical discomfort is not, on its own, sufficient to justify surgery.
In what situations should we discuss it?
A specialist consultation may be necessary if symptoms persist and remain highly debilitating despite appropriate conservative management. A genuine mechanical blockage or a specific situation may also lead to a reassessment of the options.
The principle of intervention
If arthroscopy is chosen after individual evaluation, the procedure depends on the shape and location of the lesion. When possible, as much of the functional meniscal tissue as possible is preserved. Partial resection is not without risk: removing meniscal tissue can alter the distribution of stress within the knee.
The procedure aims to treat a specific situation and does not guarantee the disappearance of all pain, particularly if the cartilage is also affected. For more information, see the page on Meniscus surgery and its indications.
A degenerative lesion visible on MRI does not, in itself, constitute an indication for surgery.
RESUME ACTIVITIES GRADUALLY
The recovery period depends on symptoms, activity level, treatment received, and the possible presence of associated osteoarthritis. In the absence of intervention, progress is primarily determined by the knee's tolerance.
01 — REGAIN COMFORTABLE MOBILITY
Flexion and extension movements are maintained progressively, within a range compatible with the symptoms.
02 — RESTORE STRENGTH
Physiotherapy may include progressive strengthening of the thigh and hip muscles to improve knee support and control.
03 — IMPROVE MOTION CONTROL
The exercises progress towards functional movements adapted to the patient's needs. The goal is to regain a more tolerable gait and everyday movements.
04 — RESUME DAILY ACTIVITIES
Walking, stairs, and usual activities are reintroduced according to the knee's response. A sustained increase in pain or swelling indicates an adjustment to the pace.
05 — RETURN TO SPORT IF THE KNEE ALLOWS
The return to sport is gradual and takes into account mobility, strength, stability, and confidence in the knee. Timeframes vary depending on symptoms, sport, and treatment; they cannot be guaranteed in advance.
The return to activity is decided based on knee function and its progress, not on a fixed date. To better understand the role of the meniscus and cartilage, consult the page dedicated to the meniscus and cartilage.
A strategy tailored to each patient
Two people with a similar degenerative meniscal tear on an MRI can experience very different symptoms. The choice of treatment takes into account the location of the pain, its duration, mobility, swelling, the condition of the cartilage, the patient's activities, and their expectations.
Dr. Benoît Coulin assesses all these factors before discussing options. Physiotherapy and activity modifications can help maintain movement, but their progression must be tailored to the symptoms. Surgery can treat certain selected situations, but it has limitations and is not indicated for every visible injury.
The objective is to choose a treatment plan that is consistent with the functional impairment and the general condition of the knee, and then to reassess it according to the evolution.
«"Treating a knee means understanding the pain before deciding on the course of action."»
FREQUENTLY ASKED QUESTIONS
Is your knee pain really coming from the meniscus?
A clinical examination allows us to compare the symptoms with the imaging results and to look for any associated cartilage damage. Dr. Benoît Coulin can then discuss with you a treatment plan tailored to your situation.
