Frayed or Torn Meniscus: When Surgery May Be Necessary

The meniscus is a c-shaped piece of cartilage that's attached to the knee joint from the shinbone. It functions to cushion the joint. Meniscus tears are a common knee condition, especially as you age.

Often people hear that the only cure is surgery. However, there are several treatments for a torn meniscus, and not all meniscus tears require surgery. That said, very few meniscus tears will heal completely without surgery.

To further complicate matters, not all meniscus tears cause symptoms. So, sometimes people have meniscus tears and never even know it.

Determining whether someone is a good candidate for surgery depends on the type of tear, factors that can influence healing, and your overall health. This article explains how the pain from a meniscus tear can improve on its own and when you may need surgery.

A man with a knee injury
yenwen / GettyImages

Kinds of Meniscus Tears

Not all meniscus tears are the same. The type of tear you experience may impact the extent of damage and your ability to recover.

Degenerative Tears

As you age, the strength of your tissue changes. Just as the skin gets wrinkles and hairs turn gray, a meniscus changes over time. Specifically, it gets weaker and more brittle. As a result, when people over 40 sustain a torn meniscus, the tissue tends to be less healthy and less likely to heal, with or without surgery.

When meniscus tears occur due to age, they are called degenerative meniscus tears. Symptoms typically occur without significant injury. The meniscus tissue shows signs of age and can look frayed in this situation. Trying to repair this type of meniscus tear surgically is like sewing together frayed fabric–the tissue won't hold together.

Injury Tears

On the other hand, younger, healthier meniscus tissue, seen in people in their teens and 20s, tends to tear more cleanly and often occurs due to an injury. The tissue is rubbery and robust, and when it tears, it tends to do so without the frayed edges.

It also tends to tear in a single line rather than multiple directions. These types of tears may be responsive to surgical repair.

Recap

Meniscus tears may be degenerative (due to older age) or an injury. Degenerative tears do not heal as well as injury tears.

Factors That Influence Healing

Certain things may impact a tear's ability to heal, including tear location and stability.

Tear Location

Even though the meniscus tissue is healthy in younger people, a tear still may not heal if it occurs along the inner edge of the meniscus. That is because the blood supply to the meniscus at its outer attachment is good, but little blood gets to the inner edge. Therefore, tears that extend into this meniscus area are less likely to heal, with or without surgery.

Stability of a Meniscus Tear

A partial meniscus tear (one that doesn't go all the way through the meniscus) is stable. On the other hand, a more profound tear that extends through the meniscus is unstable.

An unstable tear—even one surrounded by healthy tissue and a good blood supply—may be unable to heal. Unstable tears tend to pull apart or cause symptoms before significant healing occurs.

Surgery can stabilize some meniscus tears. If the torn meniscus is healthy tissue with a good blood supply, surgery to stabilize the tear may allow for healing.

Recap

Tear location and how deep the tear is influence the meniscus's ability to heal. Tears that occur near the outer attachment and partial tears are better able to recover and more likely candidates for surgical repair. However, surgery may help stabilize some deeper tears, as well.

When Surgery Is Necessary

For a meniscus tear to heal, it must have the following attributes:

  • Healthy tissue
  • Good blood supply
  • Stability

Suppose you are having surgery for a symptomatic torn meniscus. In that case, a repair is generally necessary only if the tear is unstable, you have healthy meniscus tissue, and the tear is in an area of good blood supply. Your healthcare provider will also consider your age, your activity level, and any other health issues you may have.

If the tear isn't a good candidate for surgical repair, your doctor may remove the torn portion of the meniscus, called a partial meniscectomy.

Alternatives to Surgery

Many people have meniscus tears that will improve without surgery. A degenerative meniscus tear will often have symptoms that subside over time and never require surgery.

Research has also shown that older people respond well to physical therapy as the first line of treatment for symptoms related to a meniscus tear.

Summary

Meniscus tears are a common knee injury, especially as people get older. This injury sometimes requires surgery, but not always. If you have healthy tissue, a good blood supply, and a stable injury, you might be a good candidate for surgery. Surgery may also help stabilize a more profound tear.

Was this page helpful?
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Penn Medicine. Meniscus tears: Why you should not let them go untreated.

  2. Howell R, Kumar NS, Patel N, Tom J. Degenerative meniscus: Pathogenesis, diagnosis, and treatment optionsWorld J Orthop. 2014;5(5):597–602. doi:10.5312/wjo.v5.i5.597

  3. Cleveland Clinic. Meniscal tears.

  4. American Academy of Orthopaedic Surgeons OrthoInfo. Meniscus tears.

  5. Mordecai SC, Al-hadithy N, Ware HE, Gupte CM. Treatment of meniscal tears: An evidence based approach. World J Orthop. 2014;5(3):233-41. doi:10.5312/wjo.v5.i3.233

Additional Reading