A torn meniscus is a common injury for active individuals. The meniscus is a C-shaped piece of fibrocartilage that acts as a shock absorber and joint stabilizer within the knee. While the desire to return to activity is understandable, playing on an injured knee is highly conditional and depends on the tear’s severity. Continuing activity carries significant risks.
Understanding the Meniscus and Acute Symptoms
The primary function of the menisci is to distribute load across the knee joint, which helps to minimize the stress placed on the underlying cartilage. They also contribute significantly to joint stability and assist with lubrication and proprioception, which is the body’s sense of its own position in space. When a tear occurs, this load-sharing capacity is immediately compromised.
Classic signs of a meniscal tear include pain localized to the inner or outer side of the knee, often aggravated by twisting or pivoting motions. Swelling and stiffness usually follow, sometimes taking 24 hours or more to fully develop. Mechanical symptoms are important indicators that activity must cease. These include the knee “catching,” “locking,” or “giving way” due to a piece of torn cartilage obstructing movement.
Assessing the Risk of Continuing Activity
Continuing to play sports with a torn meniscus is highly discouraged because it carries significant risks for long-term joint health. Even if a minor tear allows for limited, pain-free movement, the repetitive stress from running, jumping, or pivoting can convert a small, stable injury into a much larger, complex one. This progression can turn a tear that might have been repairable into one that requires partial removal, known as a meniscectomy.
The immediate danger of continued activity with mechanical symptoms like locking is the risk of a displaced fragment causing further damage to the articular cartilage. Loss of the meniscus’s shock-absorbing function accelerates wear and tear on the knee joint. This increases the likelihood of developing early-onset osteoarthritis, a chronic condition that severely limits future activity. Lateral meniscal tears are often treated more aggressively because the consequences of losing their function are generally more severe.
Treatment Pathways: Repair, Removal, or Rest
Once a torn meniscus is diagnosed, the recommended pathway depends on several factors, including the tear’s location, pattern, and the patient’s age and activity level. Tears located in the outer “red zone,” which has a better blood supply, have a higher potential to heal on their own or following a surgical repair. Non-operative management, which includes rest, ice, compression, and elevation (RICE), physical therapy, and pain management, is often effective for stable tears in this vascular area or for degenerative tears in less active individuals.
For unstable, large tears, or those located in the central “white zone” with poor blood supply, surgery is typically necessary. The surgeon chooses between meniscal repair, where torn edges are sutured, and a partial meniscectomy, where only damaged tissue is removed. Repair is favored in younger, active patients to preserve joint health, but requires a longer recovery (four to six months). A meniscectomy offers a faster return to activity (four to eight weeks), but increases the long-term risk of developing arthritis.
Criteria for Safely Returning to Sports
Medical clearance to return to high-impact sports must be based on objective physical milestones, not simply the absence of pain. The rehabilitation process after a meniscal injury focuses on re-establishing full, pain-free range of motion in the knee. A primary strength goal is achieving near-symmetrical muscle strength in the injured leg compared to the uninjured leg, often measured as 90% or more strength parity, particularly in the quadriceps and hamstrings.
Before being released to full play, an athlete must successfully complete functional testing designed to mimic the demands of their sport. This testing includes plyometric activities such as hopping, jumping, and landing drills. Multi-directional agility drills that involve cutting and pivoting are also required. Rushing the process increases the risk of re-injury, making it necessary to demonstrate both physical readiness and psychological confidence.