Meniscal Tear in the Knee: When Physio Is Enough (and When Surgery Helps)
· Written by Mr Sam Nahas, Consultant Knee Surgeon
Important note: Every knee and every tear is different. This is general guidance and should be personalised with your clinician and physiotherapist.
A meniscal tear is one of the most common knee problems I see. I'm Mr Nahas, a knee-only specialist at Circle Reading, and my focus is helping you choose the right option—whether that's physiotherapy, an injection, or (in selected cases) keyhole surgery.
What is the meniscus? You have two menisci in each knee (medial and lateral). They act like shock absorbers and help spread load across the joint.
Common symptoms (and why they vary)
- •Pain along the joint line (inside or outside the knee)
- •Swelling that comes and goes
- •Clicking/catching sensations
- •Difficulty squatting or twisting
- •A feeling of the knee "not trusting you"
Some tears cause a lot of symptoms; others are found on MRI but aren't the main cause of pain—especially as we get older and arthritis may also be present.
Do I need an MRI?
- •symptoms persist despite sensible rehab,
- •the diagnosis is unclear,
- •or you have mechanical symptoms (e.g., true locking).
When physiotherapy is often the best first step
- •swelling control,
- •strengthening of quads/hamstrings/glutes,
- •balance/proprioception work,
- •graded return to walking/running/sport (as appropriate).
Why? Because knee pain is often a combination of tissue irritation, swelling, and muscle inhibition—not just the tear itself.
When keyhole surgery may help
- •a tear causing true mechanical locking (knee gets stuck),
- •certain unstable tear patterns that repeatedly catch,
- •persistent symptoms after a well-supported rehab programme,
- •selected sports-related tears where repair is appropriate.
The key is choosing surgery for the right reason—not simply because a scan shows a tear.
What to expect if surgery is recommended
- •Meniscal repair (stitching it, when repairable and appropriate)
- •Partial meniscectomy (trimming the unstable fragment)
Your recovery plan depends on what is done and your individual goals. Your physiotherapist will guide progression safely.
When to seek help promptly
- •True locking (knee stuck and won't straighten)
- •Rapid swelling after a twist/injury
- •Inability to weight-bear
- •Red hot swollen knee or fever (urgent assessment)
Every knee is different. If you would like this looked at properly, Mr Nahas offers consultations within a week at Circle Reading Hospital.
Book a consultation