Meniscal Injury



  • The menisci are fibrocartilaginous structures between the femoral condyles and the tibial plateaus.
  • The menisci help to stabilize the knee (with the anterior cruciate ligament [ACL]) and distribute forces across the joint to provide shock absorption.
  • Meniscal tears can lead to knee pain and disability and, ultimately, are a risk factor for the development of knee osteoarthritis (OA).

Pediatric Considerations

  • Meniscal injuries are less common in children aged <10 years. In this population, they are often due to a discoid meniscus.
  • MRI is still the study of choice but is less sensitive and specific for diagnosing meniscal tears in children aged <12 years.
  • Increased BMI in pediatric patients correlates with more complex tears and lower repair success rates.


Bimodal age distribution—young athletes (traumatic) and older patients (degenerative)

Medial meniscus more commonly injured


  • One of the most common musculoskeletal injuries
  • Meniscal surgery is the most common type of orthopedic surgery performed in the United States.

Etiology and Pathophysiology

  • Traumatic tears are acute. They generally occur due to a twisting motion of the knee with foot planted.
    • Common in younger patients (aged <40 years) without underlying knee OA
    • Manifests with sudden pain
  • Degenerative tears are chronic. They generally occur with overuse and minimal trauma.
    • There is an age related increase in prevalence, and they are often comorbid with knee OA.
    • Symptoms evolve slowly.

No specific gene locus has been identified.

Risk Factors

  • Nonmodifiable risk factors: male, discoid meniscus, ligamentous laxity
  • Traumatic tear:
    • High degree of physical activity (especially cutting sports)
    • ACL insufficiency
  • Degenerative tear:
    • Increased age (>60 years)
    • Obesity
    • Work-related kneeling/squatting/climbing stairs

General Prevention

  • Treatment and rehabilitation of previous knee injuries, particularly ACL injuries
  • Strengthening and increased flexibility of quadriceps and hamstring muscles
  • Weight management

Commonly Associated Conditions

  • Traumatic tear: ACL concomitantly torn in 1/3 of cases
  • Degenerative tear: OA, Baker cyst (greater association with medial meniscal tears)

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