What are the signs and symptoms of a torn meniscus?

Signs and Symptoms of a Torn Meniscus

Middle-aged and older patients with meniscal tears typically present with chronic knee pain, pain with stair walking and twisting movements, lack of confidence in the knee, and clicking—symptoms that overlap significantly with early knee osteoarthritis rather than classic "mechanical" symptoms. 1

Common Presenting Symptoms

Pain Patterns

• Knee pain occurs at least monthly in over 80% of patients with MRI-verified meniscal tears 1
• Pain intensity is typically moderate or greater when twisting on the knee, walking stairs, and during general knee use 1
• Pain may develop after sudden knee flexion combined with internal or external rotation in acute traumatic tears 2
• Older patients often present without a specific injury mechanism as their tears result from degenerative processes 2

Mechanical Symptoms

• Clicking is common and reported with moderate severity in most patients 1
• True mechanical catching is actually rare despite being classically associated with meniscal tears 1
• Swelling (knee effusion) aids in diagnosis and is a frequent finding 2
• "Locked knee" (objective inability to fully extend the knee) represents a true mechanical block, though this is uncommon 3

Functional Limitations

• Lack of confidence in the knee is present in at least 80% of patients with meniscal tears 1
• Stiffness later in the day occurs more frequently in those with early radiographic osteoarthritis 1
• Patients experience difficulty with activities requiring knee rotation and weight-bearing 2

Physical Examination Findings

Key Clinical Tests

• Joint line tenderness is a reliable diagnostic finding 2
• McMurray maneuver (knee flexion/extension with rotation) helps identify tears 2
• Apley compression test and "bounce home" maneuver (testing terminal extension) aid diagnosis 2
• Knee effusion supports the diagnosis when present 2

Critical Clinical Distinctions

Age-Related Presentation Differences

• Young patients with sports-related or traumatic injuries present differently than middle-aged/older patients 3
• Degenerative tears in patients over 50 years commonly coexist with early osteoarthritis and present with symptoms indistinguishable from OA alone 1
• Sudden or subacute symptom onset does not reliably distinguish meniscal tears from degenerative knee disease 3

Overlap with Osteoarthritis

• Symptoms like frequent knee pain, clicking, and lack of confidence do NOT distinguish isolated meniscal tears from early knee osteoarthritis 1
• Swelling, catching, and stiffness later in the day are more strongly associated with radiographic osteoarthritis (odds ratio 2.3-2.4) 1
• Most middle-aged patients with degenerative meniscal tears have symptoms representing early osteoarthritis rather than isolated meniscal pathology 1

Diagnostic Imaging Confirmation

• MRI has become the test of choice for confirming meniscal injury and defining tear type, location, and severity 2
• MRI is superior to clinical examination alone for accurate diagnosis 3
• Physical examination combined with imaging provides the most reliable diagnosis 2

Important Clinical Pitfalls

• Do not assume mechanical symptoms indicate a surgically correctable meniscal tear—these symptoms are common in degenerative knee disease and often do not improve with surgery 3
• Meniscal tears are common incidental findings on imaging and are unlikely to be the actual cause of knee pain, aching, or stiffness in middle-aged and older patients 3
• The presence of a meniscal tear on MRI does not automatically indicate it is the source of symptoms, particularly in patients over 40 years 1