The meniscus is a C-shaped shock absorber of cartilage inside the knee — there is one on the inner (medial) and one on the outer (lateral) side. Tears happen two ways: a sudden twisting injury in younger, active knees, or a slow, degenerative fraying that shows up later in life, sometimes with no clear injury at all. Both get labelled "meniscus tear," but they are different problems that are often managed differently.
Does every meniscus tear need surgery?
No. A meaningful number of meniscus tears — particularly small, stable tears in an otherwise healthy knee, and many degenerative tears in older patients without mechanical symptoms — do well with structured physiotherapy, activity modification, and time. The decision is guided by the tear's pattern and location, your symptoms, and how the knee is behaving day to day, not by the MRI report alone.
Signs that lean towards a surgical opinion
- The knee locks — gets stuck at a certain angle and cannot be straightened or bent.
- Persistent catching or giving-way despite a reasonable course of physiotherapy.
- The tear pattern on MRI is one known to have poor healing potential without repair (for example, certain tears in the meniscus's inner, poorly vascularised zone).
- An associated ACL tear — the two often need to be addressed together, since an unstable knee keeps re-injuring the meniscus.
Repair versus trim: not the same operation
When surgery is indicated, there are two very different arthroscopic approaches:
Meniscus repair
The torn edges are stitched back together, preserving the tissue. This is favoured in younger patients and tears located in the outer, better-blood-supplied zone of the meniscus, because preserving meniscus tissue protects the joint's cartilage over the long run. It requires a longer, protected rehabilitation.
Partial meniscectomy (trim)
The torn, unstable fragment is trimmed away, leaving the healthy rim intact. Recovery is faster, and this is often the more realistic option for degenerative tears or tears in a zone with poor healing potential, where repair is unlikely to succeed.
What about "just resting it"?
Rest reduces symptoms in the short term for many tears, but it does not repair torn cartilage. The real question is whether your knee's mechanics — locking, instability, recurrent swelling — settle with a proper rehabilitation programme, or whether they persist and limit your function. That is what guides the decision, examined case by case.
The right treatment for a meniscus tear is the one that matches your specific tear pattern and your knee's actual behaviour — not a generic rule for all "meniscus tears."
What a structured non-surgical trial actually looks like
Choosing to "try physiotherapy first" is not the same as simply waiting and hoping. A proper trial involves targeted quadriceps and hip strengthening, activity modification to reduce aggravating movements like deep squatting or pivoting, and a defined review point — typically several weeks — at which the knee's actual response is reassessed. If locking, giving-way, or swelling persist despite this genuine effort, that is useful information in itself, and it shifts the conversation towards surgical options rather than open-ended rest.
The age question
Age influences the decision but does not decide it outright. A younger patient with a repairable tear pattern is generally steered towards repair to protect the joint over decades of remaining activity. An older patient with a degenerative fray in an already arthritic knee may gain little from meniscus surgery at all, since the underlying arthritis — not the meniscus tear — is often driving the pain; in that situation, treating the arthritis directly may matter more than the meniscus finding on the MRI.
Making the right call for your knee
If you have knee pain along the joint line, clicking, or a sense of catching after a twisting injury — or even without one — it is worth a clinical examination and, where needed, an MRI to see exactly what type of tear you are dealing with. Learn more about our approach on the sports injuries page, and reach out or message us on WhatsApp to get your knee properly assessed.