Etiology — what causes it

Traumatic tears typically follow a twisting injury on a planted foot, common in pivoting sports. Degenerative tears develop progressively in middle-aged and older adults, often without a specific incident — they are part of the broader picture of knee osteoarthritis.

Epidemiology — who gets it

Traumatic tears most common in young, athletic populations. Degenerative meniscal tears are extremely common — present on MRI in over 50% of adults over 50 (Englund et al., NEJM). Importantly, many are asymptomatic.

Clinical signs

Joint line tenderness, positive McMurray, positive Thessaly test (modest accuracy), effusion (may be minimal in degenerative tears), reduced range, and sometimes mechanical symptoms (catching, locking).

Symptoms

Medial or lateral joint line pain, often with twisting or deep flexion. Effusion sometimes present. Mechanical symptoms (catching, locking) suggestive of unstable tear or displaced fragment. Stiffness and night pain in degenerative cases.

Best evidence for chiropractic treatment

For degenerative meniscal tears, multiple RCTs (Kise et al., BMJ 2016; ESCAPE trial; FIDELITY trial) show exercise therapy is non-inferior to partial meniscectomy at 2-year follow-up. Routine arthroscopic meniscectomy for degenerative tears is no longer recommended (BMJ Rapid Recommendation, Siemieniuk et al., 2017). For traumatic tears in young athletes with mechanical symptoms, repair or partial meniscectomy may be appropriate; criteria include tear size, location, and biological repair potential.

Subtypes

  • Degenerative tear. Older adults; exercise therapy is non-inferior to surgery.
  • Traumatic vertical tear in young athlete. Repair often appropriate, especially for peripheral tears with vascular supply.
  • Bucket-handle tear. Mechanical symptoms; often requires surgical referral.

When to seek emergency care

Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.

Bottom line

Most degenerative meniscal tears do not need surgery. Exercise produces equivalent outcomes at 2 years. Traumatic tears in young athletes are assessed individually.