Meniscus

Meniscus is another word for the cartilage in the knee that acts as a shock absorber. You have two of them medial and lateral or inner and outer.  They are both C-shaped structures that are made of fibrocartilage.

The meniscus is located between the femur and the tibia or thigh and leg bone. It actually serves many functions in the knee other than shock absorber. It acts as a stabilizer preventing the lower leg from sliding forward on the femur.  It also helps to push joint fluid into the surface of the joint to help the cartilage cells survive.  The joint has a small coefficient of friction which is the same thing as saying it glides 10 times better than 2 pieces of ice sliding on one another. The meniscus allows the joint fluid to act as a lubricant for the joint and lets the femur glide and roll on the tibia.

It has a blood supply the only reaches the outer third. This will come in handy when we talk about tears and repairing them or trimming them. Listen up CrossFitters, I will let you in on a secret. When we are young it takes a lot of work or a bad injury to tear a meniscus… a bad twist in a soccer game, landing in a squat after a big jump. For people with more experience in life, it takes a lot less to tear them. Some will tear with a sharp twist while maneuvering around an airplane, getting up from playing with the kids, coming down from a rock hiking, PISTOLS. So you can see there is a clear difference between the amount of energy that goes in to the two types of tears. WHY US, older people are saying?

As we age our tissues dehydrate and lose some of their natural elasticity and hydration. Tissues become more brittle and can rip easier than when we were young (sounds like A Killers song). So we see tear patterns that are different and provide the appropriate treatment for each pattern. The treatment depends on location of tear, size of tear, and blood supply to tear. Blood carries oxygen and healing factors that allow tissues to heal. Without it there will be no healing.

People will classically notice swelling in their knee with pain along the inner or outer aspect of their knee. Also people often say it hurts in the back of their knee and confuse it for a hamstring injury. Clicking, buckling, or locking are severe symptoms. Most often it is a pain that is a stabbing knife-like pain accentuated by twisting, pivoting or squatting. I often describe it as a hangnail being pulled on. The tear can get bigger the more it gets pulled on.  Front squats, back squats, or pistols can elicit some of these symptoms. Be careful when you are in a deep squat not to rotate or twist as this may pinch the meniscus between the bones and cause a tear

So now on to treatment, basically it is to sew it together or trim the piece that is torn. Repair requires longer recovery (ask some of our CrossFit friends) than trimming. Repair is a 4 month process and trim is a 4-6 week process to get back to feeling good again. When I do arthroscopy on the knee the decision is often made at the time of surgery based on the previous criteria mentioned. Location, size, blood supply, and tear pattern. I only want to take out the bad tissue or piece that is torn and not working anyway. Again like a hangnail I trim it at the base to prevent it from getting bigger and more painful. People often want to know if they can live with a torn cartilage. I unfortunately have seen some cartilage tears do some damage to otherwise healthy appearing knees when it is moving around in the knee causing pain

Here are some real shots of meniscal tears before and after.

50 Comments

  1. Great info! Could you write about biceps pain??

  2. All done, check it out.

    • it was ITB since I kept running. What I didn’t tell them was that the pain on a scale of 1-10 was aronud a 9 when I finished running.Anyways, 2 years later (and no running in between) I find out I needed to fix my lateral meniscus and it was in pretty bad shape. After the arthroscopy my surgeon said he (took out? I’m not sure about the phrasing) 2/3 of the lateral meniscus and it would take aronud 6-7 months to get to the point where I could run a bit again.Well, now it’s almost a year later and I still feel some pain aronud my knee, feels like ITB actually. Instead of straight running I’m doing triathlon training. Unfortunately, running doesn’t feel like it used to since I have to be careful not to overuse the knee too much. Also when I stand up and flex both my quads the right knee tends to crackle a little bit but it doesn’t hurt too much (is that normal?)Is it okay for me to run as long as I don’t feel too much pain?I’m also 20 years old.

      • some people will have little cracking or noise when knee is flexed but i don’t like the pain wiht running part. You should be seen again

  3. I had a left ACL reconstruction with a pretty large medial meniscal repair last July. The recovery was slow compared to my previous two right ACL reconstructions but until about two months ago I was feeling great. Recently I had to have my knee drained and jumping/running is extremely difficult. As a crossfitter, is it better to just have that meniscal repair removed? Or keep it in as long as possible even if it is slowing me down? I’m afraid to be without all that Cushion at 30…

    • So number one most important question is why is your knee swelling. Were there arthritic changes in there or is something going on with the meniscus repair. You obviously want to leave the meniscus repair in if it is working, but if it is torn it may need to be checked out again.

  4. Doc,
    Trying to determine if its tendinitis or cartilage. Been icing and advil, seems to be getting better. I have stopped running and impact for now.
    Thoughts?

    • That is the best way to figure out if something is going to get better on its own. Sometimes people will continue to push through the pain and it just muddies the picture a little. Good luck.

  5. Great info – i have a pain just above the knee cap on my right knee. It is a throbbing rather than stabbing pain. It feels like the tissue that runs down my knee is inflamed. It has been a niggle for a while, but after heavy thrusters yesterday it is noticeably sore a lot of the time. Any thoughts?

    • most likely a quad tendonitis or patellofemoral syndrome, topics coming soon

    • Doc, I’m having an issue with my right knee- in march I fell backwards while trying to do clean in a CF garage games event- after I fell i noticed some pain in my knee right above my knee cap- I went to see a DR. And I was told after x rays I had a calcium deposit in the spot where it hurts in my knee- I was told from the exam the DR did I didn’t have any other damage and he said it was fine to continue training – he told me to ice my knee before and after workouts and gave me some advice onto form for doing squats and told me the pain I’m Gavin will ease over time and for me to deal with it and by working out will not cause any more damage- he mentioned if I did tear something that would be a good thing because he could fix the problem with surgery, and with a calcium deposit there’s nothing he can do- with all of that my coach wants me to find out more about my knee- my strength in my right knee is bad and not sure what to do – I can squat 305# with no pain in my knee and then I Try to do a pistol And i can’t do one and if I use a band with them it still hurts – the strength in my left leg is noticeably stronger now since the injury than my right- I know my flexibility is not great, with my hamstrings, hips and shoulders being the worst- i have never had knee issues before and wanted to know if you had any idea based on my situation-

      • I would have to examine you to give you any real helpful advice. It could be a lot of things but I would be guessing without seeing you. Are you local?

      • Yes I live in Medway and have Aetna for insurance if you take them- I would see you ASAP

        • Give the office a call 617 527 5040. I would be happy to see you.

          • Ok I will call in Tuesday! Thanks Doc

  6. Hey there Doc,

    Amazing information!
    I am a Brazilian Jiu-Jitsu fighter, so I end up with my knees in funky positions. I had surgery to trim my medial meniscus (left knee) in February. It felt great, was back training. Popped it again in training in May had huge swelling again. Does it sound like I tore it again?

    Now I can’t walk, until I hear a pop which I can deal with, and I walk fine. I do get that sharp pain in the back of my knee when I squat.. And when my heal touches my butt.
    Will more rolling on IT band and Hammies and opening up hips help relieve this.?

    Can strengthening my VMO and Hammies fix this?

    And I also seem to not have any symptoms when I am training BJJ and rolling around..

    Thoughts? And Thank you!!

    • Without physical exam it would be hard for the doc to tell. What was the mechanism when you felt the pop again? Another mensical tear is possible but there are more complicated diags that can accompany your symptoms as well.

    • Don’t like the pop and swelling wtih persistent pain thing, I would get evaluated.

  7. This website is great, the pictures help a lot! I recently had an incident of sudden swelling below my knee after kneeling pretty hard on tile and wood floors. That has subsided (I’m guessing bursitis?) and now after trying to be somewhat “aggressive” about doing knee strengthening type of exercises, I have pain on the outside of that same knee, tender to the touch, right around the area and above and below the lateral meniscus. Is ITBS more likely or could I have a torn meniscus without being aware of it? I am in the “brittle and dehydrated tissue” age group so I’m worried about something more serious. Thanks!

    • Lateral pain with squatting can be lateral meniscus, ITB would be from repetitive stuff. Good idea to get it checked out, Sean

  8. Hi Sean,

    I practice brazilian jiu jitsu as well as crossfit. Recently, I’ve had numerous episodes of bilateral knee locking while doing BJJ. Crossfit has been fine -can squat, pistols, etc without difficult. MRI shows a huge lateral discoid meniscus bilaterally with a tiny peripheral tear at the peripheral vascular zone of my rt meniscus. Otherwise, my discoid meniscus looks intact. Trying to decide if surgery is worthwhile to fix the tear and saucerize the mensicus. Somewhat reluctant to do so as the problem is only apparently when I train BJJ. Do you have any thoughts on success of discoid mensicus reshaping?

    • Hi Tom, I have had experience with many discoid menisci. If you are getting into locking situations then that is not a good thing. Imagine a marble getting stuck in a door jam and closing the door harder to try and get it out. You can do more damage to the joint surface and the tear can also get bigger. OPtions are simple either don’t get into locking situations or have the surgery which if it is a trimming will take 4-6 weeks for full tilt activities again usually. Happy to see you, Sean http://www.orthopedicsne.com

  9. This is a great resource for information!

    Just a quick question on meniscus injury prevention.

    I do yoga and think/hope that it is helping prevent injuries in crossfit.
    But are there any warm up’s or exercise’s that minimize the potential of injuring the meniscus?

    And when it comes to fish oil, does it provide any benefit for the meniscus or all cartilage for that matter?

    Again, thanks for the site!

    • I would say that knee flexion and gentle quad stretching would be good. Also hamstring stretches are important. I do not know of a scientific study that has proven a direct measurable benefit to cartilage or preventing tears.

  10. Thanks so much for the info. I think I have a torn meniscus, and maybe “baker’s cyst”. Possibly other issues in my knee after just a few weeks starting CF. After getting a meniscus repaired, is it “good as new” eventually? Or is it always a problem to a degree? Thank you

  11. 2 issues here repair is when it gets sewn back together and heals with scar tissue,. Repair is only done in certain tear patterns and if the tear is in an area where it has a blood supply and will heal. Trimming a meniscus is done when the tear does not have a blood supply and is like trimming a hangnail. Typically people do well and are able to return to sports after both. I would be happy to talk further to clarify any questions.

  12. Sean- any chance you’ll do a write up on “jumpers knee”?

  13. It’s in the works

  14. Hey. In 2011 i had a rigth ACL reconstruction and a year later a meniscus repair to the same knee. My knee feels great know but i am afraid to start crossfitting again. Should I be worried about it? My doc said nevier go deeper than 90* when squatting, what is your opinion? Any advice would be greatly appreciated

    • Hello :)

  15. Sorry for the delay we had a software glitch and i didnt get people’s posts. As far as squatting below 90 do not torques the knee in htat position. a lot of orthopods are weary of this because of studies that show increase pressure in the meniscus with flexion beyond 90. However what do they say to catchers downlineman, people getting off the toilet, golfers picking up a ball, etc.

  16. Doc,
    I’m a 30 yr old CF’er. Recently i worked out in the morning and went to play basketball in the evening. To start warmups i attempted a soldier kick with my right leg and felt a tweak behind my right knee. As soon as I started jumping i knew something was wrong, with sharp pain behind my knee when my knee was bent more than a few degrees. I gave it a month of rest and saw an orthopedist in Boston MA, who told me the XRay was negative and likely a strain of the hamstring and pes tendon. I’ve been back in the gym and doing PT, but still feeling oddness behind my right knee. Feels like there is a baloon back there. Does the diagnosis sound right to you?
    I’ve dropped the weight on back squats from ~225 to ~175, and can do those mostly without pain, but worried that i’m barking up the wrong tree here. Sound like meniscus? would you wait for an MRI?
    thanks for all the great info.

  17. Could be meniscus a lump in back of knee could be a baker’s cyst, just back from covering the CrossFit Games happy to see you. call office 617 527 5040 or make appointment online at orthopedicsne.com

  18. 3 years ago I had the outer meniscus repaired and this has happened on two occasions….. I go into a deep squat and it goes pop and I can not stand to put pressure on it or even walk even walk. the first time this happened my wife took me to the er, i could only walk with crutches and they did there thing and gave me a percoset and in about 20 to 30 mins latter I could walk on it again. so today the same thing happened I am setting here with a heating pad on it and I took two tramedols and it is easing up on the pain. I have cut two fingers off with a skill saw so THIS PAIN IS LIKE 10x that pain!
    So what can I do? Have it removed???

    • I would have to see you for advice on that one. see xrays examine you etc. 6175275040

  19. I’m a 55 year young Crossfitting lady….love it, and miss it! I stupidly went in a 5k. run two days later my knee swelled up, that was way back in June of this year. I massively scaled back in my Crossfit workouts due to a Great coach. Finally got an MRI and have a Inferiorly Surfacing Medial Meniscus Tear, with large knee effusion and early osteoarthritis at the media l compartment is suspected….going to a Knee Dr. At the end of the month. BUT I hate waiting to see what this all means. I’ve been only doing upper body work at the box but so badly miss doing squats, and dead lifting etc… Not really sure what else I should be working on while not there as this is a huge waiting game re. getting it looked at and then scoping etc…any good ideas for me re. Work I can do for it. I’ve been reading lately also that icing isn’t good for it on Kelly’s site. What are your thoughts on this? As well as rehab work. Thanks!

    • :)

  20. Would not do anything that hurts it. Typically squatting with a meniscal tear can hurt. Ice is for pain relief and does not help it heal or get rid of swelling faster. Scope will probably be recommended if pain is not getting better or worsening. what else?

  21. I am newer to exercise; lately I have been running and doing squats and lunges but have noticed that within a couple of lunges and squats and a few minutes into running it feels like something in the center of my knee is tearing. It doesn’t swell and the pain isn’t taking over my life; just makes working out uncomfortable. Thinking it is just areas of the body that aren’t use to being used? Thoughts?

    • Could be patellar tendinitis check out tendinitis post here

  22. Hi. 36-yr old F. Been crossfitting for about a year. Used to run alot until 4-5 yrs ago would get pain just after 1.75 mi on right knee – right side that would make it hard to go down stairs. Pain would last 1hr – 24hrs depending how long I ran on it.
    Stopped running for 3 yrs now. Only do small sprints with CF wods.
    Now possibly unrelated: when I go down in just a (air) squat, feels uncomfortable/pulling sensation with burning above and to my right of my right knee cap. Almost feels like a fb sensation as well?
    Went and saw an ortho guy who said it could be some of my cartiledge drifted over to the right (which I disagree with – maybe I was a poor historian) and suggested MRI but I’m deathly afraid of them. I know, weird phobia. Anyways, then he said he could just inject something and use a tiny camera to poke around in there and inject cortisone.
    I don’t want a bandaid or temporary solution. And I also want to know if I should discontinue squatting all together. Doesn’t hurt every time, just most of the time. And it’s not severe pain – just burning/pulling.
    Any advice?

    Dale

  23. Could be patellofemoral pain, I would have to see X-ray and examine you to give better advice. Obviously don’t recommend pushing through pain until I have seen you.

  24. Hi, I’m 24 year’s old, I started Crossfit about 7 weeks ago, I never felt better in my life, absolutely amazed with this. Unfortunately, my right knee started to hurt a lot after CF workouts and specifically when I was doing squads, my knee never swell, but the pain was getting worse with time, now it hurts if I walk too fast, so, I went to the Dr. that ordered an MRI, I have a lateral meniscus tear and several small synovial liquid cysts outside the meniscus product of the liquid leak by the tear itself. I’m scared as hell I may not be able to do CF again after the arthroscopy, they want to remove the cysts and the torn part, which is in the outer end of the right knee lateral meniscus and the tear is perpendicular to it. CF makes me feel like “out of this world” after every workout, I can’t describe it, is more than just happy. Now it’s been 2 weeks since I stop working out. I’d seen several specialists, but I have not decided who will perform the surgery yet. Is there hope? I ‘ve read about so many cases where ppl end with swelling, or pain or can’t bend the knee after 90, and worst the early arthritis it produces. They told me that after I fully recover I shouldn’t perform deep squads or pistols, which is not an option, and the risk of early arthritis because of CF should worry me, any precaution I can take if I actually recover?, I’m going insane with this, sorry if I’m asking too many questions. Great posts btw.

  25. There is always hope, I have people recover from meniscus surgery and are cross fitting again. People who don’t do well after knee arthroscopies are those who already have known arthritis in their knees. As for squatting we would have to exclude professional football linemen, catchers and electricians or plumbers.

  26. Doc,
    I was told i have a tear in the lateral and medial meniscus in my right knee and a sprained MCL. How serious is this? how long would it take me to recover with out surgery?

  27. The MCL will most likely heal without surgery and the tears may not heal depending on size, location, blood supply, and your age!

  28. Hi there, I have a horizontal tear of the body and posterior horn of the medial meniscus with a tiny 2 mm posterior parameniscal cyst. Tear extends to the inferior articulate surface in the posterior horn and body. Does fixing this typically require cutting away the damaged tissue or can it be repaired? It’s located in the red/white zone.
    Any feedback would be great

    • Depends on quality of tissue, ideally red red zone is best for repair and sewing, horizontal tears not amenable to repairs, sometimes it takes probing and examining tissue at time of scope to determine repairability.

  29. Hi,

    I’m a 40-year-old woman who did very little exercise – or even physically demanding activity – till I was 37, at which point I got myself an excellent trainer and started working out for the first time in my life. Gradually, over the last 3 years, I’ve gotten to a high level of physical fitness, mostly with cross-training and strength training. I love this stuff and it’s now a very important part of my lifestyle.

    A few months ago, while stretching after an intense workout, I felt a very sharp pain on the outer side of my left knee- almost like being cut by broken glass. At the time I was performing something like the frog pose: http://www.yinyoga.com/images/asana_frog_tadpole.gif. I originally thought it was an insect bite, but found no insects around, and didn’t notice any damage to my skin. The pain disappeared almost completely after a few minutes, but I noticed later in the day that I couldn’t kneel on that leg or even tap the knee-cap lightly without setting off the sharp pain, which was not at the knee-cap or front of the knee but at the same location as before – the joint line on the outside of the knee. I assumed I’d torn something, but I was able to do almost everything I normally did with no pain or change in ability: jumps, squats, deadlifts, even single-legged stuff, as long as I didn’t kneel on that knee. But slowly, over the course of a couple of months, I started experiencing a good bit of pain – not as sharp as before, but significant – with squats and lunges and eventually with anything involving some degree of knee flexion.

    I finally went to the orthopedist, who suspected a lateral meniscus tear, and sent me for an MRI. What the MRI revealed, however, was a discoid lateral meniscus with no discernible tears. Though the report didn’t indicate this, my orthopedist said my discoid meniscus might well be the unstable kind (Wrisberg variant), because he wasn’t sure he could see the appropriate femoral attachments, and also said that since this type of meniscus is very susceptible to tearing, there was likely a tear though it wasn’t visible in the MRI. (He was surprised though that I’d lasted till age 40 without the meniscus causing any problems, but as I said, I’d done virtually no physical activity beyond walking and some swimming for 37 years!) But since there was no visible tear and my pain was not debilitating with everyday activities, we decided to be conservative and elected not to have an arthroscopy and possible surgery. I got a cortisone shot in my knee a couple of weeks ago and that has improved the pain somewhat but not fully.

    For the last month, I’ve avoided any type of exercise involving my legs, and this past week I started walking uphill on the treadmill and the elliptical trainer, but even these cause some pain at the joint line. The pain is not severe, and I could easily live with it for a long time. But I don’t want to make it get worse; and I would like to avoid surgery if possible, especially because I’ve heard that surgery for an unstable discoid meniscus is ultimately not all that successful.

    My main question now is about the kind and level of training I can do going forward. I can deal with never doing certain things such as deep squats or stretches involving a lot of knee flexion and rotation, but I’d really like to get back to training my legs in some way. Can I slowly resume doing most other CF-style things (deadlifts, lunges, box-jumps, sprints etc.) or are they likely to make my knee condition worse? I really enjoy this style of working out and am hoping against hope that it’s not yet time for me to join the senior citizens in the aqua aerobics class. Many thanks for any advice you can give!

    • Typically I will have people in this situation try thingsd out on their own because only you know what activities will hurt. Do this not in a class on your own and with light weights. If thjings are not improved then you can get seen again.

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

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