A torn meniscus is a common knee injury that can quickly interrupt daily life, and the first question many people have is whether they can continue walking on the injured joint. The meniscus is a C-shaped piece of fibrocartilage that acts as a shock absorber and stabilizer between your thighbone and shinbone. While many people can still bear weight immediately after the injury, the decision to walk depends entirely on the tear’s specific nature and the pain it causes.
Understanding the Meniscus Tear
The menisci are two rubbery, crescent-shaped discs of cartilage within the knee joint that help transmit weight and cushion the bones during movement. The menisci work to distribute pressure across the knee, preventing the bones from grinding against each other. Tears often result from a forceful twisting or pivoting motion while the foot is planted, but they can also occur from simple degenerative wear over time, especially in older adults.
Tears are categorized by their shape and location, which influences both symptoms and healing potential. Common patterns include radial tears, which run perpendicular to the cartilage, and horizontal tears, which are often degenerative. A more severe type is the bucket-handle tear, a longitudinal tear where a segment of the cartilage can flip into the joint space. The outer third of the meniscus, known as the “red zone,” has a blood supply and a higher potential for healing, while the inner two-thirds, the “white zone,” is avascular and heals poorly.
Immediate Impact on Mobility
The ability to walk after a meniscus injury varies significantly and is not a reliable indicator of the tear’s severity. Many individuals, including athletes, can initially walk or even continue playing on a torn meniscus, with pain and swelling developing over the next 24 to 72 hours. For small, stable tears, particularly degenerative ones, gentle, controlled walking may be possible and can even help maintain muscle strength and joint flexibility during recovery.
However, continued weight-bearing on an unstable tear can increase stress on the knee joint and lead to further damage. If the tear is large or unstable, walking can cause the torn fragment to shift, leading to mechanical symptoms like catching, clicking, or the knee locking up. This sensation of instability or the knee giving way indicates that walking risks worsening the tear or causing secondary injury. Any increased pain, swelling that worsens after activity, or a feeling that the knee may give out are clear warnings that weight-bearing should be stopped immediately.
The mechanics of walking change unconsciously to avoid pain, which can put extra strain on other parts of the knee and potentially accelerate the progression of osteoarthritis over time. Putting pressure on the joint increases friction in the damaged area, which is why pain is the body’s signal to minimize activity. While complete immobilization is not always necessary, limiting activities that cause discomfort is paramount to prevent the tear from becoming larger or more complex.
Initial Care and When to Seek Medical Help
Immediate management for a suspected meniscus tear should focus on reducing inflammation and preventing further strain on the joint. The R.I.C.E. protocol is the recommended first step for acute injuries.
R.I.C.E. Protocol
The R.I.C.E. protocol involves four steps:
- Rest: Limit activities that stress the knee. For acute tears, use crutches to avoid weight-bearing.
- Ice: Apply ice packs for 15 to 20 minutes several times daily to reduce pain and swelling, especially in the first 48 hours.
- Compression: Use an elastic bandage for support and swelling control, ensuring it is not wrapped so tightly as to cause numbness or increased pain.
- Elevation: Raise the leg above the level of the heart to drain excess fluid away from the injured site.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also be used to manage pain and inflammation during this acute phase.
Certain “red flag” symptoms require immediate medical attention. These include a complete inability to bear any weight on the injured leg, or if the knee suddenly locks and cannot be straightened or bent. Rapid, significant swelling or a loss of sensation in the foot or leg also indicates a need for evaluation to rule out more serious complications. A physician must confirm the diagnosis, determine the tear’s type, and establish a treatment plan.
Treatment Pathways for a Torn Meniscus
Following a diagnosis, the treatment for a torn meniscus is determined by the tear’s type, size, location (red versus white zone), and the patient’s activity level. For many patients, particularly those with smaller, stable tears or degenerative tears, conservative non-surgical management is the initial course of action. This pathway includes physical therapy focused on strengthening the muscles surrounding the knee, such as the quadriceps and hamstrings, to enhance joint stability and function.
Physical therapy, activity modification, and NSAIDs have shown outcomes comparable to surgery for many degenerative tears, with programs often lasting 6 to 12 weeks. If symptoms persist despite conservative care, or if the tear is large, unstable, or causes persistent mechanical locking, surgical intervention may be recommended. The most common procedure is arthroscopy, a minimally invasive surgery performed through small incisions.
During arthroscopy, the surgeon will either perform a meniscectomy, which involves trimming and removing the damaged portion of the cartilage, or a meniscal repair, which sutures the torn edges back together. Repair is generally preferred to preserve the meniscus and is most successful for tears in the well-vascularized outer red zone. Recovery from a partial meniscectomy is typically shorter, around four to six weeks, while a meniscal repair requires a longer recovery, often three to six months, to allow the cartilage to heal.