What are the symptoms of a torn meniscus of the knee?

Symptoms of a Torn Meniscus

Patients with meniscal tears typically present with knee pain (especially along the joint line), pain with twisting or stair climbing, clicking, lack of confidence in the knee, and knee effusion—though these symptoms overlap significantly with early osteoarthritis and do not reliably distinguish between the two conditions. 1

Primary Symptoms

Pain Patterns

• Joint line tenderness is a hallmark finding on physical examination 2, 3
• Pain during twisting movements of the knee is present in at least 80% of patients with meniscal tears 1
• Pain when walking stairs occurs in the majority of patients, with median severity rated as at least moderate 1
• At least monthly knee pain is reported by over 80% of patients with MRI-verified meniscal tears 1

Mechanical Symptoms

• Clicking is commonly reported, with median severity at least moderate 1
• Catching sensations are actually rare in degenerative meniscal tears, despite common belief 1
• Lack of confidence in the knee is present in at least 80% of patients and represents a significant functional limitation 1
• True mechanical locking (objective inability to fully extend the knee) is uncommon and represents the only clear indication for surgical intervention in degenerative cases 3

Physical Examination Findings

• Knee effusion (swelling) aids in diagnosis and is associated with early radiographic osteoarthritis 2, 1
• Positive McMurray test (pain or clicking with knee rotation while flexing/extending) 2
• Positive Apley test (pain with compression and rotation of the tibia on the femur) 2
• Positive "bounce home" maneuver (inability to fully extend the knee passively) 2

Critical Clinical Context

Symptom Overlap with Osteoarthritis

The symptoms of degenerative meniscal tears are essentially indistinguishable from early knee osteoarthritis, which is a crucial clinical pitfall 1. Middle-aged patients with meniscal tears report symptoms commonly associated with knee osteoarthritis, and frequent knee pain, lack of confidence in the knee, and clicking do not distinguish those with a meniscal tear alone from those with early radiographic knee osteoarthritis 1.

Age-Related Differences

• Younger patients with traumatic tears typically present with a specific mechanism of injury involving sudden knee flexion with internal or external rotation 2
• Older patients (over 35 years) often present without a specific mechanism of injury, as their meniscal tears are due to degenerative processes with insidious onset 2, 4

Tear Location Patterns

• The medial meniscus is more vulnerable to injury due to its intimate attachment to the medial collateral ligament 2, 4
• The lateral meniscus is less prone to tear except when the ACL is injured, due to its greater mobility 2

Important Clinical Pitfalls

Avoid Overreliance on Mechanical Symptoms

Do not assume that clicking, catching, or intermittent "locking" sensations require surgery—these mechanical symptoms respond equally well to conservative treatment and do not predict surgical benefit 5. Less than 15% of patients experience small, temporary improvements at 3 months after arthroscopic surgery that completely disappear by 1 year 5.

Asymptomatic Tears Are Common

Many meniscal tears may be asymptomatic and represent incidental findings on MRI 6. The presence of a tear on imaging does not automatically mean it is the source of symptoms, particularly in middle-aged and older patients 7, 5.

Symptoms Often Represent Early Osteoarthritis

Self-reported swelling, catching, and stiffness later in the day are associated with early radiographic signs of osteoarthritis (odds ratios of 2.4,2.3, and 2.3 respectively) 1. These symptoms likely represent early knee osteoarthritis rather than isolated meniscal pathology 1.