Meniscus Tear Treatment in Perth
Meniscus tear treatment in Perth with Dr Rhys Clark. The difference between a traumatic tear and a degenerative one, why surgery helps the first and usually not the second, and when repair beats trimming.
The knee has two menisci — C-shaped wedges of tough cartilage sitting between the thigh bone and the shin bone. They spread load across the joint, absorb shock, and add stability.
They are also among the most commonly injured structures in the body, and among the most commonly operated on unnecessarily. Which of those two your tear falls into depends almost entirely on a distinction worth understanding before you see anyone.
Two different injuries with the same name
A traumatic tear happens in a moment. A twist, a pivot, a tackle — usually during sport, usually in a knee that was working perfectly beforehand. There is pain at the time, and swelling that builds over the following hours. These occur in otherwise healthy menisci and mostly in younger, active people.
A degenerative tear develops over years. The meniscus becomes more brittle with age, and eventually tears under ordinary load — sometimes without any incident at all, sometimes from something as unremarkable as standing up from a squat. These usually occur alongside some degree of knee arthritis, because the same process affects both.
They can look almost identical on an MRI. They behave completely differently, and they need completely different treatment. This is why how it started matters as much as what the scan shows.
Why that distinction decides everything
For degenerative tears, arthroscopic surgery to trim the torn portion has been compared against exercise therapy in a series of randomised trials, and against placebo surgery in at least one. The consistent finding is that trimming produces no clinically meaningful benefit over exercise therapy, and current guidelines reflect that.
Long-term follow-up has reinforced it. At ten years there was no difference in the progression of arthritis between people who had the operation and people who did exercise therapy — both groups improved.
For traumatic tears, particularly in younger patients and particularly where a repair is possible, surgery is a different proposition entirely and often the right one.
The practical translation: if you are over 50 with a gradual-onset painful knee and an MRI showing a meniscal tear, an operation is probably not what will help. If you are 25 and twisted your knee playing football six weeks ago and it is still catching, it very likely is.
The exception that overrides everything
A locked knee.
If the knee physically will not straighten because something is blocking it — usually a displaced bucket-handle tear, where a torn fragment has flipped into the joint like a doorstop — that needs assessing promptly regardless of your age or how the tear started.
This is one of the few genuinely time-sensitive knee problems. A fragment that stays displaced becomes progressively less likely to be repairable, and a knee held in flexion starts losing extension it may not fully get back.
The same urgency applies to a knee that is repeatedly and truly locking rather than just feeling unreliable.
Repair or remove
If an operation is warranted, there are two quite different things that might happen, and it is worth knowing which is being proposed.
Repair stitches the tear so it heals, keeping the meniscus. Possible only where the tear sits in the outer third, which is the only part with a blood supply, and depends on the pattern of the tear and your age. It preserves the meniscus’s ability to protect the joint surface. The cost is recovery — several weeks of restricted weight-bearing and limited bend while it heals.
Partial meniscectomy trims away the torn portion. Quicker recovery, less restriction. The cost is that whatever is removed is gone permanently, and the load it was spreading now passes through the cartilage underneath — which raises the risk of arthritis in that compartment years later.
Where repair is feasible it is usually worth the slower recovery, and that preference is stronger the younger you are. Not every tear can be repaired, and it is not always possible to know for certain until the joint is inspected.
What non-surgical treatment involves
For most degenerative tears, and for plenty of traumatic ones without mechanical symptoms, this is the right first step.
Exercise therapy is the treatment with the evidence — strengthening the quadriceps and hip muscles so the knee is better supported and better controlled. It is the same approach that works for knee arthritis, for the same reasons.
Alongside it: relative rest from whatever provokes it, managing swelling, and simple analgesia while things settle.
Give it a genuine trial — usually around three months — before concluding it has not worked. A tear that is still there on MRI is not evidence of failure. Plenty of people become symptom-free while the tear remains exactly as it was.
How it is assessed
A history that establishes whether this was an event or a gradual process. An examination for joint-line tenderness, effusion, and — most importantly — whether the knee fully straightens. An X-ray to establish how much arthritis is present, which is often more informative than anything else. An MRI where a repairable tear is suspected or the picture is unclear.
The point of the assessment is not to find a tear. It is to work out whether the tear that is found is the thing causing your symptoms.
Knee arthroscopy covers the operation itself and what recovery involves. If the underlying issue is arthritis rather than the tear, treating knee arthritis without surgery is the better starting point.
To have a knee assessed, book a consultation, phone the rooms on (08) 6332 6365 or email info@rhysclark.com.au. Dr Clark consults at Murdoch and Mandurah.
Does a meniscus tear need surgery?+
It depends entirely on which kind of tear it is. A traumatic tear in a younger knee — a specific twisting injury with immediate swelling — is often worth operating on, particularly if it can be repaired. A degenerative tear, which is age-related wear rather than injury, usually does not need surgery: trimming these has been compared against exercise therapy in multiple trials and does not produce better results. The exception in either case is a knee that is locked or blocked from straightening, which needs treating regardless.
What is the difference between a traumatic and a degenerative meniscus tear?+
A traumatic tear happens in a moment — a twist or pivot, often during sport, with pain and swelling over the following hours, usually in a knee that was previously fine. A degenerative tear develops gradually as the meniscus becomes more brittle with age, often without any specific injury, and typically alongside some arthritis. They can look similar on an MRI and behave very differently, which is why the story of how it started matters as much as the scan.
Can a meniscus tear heal on its own?+
Only the outer third of the meniscus has a blood supply, so tears there can heal, either on their own or with repair. Tears in the inner two-thirds generally cannot heal because there is no blood supply to do the healing. That does not mean they need surgery — many become symptom-free with time and rehabilitation even though the tear itself remains.
Is meniscus repair better than removing the torn part?+
Where it is possible, yes. The meniscus protects the joint surface, and removing part of it increases the load carried by the cartilage underneath, which raises the risk of arthritis later. Repair preserves it. The trade-off is recovery: a repair needs to heal, so it carries several weeks of restricted weight-bearing and limited bend, where a trim allows a quicker return. Whether repair is possible depends on where the tear sits, its pattern, and your age.
What does a meniscus tear feel like?+
Pain is typically localised to one side of the knee. A torn meniscus often makes the knee feel as though it is catching, clicking or about to give way, and there is usually swelling that develops over hours rather than immediately. Some people cannot fully straighten the knee. Symptoms may settle within weeks, or may persist.
What is a locked knee?+
A knee that physically cannot be straightened because something is blocking it — usually a displaced bucket-handle meniscal tear, where a torn fragment has flipped into the joint like a doorstop. This is one of the few genuinely time-sensitive knee problems and should be assessed promptly, because a fragment left displaced is less likely to be repairable later.