Clinical Symptoms of Meniscal Tears
Meniscal tears commonly present with knee pain, aching, stiffness, and mechanical symptoms (catching, locking, popping, giving-way), though these symptoms are often incidental findings and may not actually be caused by the tear itself. 1
Primary Symptom Categories
Pain and Discomfort
- Knee pain is the most common presenting complaint, typically activity-related 2
- Joint-line tenderness on physical examination (83% sensitivity, 83% specificity for meniscal tears) 2
- Aching and stiffness are frequently reported, though these are common in degenerative knee disease regardless of meniscal pathology 1
- Pain may have sudden or subacute onset, particularly in traumatic tears 1
Mechanical Symptoms
- Catching or locking of the knee joint 2, 3
- Grinding, clicking, or popping sensations 4
- Buckling or giving-way episodes 3
- Pain with pivoting movements 4
Critical caveat: Recent high-quality evidence demonstrates that these traditionally "meniscal" and "mechanical" symptoms are actually strongly associated with underlying cartilage damage rather than meniscal pathology itself (p=0.01). 4 This challenges the long-held assumption that these symptoms arise from meniscal tears.
Physical Examination Findings
- Joint effusion (knee swelling) 3, 5
- Positive McMurray test (concurrent knee rotation and extension): 61% sensitivity, 84% specificity 2
- Anterior knee pain during squatting may be present but is more specific for patellofemoral pain 2
- Click audible or palpable when taking the knee through full range of motion 3
Age-Related Presentation Patterns
Younger Patients (<40 years)
- Typically present with acute traumatic tears following twisting injuries 2
- More likely to have true mechanical symptoms from displaced meniscal tissue 2
Older Patients (≥40 years)
- Degenerative tears are common and often asymptomatic 1
- In patients over 70 years, most meniscal tears are incidental findings that do not cause symptoms 6
- Symptoms in this age group are more likely attributable to concurrent osteoarthritis and cartilage damage rather than the meniscal tear itself 4
Important Clinical Pitfalls
Do not assume mechanical symptoms indicate a surgically correctable meniscal tear. The BMJ guideline emphasizes that meniscus tears are usually incidental findings and unlikely to be the actual cause of knee pain, aching, or stiffness. 1 Tricompartmental cartilage damage is the stronger predictor of these symptoms. 4
Symptoms fluctuate naturally over time. Degenerative knee disease is chronic with fluctuating symptoms that tend to improve on average after seeing a physician, independent of intervention. 1