Aging & ArthritisImportant ConceptsJust PostedKnee



I could talk generally about meniscus tears, but not all meniscus tears are created equal. There are meniscus tears and then there are degenerative meniscus tears, and it’s the latter I’m talking about now. And the two types of meniscus tears are almost entirely different entities.


But for starters, let’s just define the two types of tears, and to do this, it’s easiest to define acute meniscus tears and then just about everything else is degenerative. That way it will be easier for you to figure out which kind you have.

Just about any meniscus tear in a person under forty who injures their knee, is an acute tear…and NOT a degenerative tear. On the flip side, just about any meniscus tear in a person over forty who experiences the more or less spontaneous onset of knee pain, is a degenerative meniscus tear.

Now there is everything in between, with the exception of a young person having a degenerative tear. I don’t think I’ve ever seen that. Of course there are always exceptions, but in general, the youthful meniscus is a very resilient structure and tears only as a result of an injury: twisting the knee in a football game, falling off a bicycle, landing bad on a trampoline, etc. There are a few young people out there with naturally loose ligaments, who can tear their meniscus cartilage with only a minor injury, but those are rare circumstances.

My focus now is the degenerative meniscus tear…everybody else’s meniscus tear. I often see elderly patients who come to me with an MRI which demonstrates a meniscus tear. The patient may or may not have had X-rays which show signs of arthritis, sometimes advanced arthritis. They think the cause of their pain is the meniscus tear itself, and many have the expectation that surgical repair is what they need.

Sometimes surgery is an alternative, but not most of the time. Degenerative meniscus tears are simply a sign of the development of arthritis. In simple terms, arthritis is the result of the gradual wearing out of the joint cartilage and the subsequent inflammation triggered by this process. It just so happens that in the knee, we have two kinds of cartilage: the shiny white stuff on the ends of the bones (just like on the end of a chicken bone), and the meniscus cartilage.

As we age, our articular cartilage and our meniscus cartilages begin to wear out. Unfortunately, in some of us, they begin to wear out quite early in life, and we’re seeing younger and younger patients with early-onset arthritis, especially in the knees.

Conditions and activities associated with degenerative meniscus tears and early knee arthritis include:

-a genetic predisposition to arthritis (and it doesn’t matter whether or not your folks actually complained)


-previous history of a knee injury

-activities involving a lot of squatting and climbing, cutting and high impact

If you experience the gradual onset of arthritis after the age of sixty, then you are likely just genetically “scheduled” to have arthritis. Your knees are just wearing out, and it doesn’t seem like such an unreasonable time in life to get it. But when you’re young, sometimes it just doesn’t make sense.


Sometimes patients experience the gradual onset of an aching sensation in the knee, perhaps even in both. They notice swelling after standing for long periods of time. Their knees hurt when they abruptly stand up from a seated position, especially if they’ve been sitting for a while. The knees ache in the morning, after mowing the lawn, or after staying with grandchildren and having to walk up and down stairs or squat to the ground to change diapers. Sound familiar?

But almost as frequently, I see older patients who have the fairly acute onset of knee pain, most commonly on the inside or in the back of the knee. They might not recall a specific injury. But they might recall some activity, perhaps an exercise program, during or after which they noted the onset of pain. Or sometimes they might remember the onset of pain after slightly twisting their knee, doing something as simple as turning from the refrigerator. Perhaps a bad step off a curb. Maybe even after a fall. But often they can’t recall any injury. They just woke up one day with pain in the knee.

They started taking some anti-inflammatories, like Advil or Aleve. They iced their knee or applied heat. Maybe that helped a little. They often try to work through the pain. Many people think that doing more exercise might help the pain. Most of the time it just makes it worse.

Their knee might swell. It might feel stiff. It hurts to stand up after they’ve been sitting for a while. The knee hurts at night, especially if it’s resting against the other knee and it feels better to put a pillow between the legs.

Sometimes the pain is severe and constant. Other times it’s mild and intermittent. And everything in between!

If this sounds familiar…you might have a degenerative meniscus tear.



 The meniscus is a tough, rubbery cartilage in between the two bones of the knee. It’s attached to the lining of the joint and has a very poor blood supply, so when it tears, it won’t heal on its own. If you’re young and have a tear that’s close to the ridiculously poor blood supply, sometimes it can be fixed. But frankly, most meniscus tears can’t be fixed, and that goes double for degenerative tears. Sorry. We can’t treat forty-plussers like high school basketball players.

Many patients come to me with MRI scans, showing a degenerative tear of the meniscus, thinking that the tear can be fixed and put back together…just like new. They’re often surprised and dismayed to find out that not only can the meniscus not be repaired, in most cases it doesn’t even need an operation. There’s something very disheartening about a condition you have to live with! But many of you have other conditions like this! Take hypertension, for example. It can be treated, but not cured. And there’s no surgery for it.  Patients often think surgery can cure their problem. Certainly in many cases, that might be true. We can “cure” a broken femur with an operation. We can “cure” carpal tunnel syndrome with one, but not the degenerative meniscus tear. We can only “treat” it. An operation for it simply removes the offending piece of meniscus, leaving an empty void where it used to be. More on that later.

In general, when a patient over forty is diagnosed with a meniscus tear, it is usually a degenerative meniscus tear. I say “in general,” because occasionally a forty or fifty-year-old will sustain a meniscus tear during a game of soccer. But even in these instances, the quality of the meniscus is still poor, and they are usually not amenable to repair.

But this discussion is about degenerative meniscus tears, and it applies to most of my readers. These tears are a symptom of the development of arthritis. If you are diagnosed with a meniscus tear, and you’re over forty, then you are likely developing arthritis. It’s complicated, because most patients will say they’ve never had arthritis before, or they’ve never had knee pain before. They don’t understand how they could be developing arthritis. Many associate the onset of their pain with an injury, and in fact may have sustained an injury at work, so it’s hard to understand how that meniscus was already in a damaged or degenerated state. It’s a big dilemma with regard to workers’ compensation, because even though most insurers will accept the tear as a “compensable injury,” they won’t accept the ensuing symptoms of arthritis as part of the injury. It’s complicated.



So if your meniscus is so tough, how did it tear so easily? I like to compare the meniscus to a pair of pants. When you buy a new pair of pants, the only way they tear is to catch them on something and rip them. That’s like the meniscus in a twenty-year-old. A twenty-year-old has to have an injury in order to tear their meniscus. They have to twist it playing soccer, or get hit from the side in a football game. They’re often associated with anterior cruciate ligament tears. But as the pants age, the seams begin wearing out. They get threadbare. Every day, you get in and out of chairs the same way. But one day you stand up from that chair, and the seam tears apart. And you can’t sew that seam back like it was when the pants were brand new because the fabric is all worn out. Sadly, unlike your pants, we can’t just go get a new meniscus.



So what can we do with that worn out, torn meniscus? Well first of all, we can live with it. There’s no rule that says if you tear your old, beat up meniscus, you must have an operation on it. That’s right. Most people think that if they have a torn meniscus, it needs a surgery, just like the professional ball players. This is not the case. Sometimes if you can modify some aggravating activities like squatting, lunging, and running, you can get along with that tear. What did we do with degenerative tears before MRI scans and knee arthroscopy? People lived with aching knees and figured out how to modify the way they did things in order to decrease their pain. Of course, we’re much less tolerant of pain now, because we think there’s always a treatment…an operation.



But wait. Even before that operation, there are other things to do. Sometimes all it takes is some relief of the inflammation. Remember, arthritis is the combination of the wearing out of cartilage (in the knee that’s the surface cartilage and the meniscus cartilages) and the inflammation it stirs up. A lot of your pain comes from the inflammation and by decreasing it, you just might be able to avoid surgery and get along with your aging knee!

Let me tell you a personal experience. When my mom was 60 years old, she came to see me as a patient! Yes, I made her make an appointment. Based on her symptoms: pain on the inside of her knee and a little swelling, I figured she was developing a little arthritis and maybe she had a degenerative meniscus tear. At the time she was doing a lot of yoga, and her program included a lot of squatting. I guess she didn’t read my Do Not Do Squats! blog! I told her to stop doing the squats. An X-ray was normal, and later an MRI demonstrated a torn meniscus…a degenerative meniscus tear. Because her knee kept swelling despite use of anti-inflammatories like Advil and Aleve, I gave her a cortisone injection. Her pain and swelling completely resolved. She also stopped all squatting exercises. I didn’t see her as a patient (we did see each other for other mother/daughter reasons) again until she was 81! I recently X-rayed her knee again. Her arthritis had advanced a little, and she had a puffy knee. I gave her another cortisone injection and then a Synvisc (hyaluronic acid) injection, and haven’t heard a peep from of her for over a year (other than the usual mother/daughter peeping). She and my dad are walkers, ballroom dancers and they travel all over the world! But they don’t squat because their orthopedic surgeon-daughter says not to!



Suffice it to say to stay out of the operating room unless it’s absolutely necessary. At 60 years of age, had my mom continued to complain of pain, despite conservative treatment, I probably would have recommended a knee arthroscopy in order to remove the offending cartilage. I would have counseled her that the surgery would not “cure” the meniscus. The cartilage would not be repaired, and nothing could be put back in its place. We could only remove part or all of the meniscus, depending on how much of it was torn. We might clean up some of the surface cartilage. Maybe remove loose fragments of cartilage floating around in her knee. But the arthritis could not be cured. It would persist, and over time it would progressively worsen. And someday she might need to have a total knee replacement.

I would have also told her that there were potential risks and complications of that surgery, like blood clots and infections, but that complications were very rare. The main thing I would have told her was that the surgery might not help her at all, and that occasionally people resume having the same pain within a short period of time. But I would have focused on the fact that most people actually do pretty well for quite a while. Knee arthroscopy is just a treatment for degenerative meniscus tears. It’s just one of the things we can do for a patient with a tear if it doesn’t get better with non-operative treatment. And it’s a good option when all else fails.

And so I say “baloney” to the experts who say that the operation “doesn’t work.” They use semantics to try to convince insurance companies not to pay for knee arthroscopy. Many of them are retired orthopedic surgeons, who don’t have a dog in the hunt anymore. Some are academicians, who might not be following these patients for long periods of time. Many of my patients have grown old with me. And some of these surgeons espouse this rhetoric, but in their practice, they continue to scope knees with degenerative meniscus tears! Why? Because it helps with the pain. Of course this surgery doesn’t “work.” That means, it doesn’t “cure” the condition of arthritis. But it helps, just like anti-inflammatories, and cortisone and hyaluronic acid injections help. It helps, just like hot and cold compresses, and knee sleeves and walking aides help. It helps, like rest and avoidance of squats and high impact exercises help. Once you have a degenerative meniscus tear, there is NO cure for what ails you. There is only treatment. And then there is total knee replacement.

It is incumbent upon your orthopedic surgeon to inform you of the difference between your degenerative meniscus tear and a college quarterback’s meniscus tear, so that you’re not disappointed when after the surgery, you aren’t exactly like you were the day before the onset of your pain. Your expectations have to be different. I often see patients for a second opinion, after they failed to achieve their expected goals following a meniscectomy for a degenerative meniscus tear. Their expectation was that the surgery would “cure” their condition…the condition of a degenerative meniscus tear, perhaps in the same way a meniscectomy would cure a 20-year-old football player, allowing him to return to the game in a few months or by the next season.

Of course, anyone who follows football or basketball knows that surgery after a torn meniscus doesn’t always cure those athletes either. You only hear about the ones who come back, but you never hear about the ones who don’t. Let’s face it. Your meniscus is a very important structure, and the loss of it is devastating no matter when a tear occurs.



Let’s mention that football player briefly, if not to demonstrate how your meniscus tear is different from his, but to clarify some long term similarities as well. In a 20-year-old, you are dealing with a fresh and youthful knee. Other than the strain of the injury on muscles, tendons, cartilage and bone, that knee is otherwise normal. Once those supportive structures heal, even though the meniscus is torn, removed or repaired, the knee is kind of back to normal. The player returns to sport whenever his knee feels good or his orthopedic surgeon releases him to play.

The knee of a 50-year-old with a degenerative meniscus tear is not that otherwise normal knee. It is a knee which has been damaged repetitively by over forty-plus years of high impact exercise, squats, standing, taking stairs and gravity and weight and living, not to mention a gene pool of who-knows-what in terms of predisposition to arthritis, deformity, gait abnormality and inflammation! Your expectation for returning to what was hurting you when you started having knee pain should be different now.

Frankly, the twenty-year-old football player’s expectation should be changed as well. Once having torn that meniscus, he will likely develop arthritis within a ten-year period of time. I wish they would stop playing sports, doing squats and participating in high impact exercises immediately. We should be giving our athletes that information and asking them to consider that option. I do! And every once in a while, they listen. They get it. But that’s usually in athletes who are done with participation in interscholastic and collegiate level sports. Most sports medicine docs don’t even try to dissuade young athletes from returning to sports, because it falls on deaf ears. It often falls on the deaf ears of forty-year-old weekend warriors too!

But sadly, a large number of high-level athletes find it impossible to ever return to sports, either because the knee cannot sustain the beating, once it recovers from the injury and surgery, or because something is missing upstairs. They lack the pain tolerance or the will to persevere. And it’s not because they’re wimps. It’s because in many there is a natural protective intuition. “This is not good for me! Stop!”

But more often than not, they don’t stop. You see them out there.  The J.J. Watts of the world. There is some element of pain tolerance, work ethic, adrenaline, hardheadedness and love of the game that keeps them coming back. There’s the money and the glory too, but that’s not all of it because I see weekend softball players like this. And there’s no money in that. Just a little glory and camaraderie. So we make our choices, and we will suffer. Because there is no question about this. You will eventually suffer if you have a meniscus tear.



Other than the patient who is a candidate for arthroscopy and meniscectomy, the treatment for degenerative meniscus tears is the same as the treatment of arthritis. Because that’s what degenerative meniscus tears are: a sign…a symptom…a part of having arthritis. And when you understand this, you can begin to understand what you and I need to do!

So who’s a candidate for knee arthroscopy, remembering that this is only a treatment and not a cure for the degenerative meniscus tear and some early degrees of arthritis? The people who are candidates for arthroscopic meniscectomies include:

Relatively young patients. And I say “relative” because there are forty-year-olds and there are forty-year-olds, and so on and so forth. Occasionally a seventy-year-old shows up with a degenerative meniscus tear which he sustained while exercising and it has locked up his knee! But truthfully, age is a factor. Allow your doctor to tell you that, even though you don’t want to hear it.

-Patients with fairly normal looking X-rays. There are early X-ray signs of arthritis, like little spurs on the edges of the bone or narrowing of the space between the femur and the tibia. As those X-ray findings become more apparent (large spurs which appear to flatten and spread the bone, or bone-on-bone arthritis) the likelihood that you will benefit from surgery lessens because these are just signs that the arthritis is advanced and the meniscus tear is not your only painful problem.

-Patients who have a fairly normal MRI. The MRI is a much more sensitive test and will show not only meniscus tears but also damage to the articular cartilage. Often a patient with a relatively normal looking knee on an X-ray will have MRI evidence of advanced arthritic changes.

-Patients who are active in their leisure time as well as in the workplace, and for whatever reason, cannot modify their activities. This can be particularly difficult for folks in their fifties and sixties, who are manual laborers or stand all day at their job. This is not a time when they can easily modify their job description, and it’s too early to retire.

Patients who have failed a course of conservative treatment, and rest, anti-inflammatories, physical therapy, cortisone or hyaluronic acid injections have failed to result in improvement.

The very elderly, those with advanced arthritic changes on X-ray or MRI, those who can modify their activities to the point where the knee no longer hurts, or those who have not yet undergone a course of conservative treatment should consider alternatives to knee arthroscopy. It’s rare for me to scope the knee of a 70-year-old or someone with advanced arthritis. I wouldn’t scope the knee of someone who was no longer complaining of pain after they stopped doing squats or had improvement in their pain after a course of P.T., taking some Aleve or having a cortisone injection. And frankly, this is a large percentage of the folks who come to see me with MRIs demonstrating a degenerative meniscus tear!



The first line of treatment for degenerative meniscus tears is to try to stop doing the activity or activities which may have caused or exacerbated the pain. Stop running. Stop squatting. Stop playing ball. See if you can have a light duty job modification temporarily or even permanently. Remember, meniscus tears don’t heal, and the most we can do for them surgically is to remove them. You will still have the arthritis.

Meniscus tears cause inflammation or swelling in the knee. So the next line of treatment is to try to decrease inflammation. If there are no contraindications to non-steroidal anti-inflammatories (NSAIDs), then you can try a prescription level NSAID (like meloxicam or Celebrex), or an over-the-counter NSAID (Advil, Aleve). These medications have the potential for side effects, so we don’t want to keep you on them indefinitely, but it’s certainly worth a try for a month or so. If you have liver or kidney disease, stomach ulcers or you’re taking a blood thinner, you should not take prescription or over-the-counter NSAIDs.

Cortisone injections are also an option. There are very few side effects of cortisone injections. Nevertheless, it’s a shot, and many patients don’t like the sharp, pointy object. But if your doctor uses a local anesthetic, and does the injection in a gentle, caring way, it shouldn’t be too terribly painful. Often they result in tremendous pain relief, and can be a part of the long-term treatment for arthritic knees. But for the person suffering from a degenerative meniscus tear, they can also provide temporary relief of pain in addition to giving the doctor an idea as to whether or not your pain is coming from the inside of your knee. There is always bad press out there about cortisone. It can cause significant side effects in people who take them for a long time. There are studies showing that they can be associated with damage to articular cartilage. This has yet to demonstrate clinical significance, and anecdotally, we can all tell you that cortisone helps, and clinically doesn’t seem to cause rapid deterioration of the already deteriorated knee! There are many choices for those of us who are too young or too overweight to have total knee replacements!

Physical therapy can be beneficial. As we age our muscles atrophy and weaken, and our balance deteriorates. These factors can affect your ability to recover from a degenerative meniscus tear. But it’s not a cure, and in some cases, patients have increased pain after PT!

Arthritic knees can also benefit from injections of hyaluronic acid (HA). Synvisc, Euflexxa, and Orthovisc are a few brand names. The reasons why these injections benefit arthritic knees are complex, and there are many theories regarding this issue. But suffice it to say, there are many patients (including some of my own family members) who are benefiting from these injections, which can be given every six months. Most skilled orthopedic surgeons can give these injections in their office, and without the use of ultrasound guidance, which can add to the cost.

There is a lot of controversy regarding cortisone and hyaluronic acid injections. They are not cheap, and insurers (including Medicare) are becoming more and more reluctant to authorize their use. But in some areas where insurers opted not to pay for HA injections, the number of total joint replacements went up an amazing 500%! Given no other options, patients in pain had to turn to joint replacement earlier than they might ordinarily have done when the injections were an option. Suffice it to say that in the hands of thousands of orthopedic surgeons around the country…and frankly, the world…cortisone and hyaluronic acid injections remain an extremely viable option for those suffering from arthritis.

But for the average patient suffering from a simple degenerative meniscus tear, with little arthritic changes on X-ray or MRI, hyaluronic acid injections might not be the mainstay of treatment. They would be indicated for those with more advanced arthritic changes in addition to the tear.



And when all else fails, and you continue to experience pain, swelling or locking…there is the knee arthroscopy. It should probably not be the first thing considered when that MRI demonstrates a degenerative tear. The conservative treatment protocol discussed above should at least be offered and discussed as an option. You are not the same as that 20-year-old football player. Knee arthroscopy is the first option for him! He will fail to improve with anti-inflammatories. He will not get better with P.T. and an injection will be ineffective. We will scope his knee and repair or remove the torn cartilage. He’ll get arthritis in that knee eventually, but he does not have it at the time of his injury.

Knee arthroscopy can be very effective for some patients who fail to improve with a conservative course of treatment. It’s not a complicated operation, and you’re not likely to experience a complication. Sure, you’ll have a grand list of potential complications, which can seem daunting when you read it. You could even die from an infection or a blood clot. Blood clots do occasionally occur following knee arthroscopy, but they’re rare, and if caught early, can be treated with blood thinners, to avoid a potentially deadly pulmonary embolism. Infections almost never occur. Persistent swelling and stiffness can result, more from the condition itself than from the surgery. And last but not least…persistent pain! Occasionally, a patient gets NO relief from the surgery at all. This is extremely rare, and not likely if we select the right patients for surgery. If a patient has advanced arthritis, they are unlikely to get long term benefit from the operation, and six months later, might find that their knee is hurting just as much as ever.

Bottom line. It’s an operation. You have to undergo anesthesia. There are potential complications and if you’re the one who has them, you won’t be happy. Which is why, when you decide to sign up for that operation…and frankly, any elective operation…you should make sure you’ve done everything you and your doctor decided on to avoid that operation. Then you can go into that operation knowing that the operation was the best alternative for you at that time.

The good news! If you’re the right patient for a knee arthroscopy, you will get some pain relief and have a good result, with little potential for complications!

Remember, NSAIDs, P.T., injections and arthroscopy are not a “cure” for the arthritis or the meniscus tear. They’re a treatment. We can’t give you back your twenty-year-old knee, and eventually that arthritis is going to catch up with you no matter what. But hopefully with these treatment options, we at least hold off on total knee replacement until you get a little older.



When all else fails, and you have advanced arthritis in your knee, which has failed to improve with use of medications, injections, activity modifications and yes, even knee arthroscopy, then you might be a candidate for total knee replacement.

And just for the record…why is it important to hold off on that total knee replacement? People ask me this all the time, because they see more and more neighbors, friends and family members having successful knee replacements at younger and younger ages. Knee replacements are the “cure” for knee arthritis. The problem is that knee replacements don’t last forever. And once they loosen or wear out, they have to be revised. Revision surgery is more complicated, and more likely to result in complications like infection, or fracture, pain and stiffness.  Frankly, the objective is for the original knee replacement to outlive you. Sorry to say it in that course way, but that’s the idea. You don’t want to have to have a revision. So if an average knee replacement lasts around 20 years, you don’t want to be thinking about revision when you’re 90. Or even 80. So it’s ideal to wait to get your knee replaced until your well into your sixties.

Many of you and your docs will say, “Why wait until my quality of life is so poor that I’m miserable?” Because you don’t want a revision.

Additionally, young patients simply aren’t as satisfied with their total knee replacements as older patients. The reasons for that are complex, but take my word for it. If you have a replacement when you’re 50, you just won’t be as happy with it as when you’re 65.

And here’s one more thing. Many of you think that when you have your knee replaced you can just go out and play ball, ski, run, squat and do anything you were doing before the knee went bad. And some of your surgeons will tell you that’s fine. Since I don’t do total joints, it’s easy for me to tell you that you shouldn’t do those things. Knee replacement is a pain relieving operation. It’s not a basketball-enabling operation. It’s not a mogul-skiing-enabling operation. And the more stuff you do to tear it up, the faster it will wear out and get you to…a revision…which we don’t want. So when you start thinking about a total knee replacement, don’t think of it as something which you need to do early so you can get back to playing sports. Think golf, walking, swimming, cycling…maybe doubles tennis with other old folks.

I think I’ve said just about everything there is to say about degenerative meniscus tear, and if you made it this far…then you know what to do!

  1. Judy Miller

    When your doctor tells you that you have arthritis it is like learning there’s no Santa Claus. How could you possibly have arthritis at the young age of 70? No way, not me!! It iseems like a right of passage to old age. What do I do? I increased my walking and joined a gym with no squats or high impact knee activities..I will win this battle! I recently went to Italy and walked up thousands of steps with no problems…..

  2. Vicky

    VERY, VERY, VERY COMPREHENSIVE ARTICLE. At first I thought I was learning too much about knee problems, but then I realized I was learning things I didn’t know…..and also things I NEEDED to know as an 82 year old woman with 82 year old knees. NO SQUATS for sure! More WALKING for sure! ……and root-beer floats with vanilla ice cream?……..well,only once a while.

  3. Laura Van Rossum

    Awesome article, Barbara! I had meniscus surgery in April. It worked amazingly for me, but I also can see what you are saying about the knee is not “cured”. It’s not as strong, etc but, thankfully, for me, it stopped the pain. Since then I have lost 22 lbs. so that helped also. I walk 10,000-15,000 steps a day depending on my work schedule. I pray the old arthritis is gonna take his time coming my way!

    1. Barbara

      Yes, that surgery is very successful in many people, but should not always be the go-to treatment in the face of a degenerative meniscus tear. As I said in the article, I disagree with many orthopedic surgeons and insurance companies, who deny patients this valuable treatment option when their pain does not improve with conservative treatment. I’m so glad you have had successful relief of your pain. Remember…avoid squats, deep knee bends and lunges, as well as high impact exercise. Your goal now is to hang on to your own knee as long as possible! Thanks for following my blog!

  4. Jana

    I injured my knee (large dog ran into the side of it) when I was 40. I was a runner and 5x a week aerobic and step exerciser at the time. the surgeon I saw diagnosed severe chondromalacia and said no more vigorous exercising or running. Fast forward 7 years and without the exercising and with a painful knee, I’d gained 40 lbs, lost endurance and muscle tone and due to several falls on my knees, had severe knee swelling and pain and could barely walk. I saw a new surgeon who had me in the OR in 2 days, removed the folded over torn meniscus flap in the knee I’d injured 7 yrs prior, plus all the floating cartilage bits and pieces. He did the other knee 6 mos later. Those 2 surgeries brought rapid pain relief and decrease of swelling and helped me exercise to lose a lot of that weight. That was an additional 7 yrs ago and although I know partial and TKA is in my future, I’ll forever be grateful to the 2nd surgeon for buying me so many more mobile and less painful years.

  5. Daniel Therrien

    Fantastic Article! I am a 44 years old acrobatic dancer (yes you read that right) doing musicals here in Germany. As you can imagine my job is very hard on the knees. I also coach gymnastics and hit the weight room pretty hard (including deep squats which I will stop doing TODAY after reading this!)

    I tore my meniscus 5 years ago doing ‘Cats’. It is a raked stage and I landed straight legged out of a tumbling pass. Tore my ACL (minor) and ripped the side of my meniscus, small tear. Went to 6 doctors (best in Austria/Germany) and they all recommended surgery. I was weary and decided R&R was a better option. I made a full recovery and have done shows for 5 years until I just bent down in the show last month and my knee popped. -sigh- so here starts the trouble. Went to the doctor and he told me (almost verbatim) what your article states. It is a degenerative tear from my last tear. Also I busted some kind of sac and there was water looking stuff in my bones. Here was the diagnosis:
    -The cruciate ligaments are intact. It shows a low joint effusion. The posterior horn of the outer meniscus shows a vertical crack. Edematous swelling in the posterior horn of the inner meniscus without circumscribed tear. Ruptured Baker’s cyst. Cartilaginous lesions in the lateral compartment with bone edema in the lateral tibial plateau-

    It is a The problem is I am contracted for shows through 2020! My pain is minor, it is just uncomfortable and tightness at the back of my knee. An unstable knee isn’t what you want to have when you are flying about and landing on an 8 show a week basis.

    My question would be what would you recommend to make my career last as long as it can? I have another Doctor appointment next week, but found your article so WELL written and understanding of exactly what I am going through, I thought it would be great to have your opinion as well. I am in Germany and EVERYTHING is free, so any option is within my grasp. No one has recommended surgery yet (like they did when I was in my 30’s), but I have to keep working. I really don’t know what else to do. Would you recommend the cortisone shot? Like I said, I’m not in pain, I just want my knee to be stable and to be able to straiten it without discomfort.

    1. Barbara

      This is disappointing for you, and hard for me to hear…even though I hear it every day. You’re in somewhat of a bind, in that your physical activity is part of your job, and not some voluntary exercise you can stop and trade for something else. So, having had the same injury as you, and expecting one of these days to have the same problem as you, this is what I would recommend. Limit your extreme practicing as much as you can. Do the more low impact, less squatting kind of practices, and only do the jumping-flying-through-the-air stuff when you absolutely must. And certainly do none of those things at any other time! Baby your knee as much as you can. Consider occasional cortisone injections, especially prior to performing, like if you’re going on a tour. Try viscosupplementation (hyaluronic acid injections). In countries with universal health care, they might not provide these injections, because they will use false studies (as our insurers and the government do here in the US) to keep you from access to a treatment which is very beneficial to MOST patients, including many of my blood relatives, and my horse, with whom I currently compete. So I wouldn’t recommend a treatment to you that I wouldn’t do on a member of my family, or myself, or my horse for that matter. But you might have to pay for it. I would be curious to know this information from you. Then you can also try other injections (biolologics) such as platelet rich plasma, stem cell , or exosomes. In the US, patients all have to pay for these themselves. Read my post called Decrease Pain from Arthritis to see if there are any non medical, non injection and non surgical things you could do, like wear a brace. These things I mention in the post do help. Last, but not least, at your age (being relatively young and not close to the age where you might take a total knee replacement), sometimes going in there arthroscopically and “cleaning things out,” helps. It’s only temporary, but when you’re young, this is often an alternative, and might get you to 2020!

      Do you live in Germany? You might be my first German reader. I have lots of readers from England and former colonies (English speaking countries), but not yet from Germany. Please forward my blog to friends and family, as I would love to get a German following. I’m currently studying German on Duolingo, und ich spreche ein bisschen Deutsch! I probably didn’t spell all of that right, and I don’t have German spell check on my computer, like I do on my cell phone. Having lots of trouble with gender in German. The sad thing is, I probably won’t EVER get it down. Very difficult stuff. If you ARE German, you write English very well! Auf Wiedersehen!

  6. Diane

    I’d like to be able to give my mom some advice – and perhaps a reality check. She has a complicated meniscus tear – and she’s 97. She also has arthritis and severe osteoporosis. Her doctor, an orthopedic surgeon, has given her a shot in the knee, advised her to take over-the-counter pain medication, and to walk – or she won’t walk again. She’s been using a scooter and walking minimally with her walker. She thinks there is something out there that should cure her. What would you advise/tell a 97 year-old? Thank you.

    1. Barbara

      Wow, this is a complicated situation, which I haven’t seen too often, simply because there aren’t that many people alive with this condition. She most certainly has a degenerative meniscus tear, and I would have to say that I would never do a knee scope on a 94 y/o. Once, I scheduled a carpal tunnel release on a 90ish woman, who was unable to button her shirt because her hand was so weak and numb from compression of that nerve in the wrist. Well, she passed away the night before her surgery! Can you imagine, if her time was the night AFTER her surgery! I can’t even think of a circumstance under which I would do an “elective” operation on a person that age. Sure, we do emergency surgery, or urgent surgery on people that age all the time. If she broke her hip, she would have a hip replacement. And in fact we do total hip replacements on fairly old individuals, simply because the rehabilitation is so easy. But total knees are a whole different animal. The pain is greater and the rehab more strenuous, and most elderly people simply can’t do it. Additionally, in the very elderly, there are some potential untoward effects of anesthesia. Sometimes extreme, intolerable pain is due to a stress fracture or stress reaction, and it is necessary to stay off the leg, in other words, temporarily get in a wheelchair. I know we don’t like for people to do this, because sometimes they never get back out of the wheelchair, but at 94…how bad would that be? It’s terrible to be that age and have pain. Usually SEVERE pain is not due to a meniscus tear, because by that time, the meniscus has been squished for a long time. Continue to try cortisone injections, rest, heat, and perhaps viscosupplementation, “the gel shots.” But first make sure there is not some other underlying cause of her pain.

  7. Gail

    Thank you for such a great article! I just turned 50 and can barely walk – My right knee has a degenerative meniscal tear. Two years ago I started feeling some pain on the medial side of the right knee which progressed to the point where I had an MRI showing the tear. The right leg and knee are very week. Since that time, I have managed to bang that knee twice, most recently two weeks ago, when it locked on me and I hit a table straight on with that knee. I had an X-Ray of the knee which was fine. However, the pain is not allowing me to walk. I saw an orthopedic surgeon in an urgent care who just told me to take NSAIDS. I was also given Voltaren cream which works for 1-2 hours to help take the edge off the pain. Not walking has caused me to quickly gain 10 lbs. I started thin so I am 135 lbs now but want to get back to being active, thin and pain-free. I have been doing PT but I can’t do much exercise. The PT mostly consists of nerve stimulation and massage. I am concerned the massage may cause further damage. What other options do I have? Will I ever be pain free? Will I regain strength in this knee? I want to be able to walk and exercise.

    1. Barbara

      Most of what I have to say about degenerative meniscus tears is in that treatise. Injuries can certainly set you back, because your knee is not a resilient to injury as it was when you were twenty. So have some patience with it. If you have exhausted a conservative course of treatment, you may eventually need a meniscectomy, as I mentioned in my post. I do believe you will eventually be able to exercise. I can’t tell you that you’ll be able to walk long distances, with or without a meniscectomy. Cycling and swimming are better for your knee. Eventually you may require total knee arthroplasty, and I can’t tell you how far away from that you are. I can say, that you are too young to expect to have a good long term outcome from a total knee replacement. As I said in the blog post, younger patients do not have as good an outcome. No reasonable orthopedic surgeon would perform a total knee replacement on a patient with a degenerative meniscus repair who had sudden increase in pain after a blunt injury. That would not be the proper indication for the surgery. You would have to have advanced degenerative changes and have gotten over the injury. But my assumption is that you don’t have advanced arthritis changes in your knee. Continue the conservative course of treatment your doc recommends. Massage therapy is unlikely to “harm” you, even though it could “hurt.”

  8. Carol Jabs

    This is a great article of information. I am a workers comp “victim” and needed this cause the Drs have beat around bush and never talked to me. Now I know what to ask, in their language, so I can get the help and treatment I need for my meniscus tears. Thank u

  9. Jim Maher

    As a 68 year old physician who has a goal of walking around the world before I am 75 (I have 10,000 miles in and try to do a minimum of 5 a day) I found this very informative and helpful. I have a small posterior tear and have had pain for 3 months, have used minimal meds but have found I can’t kneel and have pain with weight bearing about 80% of the time. X rays normal and other than mild chondromalacia patellae the MRI shows only the tear. I’m not sure I am ready to use crutches or a walker for 6 weeks while healing from a repair, but also am having trouble doing patient care with the pain, unable to kneel to take a blood pressure on a house call, etc. will be talking to my ortho soon (MRI done this AM). Thanks for all the info– will be needing to digest and prioritize, I guess.

    1. Barbara

      You’re absolutely right. You will need to prioritize. You’re walking a lot, and as you recall from my blog post, it’s really not natural for you to walk that much every day, and in a natural world you probably wouldn’t live this long anyway! Some of the things you must consider are the following:
      1) Is one of your priorities to avoid a total knee replacement? If so, then you should back off a little on the walking, maybe ride a bicycle part of the way around the world. And if you think that having a total knee replacement will enable you to walk more, think again. A recent study demonstrated the obvious. People who increase their activities after a total knee replacements, had to undergo revisions sooner than those who didn’t increase their activity after a knee replacement. It’s always best to avoid surgery. And by the way, you would not have a “repair.” The torn portion of your meniscus would simply be removed. As we get older, we are no longer candidates for repair, as the meniscus doesn’t have a good blood supply, even when we’re 20, nevermind when we’re 68.
      2) Is one of your goals to be able to continue to work? If so, back off on the walking. You don’t really have a sedentary job. If you’re like me, you’re up and down, standing while you dictate a chart or look at your computer, make calls, etc., and sitting a little while you interview a patient. Standing to examine them. Walking around the office or the hospital, etc. Yes, you’ll be in less pain after a total knee replacement, but there’s no guarantee that you’ll be in less pain after a knee scope.
      3) Is your goal to be able to kneel. Well, don’t make that a goal. Sit in a chair to take blood pressures. Don’t kneel or squat. Your femoral condyle tugs on the posterior third of the meniscus when you kneel or squat, and that’s where 95% of degenerative tears occur. And you won’t be able to kneel after a knee replacement. The plastic patellar button won’t hold up to it, and the front of the knee is forever sensitive following that operation. So get in the habit of not kneeling, and your knee will thank you for it.
      4) Is your goal to keep walking “around the world?” Then make that your goal, and stop the other activities which are aggravating your knee.

      You DO have to prioritize. Make the choices. Your knee won’t allow you to have it all at this point in your life. I’ll make a small bet with you. Stop squatting, kneeling, don’t do any deep knee bends for exercise, avoid stair climbing as much as possible, use handicap toilets, so your knees don’t have to bend as far, use your hands to help push you in and out of chairs and couches…and I’ll bet you can keep walking and working, and maybe avoid surgery altogether.

  10. Jennifer

    I loved reading your article. Thank you so much. My husband is 49 and has worked in a factory on concrete (22 years) walking several miles per day in steel toe shoes. His knee started bothering him about a month ago after vacation. He’s not worked since October 19th. Orthopedic doctor prescribed Celebrex (and he ices several times per day) but it has not helped. Had scope about 8 years ago so doctor told us surgery only had about 50/50 chance of helping. MRI done Thursday and we go back tomorrow to discuss options. Problem is he cannot alter his working conditions but cannot work in the amount of pain he feels when walking. Will probably try lubricating injections next. What are options if injections or cortisone don’t work? Would they do surgery and remove meniscus? Thanks! I’m going to ready your other article about squats. I’m 47 and recently joined a gym. I mainly just walk with a friend but now want to be careful and avoid squats or things that could cause problems for myself. Thanks again for providing such a great article!

    1. Barbara

      Glad you’re getting something out of my blog. Sorry to hear about your husband. If you read that entire article, you will know that he fits into that grey zone category where decision-making is difficult. He’s probably got somewhat advanced degenerative changes in his knee. Second surgeries are often of little benefit, unless there is a new condition. Nevertheless, he is young, and way to young to throw in the towel. His situation is complicated by his work. He must strive to diminish the amount of walking that he does. If this is impossible, he must not be doing any exercise or participating in any sports which also stress his knees. He should be swimming or riding a bike. He should try the “gel shots.” They are very effective. If you have a lot of cash sitting around, burning a hole in your pockets, he could also try PRP or stem cell injections. They work too, but insurance doesn’t cover them, so you have to pay cash for them. When all else fails, because he is young, a second arthroscopy might be indicated. But not if he has a lot of bone edema on his MRI. Then he’s got to rest. No matter what happens, he needs to see if there’s any way he can eventually work himself into a less physical job. I hope this information helps. Have a happy Thanksgiving! And thanks for reading my blog. Please pass it on to friends and family!

  11. Jennifer

    Thank you for this article — I learned SO much!
    I’m a 54-year old professional actor/dancer/director/choreographer. A year and a half ago, I suffered a broken ankle, torn meniscus and chipped tooth in rehearsals for a show I was in. I had 2 surgeries on the ankle and once the ankle “recovered” (PT, etc), the torn meniscus was discovered (it had been overlooked by the more obvious ankle break). I had arthroscopic surgery on the meniscus last May. Was in PT/Work Conditioning — doing LOTS of squats (wish I had read this before!). I still have a lot of swelling in the knee and discomfort. PT has released me, saying I’ve hit a plateau. Now, I’m glad they did – as they obviously were not moving me in the direction that is best for my injury. But I’m left with not knowing where to go from here. Am I just S.O.L.? My ortho surgeon hasn’t released me to return to work – a problem with insurance folks, because they don’t “get” the demands of my job as an actor/dancer. He has me restricted to no squats, no ladders/steps. He offered (not sure it’d be covered) cortisone shots. Is this my best option – but long term?? I’d so appreciate your insight. Thank you!

    1. Barbara

      Sorry for the late response. Just busy, and my blog took a back burner.
      You likely have some degenerative changes, as most people with meniscus tears over the age of forty do. It doesn’t matter that you had an injury. Injuries can precipitate the presentation of those arthritic changes. But at this point…it’s a moot point, because you have this meniscus tear and there’s no going back to your 20-year-old, or even 40-year-old knee. He’s right about squats. Even if your knee started feeling better, you would still likely have problems with extremes of exercise and work (as is inherent in dancing). I do think your best options at this point, besides activity modifications, are the occasional use of anti-inflammatories (if you can take them), and injections (cortisone, hyaluronic acid, platelet rich plasma, stem cell). These things work, and there’s really no downside to using them. Ignore what you read. THEY WORK! And what choice do you have. A second surgery won’t help. Eventually you will likely have a total knee replacement, but you want to put that off for as long as possible. Get old before you have that surgery, if you can wait.

  12. Jon

    I would welcome any advice you can give – I am 58 years old 6’4” 18 stone and played quite a bit of social tennis. Left knee gone a bit wobbly recently, probably because of tennis. MRI said the I have “unstable – parrot beak tear of the posterior horn of the medial meniscus adjacent to the posterior root, with a horizontal cleavage tear extending into the posterior horn”. Walking is fine but I can feel there is an ache there all the time, whcih does not go away. We put a steroid injection in there but that seems to have done nothing. Dilema now is whether to remove the tear surgically and maybe I will then be able to walk without any pain at all (and hopefully even go back to tennis), or whether I am kidding myself and I am going to have to live with a painful knee even if I have surgery ???

    1. Barbara

      As I said in that post, there is no guarantee on any of this, other than the fact that your knee will gradually get worse over time, as a progression of the disease process. So you will likely live with some level of discomfort, and that definition depends on your tolerance for it. Root tears are complicated because they essentially destabilize the meniscus, so we often have to remove the entire meniscus. Not always though. I just did one yesterday, in which I just removed a part of the meniscus, until I got to a point where the cartilage was stable. These patients usually do well. I had operated on his other knee, with a similar situation 5 years ago, so he wanted me to scope this one when he failed to achieve adequate pain relief with injections and activity modifications. At 64, there would be little value to repairing a root tear. In younger patients that’s what we do. But you likely already have a lot of degenerative changes in your knee. No matter what course you take, you must modify activities: no squats, etc. Avoid stairs as a matter of course. No high impact exercise. You know the routine. Expect to have a little discomfort when you get out of a chair. Look for my blog called “10 Tips to Decrease Knee Arthritis Pain” or something like that. Merry Christmas!

    1. Barbara

      Glad you got some good info from my post regarding meniscus tears. It’s complicated, and the more you understand, the more you are prepared to help your doc make a plan for YOU. So…stem cells. Okay, we’re using them pretty much in the same way we use cortisone or hyaluronic acid (gel/viscosupplimentation) injections: for pain relief. They’re like your body’s own super-charged anti-inflammatories, but no one really knows about their potential for healing or repairing. Somethings we’re looking into are liposomes and exosomes, which might have more reparative potential. The problem for older patients with degenerative meniscus tears, is that even if you repair the meniscus, the surrounding articular cartilage is shot. Additionally, at this time there is no such thing as “recreation” of the meniscus. In a younger patient, with normal articular cartilage, and a meniscus tear, the PRP, stem cells, etc., could be used to assist the repair. It might be injected at the meniscocapsular junction, where the repair is performed. Stem cells can be harvested at the time of a meniscectomy, and injected in the knee, perhaps hoping for diminished inflammation, and a prayer for reparation.

  13. Tammi P.

    Your article was very inforative and brings up questions I have regarding my right knee chronic pain. In Feb 2017 I had a painful pop in my right knee. Did a MRI and had a torn meniscal tear posterior horn. Mar 2017 had arthroscopic surgery to repair. Still had pain post-op. In speacking with my surgeon he felt it best to do a patella-femoral replacement. I begged for a total knee but he felt it best for the parcial. Dec 2017 the patella-femoral surgery was performed. 2 months after my surgery and continuing with my painful PT, I kept telling my surgeon I had sever pain throughout my right knee and pressure in the back of my knee. My surgeon kept telling me my knee was recovering and to give it a year. All throughout 2018 I had sever pain and pisterior pressure in my knee making it very difficult to walk or stand and wasn’t able to returned back to my job as a nurse in the OR. I tried steroids and the gel injections still no relielf. In July 2018 I even had a second opinon and the xray showed all my hardware in good standing but I told the doctor I had sever pain. He told me to give it a year. (His way of telling me he didn’t want to help me). So after dealing with pain since my Dec 2017, in Nov 2018 I seeked a 3rd orthopedic surgeon opinion and he ordered an MRI “MARs” and I was diagnosed with a Complex Posterior Horn Meiscus Tear. So a whole year I was walking around with a menuscus tear causing sevier pain. Dec 13, 2018 had another Arthroscopic surgery to repair the tear. Surgery went great but once again I felt presume posterior of my knee. Two weeks after surgery I felt a pop in my knee with sever pain. Ugggggg. I called my surgeon and left a message but no return calls as of yet. I’m back to sevier pain and can’t walk without aggravating it. Today I have my first post-op surgery follow up and will tell him about my pop and pain.

    Sorry for the long note but wanted you to have the full background on my knee. My question to you is this. Is it time I get a total knee revision? I’m 50 yrs old and in your article you suggest not to go this route at my age. I believe my meniscus is shot and the tissue is not strong enough to keep from tearing again. Or, should I undergo another meniscus repair to hold off from a total knee revision? Your opion would be deeply appreciated. Thank You

    1. Barbara

      Sorry you’re having so much pain. I have to be honest, and tell you I can’t just give you specific information because you’re not my patient, I haven’t examined you or looked at your studies. But I can tell you that total knee arthroplasty would not be a good idea in any 50-year-old. I would do everything to try to keep your own knee for many more years. Because you’ve had a patellofemoral resurfacing, you will be having a revision knee replacement. More bone will be cut off. You’re not as likely to have a great result, and you’re more likely to have a complication. You are also not likely to be having a “repair” of your meniscus. In older patients, it’s using a partial or complete meniscectomy (removal) and not a repair. I also can’t tell you what is generating your pain. It might be the meniscus, but it could also be your articular cartilage, adhesions or mechanical issues causing pain. Sorry I can’t be of much help. You must rely on the recommendations of your surgeon…or get a second opinion.

  14. Tim Newell

    Hi Barb,

    I had meniscus surgery on both knees, right one great, left one had a complex tear and i fair amount of meniscus was removed. I have not been pain free since the surgery, tried all the shots and exercise. I am looking into the meniscus replacement NUSurface but it is not yet approved in the USA. I am 62 185 and active, use a brace and avoid squats. I know you dont have my entire case, but I really dont want a TKR but looking for relief. Are there any other remedy’s for this condition? I think if I I could get the NuSurface replacement it would replace the bone on bone condition.

    1. Barbara

      No. It will not relieve your pain because you already have arthritis, and that’s why the knee scope did not relieve your pain. I can tell you that in my experience, most patients do get some relief from the surgery. That can range from 50-100% relief, and it can last from 6 months to many years. But every once in a while a patient gets no relief and they recognize it shortly after surgery. This is why I try as much as possible to initiate a course of conservative treatment BEFORE surgery, and go over everything I have written in my blog. That way patients understand exactly what’s going on in their knee, and why the surgery is not meant to permanently eliminate pain…especially those who insist on surgery because they are “young and active” and don’t want to undergo a conservative course of treatment. Once patients begin to experience pain after the knee is scoped…and EVERYONE does eventually because it is a treatment, and NOT a cure for the problem, then I re-initiate a course of conservative treatment, including activity modifications (rest), NSAIDs (if they can take them), injections (cortisone, hyaluronic acid, PRP, stem cell, whatever), until that fails and they get old enough to have a total knee replacement (TKR). But because you likely have significant degenerative changes in your knee, and you are 62 y/o, you should now undergo conservative treatment until you are ready for TKR. The meniscus transplant will not replace the bone on bone condition. No more surgeries until TKR, please. The more surgeries you have, there is a slightly higher incidence of infection of your TKR. I’d like for you to try to make 65, or just get as old as possible, before TKR, because they eventually loosen, and then you have to have a revision, which is more complicated than the original TKR, and more likely to have complications, such as infection, stiffness or just a less than ideal outcome. Back to see your orthopod, and try some injections maybe.

  15. Lorraine

    Thank you for your extensive article concerning meniscus tears. I had surgery for a torn meniscus in October 2018. Prior to that, I had
    P T for 8 weeks hoping to avoid surgery and relieve the discomfort of the tear. I say discomfort because I was not in severe pain, only when I would twist my leg or when I walked a long distance. I am an avid walker, hiker, and practice yoga, I also work out at the gym several days a week. Six months after the P T, I decided to have the surgery. I wanted relief from this nuisance. My Orthopedic surgeon said that the M R I showed arthritis and he mentioned that there could still be pain after the surgery but, he glanced over it. I say that because I don’t recall him ever giving any warning to me of the possibility of severe pain. I was literally pain free for two weeks after the surgery. I was so excited to feel this good. P T was scheduled and I felt home free. I went to an event, I wore a slightly raised heel boot for about an hour. The next day I had a stabbing pain in the medial area of my knee when walking. It felt as though something was rubbing against a bone in my knee and it continued. I started P T right after that thinking that I would get relief. I’m on my 6th week of
    P T 3days a week with little to no relief. The pain is a stabbing, grinding, scraping pain that occurs only when I walk. I still have good range of motion, strength in doing exercises but when I walk, this pain wears me down, it is terrible. I have seen my Dr. and he gave me a cortisone injection but, there was no relief from that. The Dr. said I have arthritis but gave me no indication as to what is next. Cortisone injection, “I’ll see you in 8 weeks”. That was his response. My P T has shown more concern and put more energy into providing relief to me than my Dr. So, needless to say, I’m feeling very discouraged and quite frustrated. The confusion for me is did I do this to myself by wearing a pair of heels for one hour that were less than 2 inches high? Did I cause something to move inside my knee? Did I cause something to irritate my knee? Or……is this caused by arthritis? My P T had me try B F R – blood flow resistance therapy. His thoughts were that I would build up my quad quickly which would provide support. I did one series and ended up with a bad headache and lightheadedness so, I didn’t continue with that routine. My left quad measures an inch smaller in size than the right quad. I’m still in pain when walking. Today my P T taped my knee and I’m happy to say that I have been without pain for five hours. I also purchased a pair of sneakers that provide me good support due to the fact that I’m flatfooted and I pronate in. Now, what is next, I don’t know? Am I looking at getting a knee replacement in the not too distant future if this pain continues? I’m 73 years young, small stature, just under 5 ft. not overweight, I’m active, (or have been), walking, working out, gardening, traveling, lot’s of energy and enjoying all that life has
    to offer. This terrible pain has slowed me down so much. Your blog is so direct and honest, no sugar coating. I’m hoping that you can give me some indication as to where to go from here, KR surgery is the last thing I want to do, and, since reading this blog I realize that it is not the answer for everyone. I do want to remain active and healthy. Is a second opinion in order? It doesn’t seem that K R surgery will be the fix and yetI have the feeling that this is where the Ortho Dr. is headed.
    Thanks for any input and advice that you can give.

    1. Barbara

      So sorry you’re having so much pain. I can’t examine you and so keep that in mind when I make a general recommendation. Obviously, it’s not based on you. It’s based on all the factors you mention. At 73, I would say the next choice is total knee replacement. You already had arthritis when you had the surgery. The hope was that the meniscectomy would relieve the pain. It simply didn’t work. It has nothing to do with your high heels. It’s just the natural progression of your disease. You’ll be happy with the total knee! You’re the right age, have the right condition and are a small person. This is ideal! Don’t try any more treatments.

  16. Lauren

    A great read and very informative article. I’m currently undergoing investigations for a suspected meniscus tear in posterior horn of my medial meniscus in my left knee. 10 years ago I had a partial menisectomy in my right knee for a bucket handle tear, 10 years on I am 95% pain free apart from mild crepitus but have full ROM and minimal problems. Nowadays my Dr mentioned that partial/total menisectomies are not as common and would often go for physio as treatment instead. My concern is I am an active 25 y/o female with a very active job on my feet all day and currently unable to perform well at work due to the pain, stiffness and locking in my left knee. I’ve had symptoms for over a year now but no incident or injury that I can recall to have caused this meniscus tear. My question – is it possible for a young, active 25 y/o to have a degenerative meniscus tear? Should I push to have an arthroscopy or let physio treatment take its course? I’ve currently had a couple of months of physio and yet no alleviation of locking and pain. Thank you in advance for your advice.

    1. Barbara

      This is a complicated problem, especially at your age. Studies and experience demonstrate that we develop post-traumatic arthritis (arthritis as a long-term complication of injury) about 10 years after meniscus or ACL tears. If your history is that you tore your meniscus at the age of 15, then you are likely developing post-traumatic arthritis. In general, we try to repair the meniscus cartilages of young patients, but sometimes this is not possible, and partial or complete meniscectomies are necessary. These patients will most certainly develop arthritis at a young age. Your surgeon is correct when he says that a conservative course of treatment is indicated. This is definitely the current recommendation as it pertains to degenerative meniscus tears. However, I am reluctant to call any meniscus tear in a 25 y/o “degenerative,” even if you are developing post-traumatic arthritis. If you already have significant loss of articular cartilage, then indeed, there is little value in a second surgery, unless you have a large tear. I would give PT, and perhaps injections of hyaluronic acid, PRP or stem cells a chance. However, if you do not have much articular cartilage damage, I would consider meniscal transplantation. This is often done in younger patients with little damage to articular cartilage. Needless to say, I do not know you or your knee, so I cannot specifically guide you in your decision-making, and am simply reciting some options available to you. I’m sorry you sustained an injury at such a young age. This is common however, and often, even after our children have been injured, they return to sports, only to add insult to injury. I always try to talk my injured athletes out of continuing to participate in sports. It’s bad for the knees…

  17. Sally smith

    Thanks for the article. Very informative. I had surgery after lateral tear to meniscus on knee at 20 years old. Now at 26, woke up this morning to it feeling exactly like prior to having surgery. Before I had surgery, it used to lock up and I’d drop to the ground. Because of my age I don’t want to continue with it being an issue. However thank you for your recommendation to avoid on the knee replacement surgery. I’m going to get it checked out soon if the symptoms continue. This can happen to anyone. Surgery did not last for more than 6 years for me.

    1. Barbara

      Sally, Sorry to hear this story, but I hear it often. That is a common experience. You might have a recurrent meniscus tear, or simply the beginning of post-traumatic arthritis. Please stop squats, deep knee bends, lunges, high impact exercises, if you’re doing them. Agree with a plan to see your doc.

  18. David

    There was no mention of stem cell therapy in your excellent article? Is that an alternative? iORTHOBIOLOGIX did some work for me and it helped. I’m 63, left knee pain, inside front part of knee, a little arthritis, arthroscopic surgery to remove a lot of miniscous 20 years ago.

    1. Barbara

      As you’re probably aware, stem cell, PRP, exosomes, etc., are not FDA approved for the treatment of arthritis. No double-blind studies have been done (nor will they likely ever be done, because plenty of docs are using them with variable success…without double-blind studies)which confirm their efficacy in “re-growing cartilage.” Nonetheless, they have been studied as a treatment for arthritis, and compare well to hyaluronic acid (viscosupplementation). They might be a little better. What we do know is that they are great anti-inflammatories. At the time of the writing of that blog, I had mixed feelings about whether or not I felt they should be mentioned or even used. Very expensive. Since then, I have started using PRP and stem cell treatments, simply because of patient demand. And to be honest, they work just fine. My approach is to use PRP in the office setting, and stem cell in the OR. In patients with chondromalacia, arthritis, degenerative meniscus tears, I might use them intra-operatively, when scoping their knees. If we’re going forth with conservative treatment, I’ll use them if HA hasn’t helped, or even in addition to HA, when necessary.

  19. Helen

    `I am a 59 year young women. I had enyjoyed running with my dogs and and work as a Ultrasound Technologist. I fell 2 1/2 months ago and it’s has been horrible pain day and night cramping in my thighs and knee unstable. I have a meniscus tear and I want my life back doing patient care I need to be able to move to catch a patient if need and lift.

    1. Barbara

      Basically, I’ve said it all in that gynormous post regarding degenerative menisicus tears. You gotta look at all my recommendations, and go through each of them to see what gives you relief. You could also add platelet rich plasma and stem cell therapy to that list. They’re just options. Insurance doesn’t cover it though. If conservative treatment fails, you might need a scope. Sorry.

    2. Barbara

      Sorry for the delayed response. I don’t know how your query got lost, but it’s found now. At 59, your tear is likely to have a degenerative component to it, and so it’s not an automatic indication for surgery, like it would be if you were 20, with an otherwise normal knee. No matter what though, you need to follow the recommendation of your orthopedic surgeon. They are the only ones who have seen you and examined your knee. You will get your life back, unless you already have advanced arthritis.

  20. Caroline

    I am almost 59, female and am recovering from a total hip replacement last October. We got given squats and steps ups and after a couple of weeks both my knees became painful. The right knee became a problem in 2004. I got orthotics, they really helped. I was told it was probably a meniscus tear. I got a steroid injection and the pain went away. Last summer my left knee suddenly became painful after a walk. I now understand I have mild arthritis in both knees with degenerating meniscus in both knees too. My knees are settling down two weeks after stopping the squats and step ups exercise. I really want to keep my knees going for as long as possible. What advice do you give me to do this – i do yoga, walking and swimming. Should I go and see the knee consultant from 2004 again. I had hoped to be free from medics following my THR as my right hip deteriorated swiftly over two years. PS your article is amazing and has really helped me.

    1. Barbara

      No squats, deep knee bends, lunges, avoid stairs, no high impact exercises. Consider injections: cortisone, hyaluronic acid, PRP, stem cell, exosomes.

  21. terry

    Hi Barbara, just read your article and the comments, best article i have read to date and have looked at many, in feb 2017 i had an mri that revealed an oblique tear of posterior horn of medial meniscus, did rehab prescribed by physio and seemed to recover well, however in july 2018 i experienced similar feelings and had 2nd MRI which revealed tearing undersurface and radial free edge posterior horn medial once more, all acl, fcl, quadriceps and colaterall ligaments are intact, i have been back on rehab since and saw a consultant last week who after looking at both MRI’s said i have a degenerative horizontal medial meniscus tear, i am 51 but a very fit young 51, my query is that all strength exercises after both diagnosis have plenty of squats and lunges in them (goblet squats etc) so i am confused as to why a physio to olympic team level would recommend them when you say to avoid them completely? i have seen improvement since taking up cycling a month ago, doing 20-30k cycles and am able to run, straight line running without pain more times than not, the odd 5k but usually 1k at a time doing circuit training, its the football i want to play really and this is where i get the problems the following day, have not played in 2 months but will go back to it this week and see reaction, consultant recommended continued rehab, if not working possibly a cortisone injection and then op if required, funnily enough he said he has exact same injury and that his thighs etc were killing him from squatting the day i visited, he also said that he has since had an injection and feeling much better, i feel no clearer on what to do however, well done again on a fantastically concise article, regards, terry

    1. Barbara

      I don’t know why people (trainers, doctors, yoga instructors) recommend squats. I make a lot of money off squats. Does that tell you something. I really think that people just don’t understand. There is no benefit from doing squats that you can’t achieve with something else, like walking, jogging, cycling or swimming. No one needs that level of intensity to function throughout life. NO ONE! It’s totally optional, and there is great potential for injury, and it’s part of the reason I have a job. I should be promoting squats! I really think these professionals just don’t understand, or don’t care. They’re just oblivious. And the reason for that, is that people just disappear from their program, so they are unaware of the damage being done. I had to develop my own program, which I give to my patients, because even the physical therapists were having them do squats. There you have it. Keep doing what intuitively seems to be working for you. No squats. Injections of cortisone, hyaluronic acid, platelet rich plasma or stem cells, can all have a beneficial effect. Stay out of the OR if you can. But as you read in my post, if all else fails, at your relatively young age, I would still consider a scope, if your degenerative changes weren’t advanced. Hope this helps. I’m so glad you are getting something out of my blog. Please pass it on to your friends and family too!

  22. Conrad

    hi Barbara
    Brilliant article – very in-depth and informative.
    I’m a 52 year old male with no ACL in my right knee (old sports injury), 2 previous athroscopies and now a further, almost certainly, degenerative meniscus tear which is very painful!. My MRI shows I have the onset of arthritis.
    I played tennis 5 times a week, I can’t bear to go without it. Can I get an ACL reconstruction to increase stabiity? Or do I have to live with the degenerative tear, get a cortisone injection, do physio and reduce the tennis to gentle hitting?
    My Left knee has been brilliant since i had an ACL reconstruction in 2012 (aged 45) but my consultant is telling me that I shouldn’t have an ACL reconstruction in the right because of the poor state of the cartilage.
    thank you in advance for your thoughts Barbara.

    1. Barbara

      You’re spot on regarding your assessment of the situation. Once a person has degenerative changes, an ACL reconstruction would be contraindicated. You could end up worse off. Back off on the tennis a little. Get cortisone, hyaluronic acid or PRP injections, and hang in there with your own knee for as long as you can. Remember this…studies show that folks who get more active after total joint replacement, end up with a revision at a younger age. Total joint replacement revisions are salvage operations and more likely to be complicated. So it’s not a good idea to play a bunch of tennis after TKR. Hope this helps. Thanks for reading my blog and I’m glad you got something out of it. Please recommend it to friends and family!

  23. Conrad

    Thanks Barbara – really helpful. I have already recommended your blog to a couple of similar middle aged knee pain sufferers.

    My consultant has actually suggested an osteotomy may end up being the way to go to take pressure of the arthritic part of the knee, but he warns this is a big op, so steroid inhection first, as you rightly suggest.
    Thanks again

    1. Barbara

      Okay, you must have some significant deformity around your knee. That’s different. You must also be relatively young. We don’t do as many osteotomies now, as in the past. Patients actually do pretty well with them though. I had a patient whose knees lasted about 20 years after the osteotomies! Now he has total knee replacements, but he’s the right age for them. It IS a big operation. A little potential for complications. When I do surgeries on people, or even when I treat patients, I always ask myself…”Is this what I would do for my child, husband, parents, best friend?” So ask your doc that question.

  24. warren

    Thanks I have a understanding of my knee now. My high energy life style will be modified now.My 64 year old knee will not squat any more.Family genes kept all of my family members living to 90,s.No skiing and sandlot football.I had meniscus surgery 3 years ago .Sitting and the first 3 steps is the worse.I am too young for knee replacement.Once a year ok for cortisone shot?

    1. Barbara

      If you haven’t already read this post on my blog…check it out: https://drbarbarabergin.com/decrease-pain-from-knee-arthritis/
      Yes, cortisone is fine once a year. It’s even fine 3-4 times a year, if it keeps you out of the OR. Don’t suffer long though. You’ve reached a good age to consider TKR. So go through all the conservative measures first: cortisone, hyaluronic acid (gel shots), and whatever else you can do. Then total knee replacement when all else fails, assuming your health is good, and you’re not morbidly obese.

  25. Leigh Ann Smith

    I’ve been reading a lot of articles in preparation for an appointment with my ortho, and this was the most helpful by far. I’m 61 and had a meniscus tear 4-5 years ago. My ortho gave me a cortisone shot, PT, and Celebrex, and I did very well for 2-3 years. Then it flared back up a year or so ago. I went back in and got another shot, but this time it only helped for a few months, so I’m going to go back in. Mostly the pain is mild, but if I’m on my feet a lot one day, it will flare up and really hurt a lot. Your previous reply about 3-4 times a year being okay was helpful!
    My question is about the Celebrex. If I forget to take it one day, my knee really hurts. Not only that, but my hips hurt too, so I think we know where that is going. Anyway, everything I read says not to take it indefinitely, but I’ve been taking it for years…and it does help a lot. Should I plan to eventually go off the Celebrex? That sounds pretty awful.
    Also, I read lots of things about what kinds of exercise NOT to do with a torn meniscus, but very little about what TO do, especially in terms of cardio exercise. I’ve seen you mention cycling, so I guess that must be okay. How about an elliptical? One thing I read said not to use one if you have knee pain. Thanks!

    1. Barbara

      I can’t tell you what to do or not to do since you’re not my patient. I can speak generally, and tell you what I would do. Firstly, with regard to ANY NSAID, be it Celebrex or Advil, I don’t think it should be used every day, indefinitely. I would take breaks from it, and that’s what I tell my patients. If you have any serious cardiac history, if you’re taking blood thinners like Eliquis, if you’ve had stomach ulcers, or if you have any liver or kidney function issues, you absolutely should not take NSAIDS.

      Well, I always say, it’s easier to tell patients what no to do over what TO DO. There is actually no exercise that’s “good for” an arthritic knee, other than to maintain flexibility. Most forms of exercise cause some level of wear and tear. People always ask me if swimming or walking are “good for the knee.” No! They’re good for you in general…for your body, but they’re not necessarily good for the knee. But if you really need or want to exercise, then I prefer swimming and cycling over everything else because it’s less weight bearing or low impact. Eliptical trainer is fine in most cases. But for every 100 patients I tell that these exercises are fine, there are a dozen who claim they hurt their knee. Just gotta try it out and see for yourself.

  26. Francesca

    Hi Barbara,

    Very informative article! I’m a lifelong social tennis player. 45 years now. I just noticed that I might have a meniscus cyst on the outer portion of the right knee. Yes, just noticed. No trauma, just more of a hmmmm, that’s an odd thing on the outside knee. And then felt a cyst. Once I felt the cyst, things made sense with low grade meniscus issues. Needing pillow between knees at night etc. Now that I feel, the cyst, falling into the degenerative knee category. What can you say about meniscus cysts. I’ll go in for an official diagnosis, but want to have some information beforehand. Should we leave meniscus cysts alone if they don’t bother you so much? Should I stop playing tennis and pick up cycling to make my knees last longer. Since I now have a sign of degenerative knees? And are use of ellipticals considered high or low impact on knees?


    1. Barbara

      Glad you found my post informative. I think it’s really starting to generate interest on world wide web for some reason. That’s probably because there’s just not a lot of frank talking out there, about this subject…in this way. Happy to share a little more with you about meniscal cysts, as they are a part of having degenerative meniscus tears and arthritis. They’re not that common however. The pathology is very much like that of Baker’s cysts or popliteal cysts. You probably have one of those too, but just can’t feel it because they’re deep in the back of the knee. Popliteal cysts and other peri-meniscal cysts form because the torn meniscus leaves creates a rent in the lining of the joint, which allows fluid from the inside of the knee to filter its way through the tear and put pressure against the capsule of the knee, this eventually begins to blow out a bubble in the capsule. If there’s no other tissue around to keep the cyst from growing, it can get quite large, like the Baker’s cyst can. Sometimes they get so big, they rupture, causing a lot of pain and swelling, which is often mistaken for a blood clot. Most people end up in the ER, getting an ultrasound study to determine whether or not they actually have a blood clot.

      Occasionally, the rent in the capsule occurs along the inside or outside of the knee. As the fluid begins to press its way out, it comes up against more firm tissues, like ligaments or tendons. Those tissues don’t give way as easily as the soft tissues in the back of the knee, and the cyst, while small, will create a lot of pressure. Remember the fairy tale, The Princess and the Pea? The cyst feels hard and tender.

      There’s another source of a meniscus related mass on the side of the knee, and that’s an extruded meniscus. This condition occurs as a result of the destabilization of the meniscus and the pressure between the tibia and femur, which can cause that meniscus to squeeze out between the two bones. This can be a very painful condition, and is often resistant to treatment, other than total knee replacement. There’s no putting it back in place, and even after meniscectomy, the two damaged bone ends are touching each other, and are often devoid of articular cartilage.

      If the cyst is painful, you will end up with an MRI, likely undergo conservative treatment for that problem. Ultimately you might end up under the knife. I have a lot of patients with meniscal cysts, who I’ve managed conservatively. Some have had surgery. When we operate on meniscal cysts (popliteal and otherwise), they usually come back…

      Bottom line. If the cyst is not painful, don’t touch it. I know…sometimes they can truly be unsightly, especially if you’ve got nice legs and like to wear shorts and skirts. I would have to say that the majority of my patients over 50 don’t wear shorts and skirts much anymore, especially now that stockings are not in fashion. The person who decided we should go stockingless was truly a hater, and did a lot of damage to the skirt industry. Sorry…not medical…every once in a while I like to make a fashion statement…

      1. Francesca

        Hi Barbara,

        Thanks for the response! If non-bothersome meniscus cyst is present, do you recommend not playing tennis? I can’t tell if it will make the situation “worse”. Or ok to proceed until situation changes, if it ever becomes more painful. And I’m not a fashionista, by any means! So Im fine not touching it.

        Thanks again for the insight!

        1. Barbara

          If you don’t care that much about playing tennis, then I wouldn’t. Any kind of high impact exercise will not be good for your knee.

        2. Francesca

          Hi Dr!

          Had my MRI. It ended up being a ganglion cyst, no signs of bursitis, with ACL, PCL, and meniscus being intact. With minimal signs of chondromalacia.

          1. Barbara

            I’m not sure if you’re a patient, but if you are, we cannot communicate through my blog. Please contact my office. If you’re not a patient of mine, you’ll need to see an orthopedic surgeon, because I can’t tell you specific things about your MRI results. Sorry.

  27. Michael H

    47/M. First two days I followed “RICE” 100% with limited relief. Now, my knee is locked up so bad I can’t straighten it or walk for the third day. I went to the Mayo Clinic in AZ to see a Dr. Assistant this morning and they took an x-ray and gave me a prescription anti-inflammatory, he seemed very concerned with my injury. I am waiting to hear if my insurance will approve a MRI, and have scheduled a visit with an Orthopedic specialist, but it is two weeks away. My pain level is a 10+ if I put any weight on my knee. Does this sound like a typical case or should I try to escalate to avoid hurting the situation even more? BTW, your article was excellent (depressing, but excellent at setting expectations) I will also be sure to tell my sons – NO SQUATS. Thank you for your help, we all appreciate your time.

    1. Barbara

      A locked knee is no good. This can be due to an actual physical block, like a torn meniscus or a loose body, or it can feel like it’s locked because it’s painful and swollen.
      Where do you live that you have to wait 2 weeks for a consultation with the orthopod? If you live in San Antonio, just come on down the road and see me. If it’s England…sorry. I don’t like a locked knee. The longer it stays like that, the harder it is to get the range of motion back. If it’s a loose body or meniscus tear, that needs to get taken care of pretty quick…MRI, surgery? If it’s just frozen because it’s painful, then stretching and PT might be indicated.

  28. Sheri Mendon

    Hi Dr. Barbara,
    Thank you for your article on degenerative meniscus tears. I am a 57 year female with a large meniscus tear in my right knee and am scheduled for surgery on March 27, 2019. My knee began bothering me in October of 2018, but I was hoping it would heal on it’s own, as I had a tear in my left knee a couple years back, which is significantly better, without surgery. My orthopedic surgeon suggested to wait it out and to bike and swim. He was right!

    Not the case with my right knee, as it only got worse and exercising aggravates it more.

    When my job schedule finally allowed me to take the time needed to visit my orthopedic surgeon and get an MRI, my tear was quite large and the doctor told me that I really needed to have surgery, as at this point I am having a hard time walking without pain.

    I have a question that maybe you can answer, is there an antinflammatory that I can take that will not harm my kidneys? I haven’t been taking anything at all for the pain or the swelling, and my knee is pretty swollen, which makes the pain worse. I haven’t had a cortisone shot because I am scheduled for surgery. I am also afraid that after the surgery I am going to be in a heap of pain because of the swelling. I can take tylenol with codeine for pain, but that doesn’t help with the swelling.

    I have a fairly high pain tolerance and try to stay away from pain medication, but there are times when they are needed. I had rotator cuff surgery a few years back, with a full thickness tear, and the pain afterwards was worse than child birth! Then I had discectomy and laminectomy surgery two years ago on my lower back, that is when I found out my kidneys had problems, but that surgery and recovery was a walk in the park. I really did not need much pain medication

    But, right now, I my knee is so swollen, that I’m afraid it will be so much worse after the knee surgery. How can I get this swelling down without harming my kidneys?

    Any help would be appreciated.


    1. Barbara

      There are NO NSAIDS which do not have the potential to damage the kidneys. If you have kidney disease, such as end stage renal disease, then you may not take any NSAIDS, or you shouldn’t. But if you have normal kidney function, limited use of NSAIDS is acceptable, and certainly standard of care. Many people have an unnecessary fear of NSAIDS. When taken in limited amounts, they can be quite harmless, and are beneficial. Nevertheless, if you’ve been told not to take them, then there is a reason for this, and you must not. Other than steroids (pills or shots) there is nothing else you can take to reliably reduce inflammation. I would not trust non-traditional forms of treatment such as non-FDA approved anti-inflammatories like turmeric. If they can reduce inflammation, perhaps they might also have a similar effect on the kidneys or other organs, and they just haven’t been studied…because no one has to study them. They’re not FDA approved. While you would not want a cortisone injection in the near-operative period, perhaps your doctor would consider a short course of cortisone pills, which have a short duration of efficacy in most cases. Just talk to your doc about it. Otherwise, you’ve just got to wait.

  29. Gail

    Hi Dr. Barbara,
    Thank you for your article. I’m a 66 year old female, 8 weeks post op from double knee arthroscopy for meniscus tears. Very arthritic knees, cartilage extremely diminished. Just finished PT but my legs ache constantly. I’ve been a big walker and very active in the past. I’m unable to walk a distance now without knee pain and leg aches. I’ve looked into stem cell, PRP before the inevitable knee replacement. I really want to get back into walking like I use to. Any suggestions to alleviate my aching legs? How do you know when you need the replacement?

    1. Barbara

      At your age (being old enough to comfortably make the decision to have a total knee replacement [TKR]) you will make the decision to have the surgery once you have failed all conservative options (medications, injections, therapy, modification of activities, knee arthroscopy) and your pain is significantly affecting the quality of your life. When all that fails, your pain affects the quality of your life, and if your health is good, you are then a good candidate for TKR. Go for it, and it is a good operation for you. To be honest, a doctor does not have to tell you when the time is right. Most of my patients know when the time is right, and they request it. In the meantime, you’ve read my blog post regarding meniscus tears and my 10 tips to decrease pain of knee arthritis blog post. If you haven’t, then read them, and you’ll know what you can do to help!

  30. Judith

    Thank you for this article! After reading lots of other websites (which didn’t help much) I finally understood something about my own situation. I’m 47 and until now didn’t really understand how on earth I got this meniscus tear, but if it’s degenerative that makes some sense to me. Even if it’s not good news at least I understand now that I have to learn to live with it.
    Vielen Dank. Ich werde jetzt Ihre anderen Artikel lesen. ^^
    Your second [!?] reader from Germany

    1. Barbara

      Sorry you have a degenerative meniscus tear. I’m so glad you found my blog so you can understand it, and recognize why you shouldn’t jump to surgery.

      Also so glad to hear some folks in Germany are reading my blog. I’m learning German, and hope to travel there someday, although…it’s a difficult language to learn to speak, and I expect it will never amount to much more than a learning exercise. I’m sure I can ask directions and order ein bier! Oh my, the gender (der, die, das) problem. This is what gets so problematic when trying to learn German!

      Back to your knee…no squats and no high impact exercises. You’re European, so this probably isn’t an issue, but just in case it is…maintain a healthy body weight.

      Best to you!

  31. Judith

    Thank you for your answer!
    And for the advice, too!
    Something I was wondering about re the squats. Does this also apply to fully bending the knee when you don’t put your full body weight on it?
    In Germany, a currently popular doctor is recommending stretching the calf and thigh muscles in order to alleviate the pressure on the knee. Would you recommend that, too?
    (One of the recommended exercises is lying on your belly and trying to pull your foot towards your bottom in order to stretch the thigh muscles. Which means to fully bend the knee. Would this be a mistake, like the squats?)

    Yes, I can imagine that the grammatical genders are frustrating when learning German… I used to teach German. ^^
    If you’re learning vocabulary the old-fashioned way by writing it down by hand, you could use different colours for the different genders.
    When learning a language there’s the “intermediate plateau” that’s discouraging, i.e. as a beginner it feels as if you make fast progress, but once you’re intermediate it feels as if you’re learning and learning and learning and not getting anywhere. But you eventually do! Don’t give up! =)

    Noch mal vielen Dank für die Tipps!
    Alles Gute!

    1. Barbara

      Stretching is a good thing to do, no matter what. Of course, everything in moderation. Recently, I developed some probable arthritic pain in one of my knees, and it caused me to start walking with a slightly bent-knee gait. I recognized it pretty quickly, of course, but it really couldn’t be helped. Nevertheless, it got worse. About a week ago, I decided to fix the bent-knee gait, no matter what, and so I started stretching. Not only did the gait get better…so did the pain! So your comment regarding the stretching is very timely. This is why studies show that physical therapy helps knee arthritis as much as anything.

      My experience with German is pretty much spot on with your description. I made rapid advancements early on, and was zipping through my Duolingo and Pimsleur lessons. Then suddenly things came to a standstill. I found myself skipping days, then weeks, and finally months went by. Then I went back at it, and while my progress is slower, I AM making progress. Maybe I’ll be able to ask for a bier, and have a brief political conversation, right? haha!

      Keep on stretching! And no squatting. And yes you can bend your knee without squatting.

  32. Julie Y.

    I am 45 year old female who is very active and loves to play tennis, hike and run. In April I squatted down while playing tennis and heard a pop in my right knee and subsequently had knee pain, swelling and locking at about 10 degrees of extension. This locking continued for about two months while I decreased my activity, conservative care, PT, and took anti inflammatories. The last month I have been taping my knee and have felt better and it doesn’t lock up anymore. It is just always stiff, tight and painful posterior laterally. More activity=more swelling and discomfort. I cannot maintain my knee extension. I am always trying to work on stretching my knee to neutral. The pain in my knee really effects everything I do since even walking becomes more difficult later in the day.

    I’ve been to a couple orthopedic physicians for their opinion. I do have past history of knee surgeries. ACL reconstruction 23 years ago, and two knee menisectomies in the last year and a half. I was feeling excellent after the last knee scope and was back to tennis, jogging, etc until two months post op I squatted and heard/felt that pop. The orthopedic surgeons recommended conservative care and I just received a synvisc injection a few days ago. They say I have severe degenerative arthritic changes laterally. However on an X-ray my joint space is beautiful.

    I am praying for some relief from the nagging pain and swelling, however I have not felt much change yet. I know it can take two months to be most effective.

    Being 45, I feel my options are limited. What do you recommend? I feel like I have a tear that was blocking my motion, but somehow that locking resolved. I feel like I should get better from (surgically) taking that torn piece out. But after reading your article it sounds much more complicated.
    Any thoughts?

    1. Barbara

      Sorry for the delayed response. To be honest, if you tore your ACL 23 years ago, by now you would indeed have post traumatic arthritis. I can’t imagine where the “beautiful joint space” was reported or seen. It would be inconsistent with convention. I’ve yet to see any person more than 10 years out from an ACL injury without some evidence radiographically or on an MRI of post traumatic arthritis, and this is what is borne out in study after study. And as you have read in my treatise regarding mensicus tears after 40, the fact that you have had two scopes in the past year and a half, also confirms my suspicions. These are not your daughter’s meniscus tears. Even though you are only 45, your injury aged your knees prematurely. Your symptoms are consistent with the arthritis you are experiencing. Conservative treatment, in the form of activity modifications, physical therapy, weight loss (if indicated), injections (cortisone, hyaluronic acid, and maybe biologics if you can afford them and if your docs think they could help), is indicated, just to keep you from having a total knee replacement at a young age. But sadly, you may be one of the many young patients who end up having to have total joint replacements, once you’ve run out of options. I can’t speak specifically to YOUR knee, but your history is certainly consistent with many athletes who have torn their ACLs when they were in school. I would have to say for you to listen to your docs. Obviously, I can’t speak specifically to your knee.

  33. Andrew

    Dr. Bergin,

    Thank you so much for the lengthy article which is not only informative, but is directed at a specific audience. I am a 58 year old male, 15 pounds heavier than ideal with no medical issues and I have a “flap” meniscus tear which was “created” by a too-aggressive bike ride early in the spring (before my muscles were up to the challenge of the stress), but the MRI agrees with what you so clearly point out: meniscus tears for people my age also involve degenerative meniscus. My orthopedist recommended “aggressive but patient physical therapy”–lots of floor exercises and stretching to build up general muscle strength rather than using weights and machines–and I am seeing improved mobility, but still can’t imagine riding a bike for an hour the way that I used to. For example, my daily “heel slides” are almost equal now whereas last month there was quite a bit of difference between where I could comfortably bend my injured knee and my non-injured knee. The progression that my orthopedist gave me was: 1) physical therapy to build the muscles around the knee and hip along with NSAIDs, knee braces, ice as needed 2) cortisone if #1 doesn’t allow me to return to “reasonable” physical activity 3) arthroscopic surgery to remove the “flap” if there is no response to the cortisone. All of this leads (eventually, if I live long enough) to knee replacement.
    My questions for you: 1) How valuable are second opinions in your experience? 2) What are my “reasonable” goals–is being able to ride a bike at 15 mph for an hour 3 times per week “reasonable?” 3) How do I decide when to ask for cortisone? 4) What is your experience with physically active patients (main form of exercise bike riding, swimming, nordic track indoor ski machine) who have both a “flap” tear and degeneration of the meniscus?

    Thank you so much for this wonderful article. The focus on treatment rather than cure, the idea of “reasonable” expectations, and the clearly stated dictum “no squats!” are all here together and not anywhere else that I have seen (and I have read quite a bit).

    1. Barbara

      Glad you found my blog post informative. Just for the record…any meniscus tear after forty is a degenerative tear, no matter what the shape. It has to do with the weakening of the meniscus and the fact that the rest of the knee is not a normal knee. When we tear that meniscus when we’re 20, the rest of the knee is normal, and it’s harder to tear that meniscus. At forty-plus…our articular cartilage is older, and probably damaged. We already have the early breakdown of that beautiful articular cartilage surface, which was so wonderful when we were young. Now, the flap tear is often more symptomatic. If I scope 100 knees in people over 40, probably half of them have flap tears. I haven’t studied this, but anecdotally, they are more likely to flip flop around in the joint, pinching between the surfaces and causing mechanical symptoms. I would also anecdotally say that I’m more likely to see these types of tears in men. But again, I say “anecdotally,” because I certainly have not done a double-blind, prospective study on this. Perhaps someone should…

      At 58, if you do not get relief from a conservative course of treatment, and your X-rays do not show very advanced degenerative changes, AND you have made the adjustment of discontinuing high impact exercises and all forms of squatting, then a knee scope is likely in your future. You’re too young to walk around with a limp for the next decade, and you’re too young to have your knee replaced…in my opinion.

      I like what your orthopedist is saying. Don’t really think you need a second opinion…other than the fact that he is saying “total knee replacement.” Either that means that your plain X-rays and MRI show that the degenerative process is more advanced, in which case an knee scope would be a waste of surgery, or he prefers doing total knee replacements, which is hard to imagine, because most orthopods like doing knee scopes, even if they are total joint guys. Reading between the lines…my guess is that your arthritis changes are more advanced than you might think. It’s more advanced than just a degenerative meniscus tear. Do everything you can to avoid a total knee replacement:
      -cortisone injections
      -physical therapy
      -modification of activities
      -some weight loss (15 pounds ain’t much to write home about), but every little bit helps

      Best to you-

  34. Brent Zanger

    I was very impressed with your blog and I recently had a knee arthroscopy to repair my own torn meniscus. I am 42 and a teacher in the United States. I was diagnosed with degenerative arthritis in both knees and the torn flap was removed upon recommendation of my doctor. I have researched and tried to educate myself to look at how to “grow old” with this condition the rest of my life. I found a new study being conducted by one doctor in UCLA. The procedure he has posted on YouTube is a study that reduces inflammation associated with knee pain for degenerative arthritis. He is calling it Genicular Artery Embolization.” It appears to be promising and I have mentioned this with my doctor but he brushed this aside and really showed no interest in the topic. As an educator I am always looking at ways to improve in my own profession and I was a little shocked at my own doctor’s lack of interest. I am curious if you would watch the attached video and have any insight on this suggestive procedure. I understand it is only a study but it appears to be working and proven in Japan. He is currently the only surgeon in the United States performing this procedure. Thank you and I look forward to your response.

    1. Barbara

      Brent, sorry for delayed response. I watched this video with interest. Not sure if this technique would be effective. There are so many pain generators in the arthritic knee. I just don’t think this would adequately address them. We saw this with genicular nerve injections as well. We thought they would really be effective, and it was such a disappointment. It spoke to the fact that there were a lot of pain generators in the knee.

  35. Elizabeth

    Hi Dr. Bergin,
    I am 56. I was having pain below my knee just above my calf. My Orthopedist took xrays and I have arthritis in my knees. He also said my knee was bent and that I was compensating for it. I went to PT and they straightened my knee. I was still having pain and got an MRI. I have tears in my mensicus, ACL and a small cyst all due to the arthritis. My Dr gave me a cortisone and then when I saw him again he gave me another one. I saw him last week and said I was feeling better even the back of my leg by my calf. While the visit before he said he could do arthroscopic surgery, this time since the shot worked he was steering away from it. He has told much of what you have in your article. Last week he said he could even make my pain worse. The surgery is not a guarantee. After seeing him I went to NYC and wanted to see how long I could walk and I walked about 6 miles but that pain in the calf started up again. I couldn’t believe after telling him earlier that day that it came back. I haven’t been to the gym in months as I wanted the MRI and wanted to rest my knee/leg, but I want my life back. I get that squats are a no no and I am a yoga teacher but modifications are ok I can live with them. I am a 5-6 times a week gym person with boxing, hitting the bag and strength training as my exercise routine. I wonder if the calf pain may be the ACL aspect and am now thinking about a vegetarian diet with the goal being to get rid of anything in my diet that causes inflammation. Someone recommended the book Prevent and reverse heart disease by Dr Caldwell Esseltyn if I wanted to go vegetarian. I met someone who works at a chiropractor and she told me about a brace for the knee specifically for ACL tears. What are your thoughts about wearing a knee brace while walking for a long time? I am so grateful that google brought me to your site. Any thoughts you have are appreciated; thanks in advance.

    In gratitude,

    1. Barbara

      That’s a lot of info. Not sure I can answer everything, and since you’re not my patient, I can’t be 100% sure of exactly what is wrong with your knee.
      Pain in the back of the knee, in knees with arthritis can be due to to a Bakers cyst, which are benign cysts associated with arthritis. They don’t need to be operated on. They do t go away though. They can get better after injections. The pain can be due to your contracture too. The back of the knee wants to stay tight, even though you’ve stretched it out. The meniscus tear can cause pain too. That’s where the majority of tears occur.
      A lot of increased weight bearing exercise, like excessive walking, kick boxing, jumping, etc., will definitely aggravate your arthritis. You can’t get your old life back. Even having a total knee replacement won’t give you your old life back. Try to figure out new things to do. Walk less. Cycle. Swim.

      In my opinion there are no diets which will correct your problem. If you are overweight, losing weight by any means will definitely help your knees, but will not reverse changes. It will just slow down the process.

      I know this doesn’t “help” you, but maybe gives you better understanding of what’s going on and what you should do.

  36. Lucia O Farrell

    Hi Dr Barbara,
    I am 70 years old.For the past six months,i have a lot of sharp,stabbing pain in the right knee,which is causing me to limp badly,and to feel very debilitated.Orthopaedic surgeon has diagnosed a medial meniscus tear,and recommended arthroscopic excision of tear.Imaging shows no gross arthritic changes.I have an ulcer and a hernia,so anti-inflammatories are bad news.I would welcome your advice please.

    Many thanks

    1. Barbara

      I have occasionally seen patients in their 70s, with symptomatic meniscus tears and very little articular cartilage loss. I always try conservative treatment first, including activity modifications, cortisone injections, hyaluronic acid injections, and NSAIDS. If that doesn’t work, and they accept the potential risks and complications of surgery…including the possibility that it might not fix their pain and they could get worse, then I’ll scope their knee and remove the offending meniscus. Regardless of what the MRI shows, I ALWAYS find arthritis in their knee! But to be honest, those patients have always done well post op.

  37. Beckie

    This is such a helpful blog. I’m 34 (sadly was below your 40 rule) and 4 months ago I was diagnosed by MRI with a shredded degenerative complex meniscus tear. I used to run for an hour pretty much everyday (prob what caused it) but it feels like life as I knew it was over! I’ve been told I will never run again. I have full range of movement, no pain when I cycle in the gym/use cross trainer, but walking is painful and even after all this time I still have a limp! Stairs are the worst. I look 70 going down them! I was so active and just feel hopeless now! Some days there’s no pain, others it’s really bad. I’m trying to avoid an operation as they said they may have to remove the entire meniscus. I don’t have arthritis yet and the but there is a little bone edema. Articulate cartilage is still in tact. I’ve tried PT, acupuncture, swimming, cycling. I have some muscle wastage of my Vmo which isn’t coming back! Please help! Should I just get the operation!? Sorry for the essay but I’m literally at my wits end! For others needing advice, I have bought an ossa brace which, although expensive, has been amazing!

    1. Barbara

      I’m so sorry to hear this Beckie. As I probably said somewhere in my blog post, there are those that fall out of this typical window. Firstly, in recent years, I am seeing more and more young people with early arthritic changes in their knees. This is due to many things, not the least and most unfortunate cause of which is genetic. These are young 35-40-year-olds, who have not sustained injuries and are not overweight…the other two most common causes of arthritic changes in young people. And in general, any time you have arthritic changes on an x-ray, there is most likely the associated meniscus tear. In order for bones to look closer together on an x-ray (one of the early signs of arthritis that can be seen on an x-ray), something has to go missing, and that’s either articular cartilage or meniscus cartilage. You have a meniscus tear.

      Again, as I said in the blog, there are those who do not do well with a conservative course of treatment. They have failed with activity modifications, such as limitation of high impact exercise and discontinuation of squatting. NSAIDS don’t help. Injections of steroids, hyaluronic acid and biologics such as PRP and stem cells, haven’t been that successful. They try physical therapy.They try braces. All to no avail. In those cases, thank goodness we have knee arthroscopy. It usually helps, despite the fact that studies say they don’t. It’s a temporary help, but it does help. The knee scope cannot give you back your meniscus. It can’t restore articular cartilage. The arthritis continues to progress, as it always will. However, often after the knee scope, and removal of the offending torn cartilages, not only does the knee feel some better, it also seems that the other treatment modalities work better. I think the removal of particles, and flopping pieces of meniscus just helps. When all else fails, total knee replacement is indicated. In young people with extremely bowed knees, sometimes an operation called a tibial osteotomy helps as well. Last, but not least, at your age, with good articular cartilage intact, sometimes a meniscus transplant is effective, depending on the source of your meniscus tear. If it’s because you have injured it in the remote past, and no other part of your knee is affected, a transplant can be effective. If your arthritis is due to a generalized arthritic condition or obesity, then a meniscus transplant would likely fail.

      Now this is a touchy subject, even with my own patients. I don’t know you, and I’m not implying anything, but if you are significantly overweight, like more than say, twenty pounds, then you must lose weight. Your outcome, no matter what, will be dismal if you don’t. And you cannot lose significant weight through exercise. 95% of weight loss is through diet alone. If you increase your exercise, by doing anything other than the gentlest forms of water aerobics and stationary bike riding, you are likely to hurt your knee. It is a vicious cycle. Morbid obesity, is sadly, not only a cause of early arthritis…it will lead to rapid progression of the disease, result in failure of any treatments to work, and put you in the position of being a very poor candidate for total knee replacement, and even knee arthroscopy.

      Needless to say, these are things you must discuss with your surgeon. I have not examined you, since you’re not my patient. These are just some generalized comments you might find helpful. I’m very sorry for your condition, and wish you the best.

  38. Beckie

    Thank you so much for the quick reply! I fall into the first category, there wasn’t a sudden injury that caused it. I just woke up one morning after the gym with crunching when I put weight on my leg. And if anything I’m underweight! Obsessed with exercise!
    I did my ACL 12 years ago in the other knee and I wonder if it led to overcompensating on the right!
    I’m going to make another appointment with my surgeon in London and discuss the injections you mention. I think I’ll need the op and he did mention the meniscus transplant to me but said I shouldn’t be thinking about that until way down the line – I’m not sure why! I just hope the 40min static cycling, x trainer and swimming I do every day (one per day not all)! Isn’t doing any more damage and that the shredded meniscus won’t wear away the articulations cartilige as I walk. It’s in the posterior horn of the medial meniscus. Just wish I could find others out there with the same for advice! Thank you so much for yours. What a great blog! Much needed!!!

    1. Barbara

      So sorry to hear this. Was hoping to be able to blame it on something. Why? Because it gives me hope for human bodies. It’s so frustrating when people just have random stuff like this. I feel so useless/helpless when I see patients like you. But…you’re right about the compensation. You most definitely have post traumatic arthritis in your other knee, and over many years, you’ve likely overused this one out of necessity. Still. It’s a little much. My suspicion is that you might have had a more minor injury to this knee at some point. That gives me more hope. Not necessarily for you, because that train has left the station. It gives me hope that if I keep preaching against sports and squats, I can help prevent some of this devastation a keep seeing over and over!

      There is a window of opportunity for meniscus transplant. That window may be closing. You have to be young enough and have very little…if any…articular cartilage damage. Once there is significant cartilage damage, meniscus transplant has missed its mark…to prevent the onslaught of arthritis! I hate to suggest this, but in a country with socialized medicine, there would be little incentive for you to get a meniscus transplant. They are expensive. Could it be something you might have to pay for it yourself? Or you might have to become the squeaky wheel. They might be hoping for you to just disappear. Keep asking. Eventually, they’ll do an MRI or a scope and find articular cartilage damage, and then say, “Ah ha, see? You’re no longer a candidate for meniscus transplant. Sorry.”

      I might be totally off base here, with regard to socialized medicine, and if so, I’m sorry. But I’m not off base with regard to timing on meniscus transplant. That window of opportunity might be slowly closing. Of course, again…you’re surgeon knows you and your case. They would not like for you to get advice from across the pond! I wouldn’t if you were my patient! Haha! I’d say to tell that Yank to take a royal hike!

      Best to you.

      1. mark


        Have read your article today and most other articles on the internet surrounding knee / meniscal injuries. With a hope to diagnose what my issues are.

        I am based in the Uk.
        41 YOM – 75kg

        Going back 2 months ago now i knelt at an awkward angle and heard / felt a pop in my right knee.
        At the time it was painful, but only for a few second (10-15) before easing. This was at work, and i continued as normal. I continued to work over the next few days without any real problems as well.

        A few days later, on waking i had knee pain and found it difficult to bend. Taking 10 mins before i was confident to walk on. No real swelling or bruising.
        Stairs were an issue.
        I had medial pain, mainly over the femoral condyle and mainly when the knee was straight. On palpation.
        I also had pain if i tensed the quad.
        Pain at night asleep and always pain on waking and stiffness.

        Dr. initially sent me for x-ray without examining the knee, results are fine no sign of arthritis.
        2nd Dr a week later, arranged an orthopaedic appt.

        Whilst waiting for the orthopaedic appt, i saw 3 PT’s all saying the same thing.

        MCL tear with probability of meniscus tear. Positive Mc murrays tests.

        My physio gave me strengthening exercises due to muscle atrophy of the quad. NO SQUATS and told me to continue to exercise if pain was less than a 3/10 score.

        4 weeks after injury i had the orthopaedic appointment, who confirmed what the PT’s had said and at last arranged an MRI appointment. I will be having this today. 2 months after the injury occurred.

        I have intermittent stabbing pain, and intermittent dull aches.
        There is still pain on palpation on the medial side, especially with the leg straight.
        Still pain when tensing the quad.
        Still pain on twisting.
        Pain on crouching where it feels like my knee wants to explode and on kneeling also.

        I have a very active job, which includes all the above. Which i am currently unable to do.
        I had been running for the last 18 months and although my physio says i am able to continue if there is no pain i am wary of aggravating anything.

        My symptoms are slightly better than when i first had the injury. I don’t have a limp when i walk now, and i can manage steps.
        If i keep my leg straight for any period of time, it then hurts to bend and vice versa.

        Pretty sure you know (and probably i do) what the MRI will say,
        But i am struggling coming to terms with the fact there is no fix and the symptoms will persist.
        Although great medical services are available in the UK, the amount of time it has taken to receive an MRI appointment is normal, it is usually another 6 weeks before receiving the results. And if surgery was an option, there is at least a 6-12 month waiting list.

        So infuriating.

        1. Barbara

          Can you tell me the results of your MRI? Even if you haven’t talked to a doctor, you should be able to get the results from a private, on line portal, right? If so, tell me results, and your email address, and we’ll carry this conversation on in private. I won’t post your reply with email. You may actually be able to see my email address. Somehow…that happens. Then just email me.

  39. Julie

    I am 53 and have had 2 knee replacements on the same knee, without any known injury to said knee. In 1998 I fell out of my truck, hitting my tailbone up to my head. Immediately I began physical therapy on my back and neck. Through the years, it has gradually gotten worse, causing me to walk with a limp. No surgery has been suggested by any doctor for my back. I have searched the internet for a reason to connect my back injury to my meniscus deterioration and moreover my knee replacement. In your professional opinion, is it possible for my back issues to have caused my meniscus deterioration? Thank you.

    1. Barbara

      I can say with certainty that your tailbone and meniscus problems have nothing to do with each other, unless you happened to injure your knee when you injured your back, and just didn’t know it.

  40. Doug

    I am a 68-year-old man. I was playing volleyball on November 26, 2019, and had sudden sharp pain when I went for the ball. I saw a doctor and physiotherapist and thought I had torn my MCL. I thought it was pretty well better, but I was dancing December 31 and again had a sudden sharp pain and this time could not walk for days. An MRI showed that I have a large bucket handle tear of the medial meniscus. The ligaments show as okay on the MRI, but the surgeon thinks that the ACL may be torn since there is a laxity in the ACL that the good leg does not have. I am wondering if my meniscus tear is degenerative or acute; back in my younger days I think I would have been fine….

    The rest of the MRI report was as follows: “There is a 4 mm full-thickness cartilage fissure involving the medial patellar facet and there is subjacent marrow edema. There is a 2 mm full-thickness cartilage defect involving the lateral femoral condyle with trace subchondral marrow edema. There is a moderate-sized joint effusion. There is a 1.5 x 0.4 x 5.3 cm Baker’s cyst.”

    Currently, I can’t fully extend the injured leg. I am often walking with a limp and can’t walk far; previously I could go on long hikes and full-day backcountry cross-country skiing.

    My surgeon in Canada is recommending the removal of the torn parts of the meniscus. I have read about Dr. Kevin Stone’s development of the Collagen Meniscus Implant. Your readers may visit https://www.stryker.com/us/en/sports-medicine/products/cmi-collagen-meniscus-implant.html. It is not approved in Canada but is approved in the US and Europe. I understand that it provides a scaffold for the meniscus to regrow and although the result is not identical to the original meniscus, it provides some padding. I am hoping it would slow down the development of arthritis. What are your views on this product? I am considering either getting the implant now if recommended or seeing how my knee does after the partial meniscectomy and possibly getting the implant later.

    1. Barbara

      Can’t see your MRI of course, but your meniscus tear if degenerative, simply based on your age and the fact that you have a Baker’s cyst. Would not consider a meniscal transplant, and FYI…I’m 65, so I’m not just pooh poohing it because “you’re old,” but…you’re old! You’ve already got arthritis. Meniscus transplants are for younger patients with normal articular cartilage. If you have failed conservative treatment, like rest, NSAIDS, PT, and injections, and still have pain, catching, popping, locking, then consider scope and meniscectomy. Not likely repairable. And if it is repairable, it’s likely to re-tear. I could go on. If you go downhill from this point on, whether you have surgery or not, you will ultimately be a candidate for total knee replacement. I know you don’t want that right now, you will if you get tired of the pain. But now that you’re in your 60s, you’re a good candidate for that surgery!

  41. Doug Fairbanks

    Thanks, Dr. Bergin for your quick reply! I hadn’t expected a reply so quickly and was just checking back to see if my question was posted.

    I was thinking of the Collagen Meniscus Implant, rather than a transplant. Do you use the Collagen Meniscus Implant in your practice? I noticed from the MRI report than I had arthritis in the other two compartments of the knee, but not in the medial compartment. Were you thinking that there would be arthritis in the medial compartment as well, based on my age?

    1. Barbara

      No…on all fronts. No, I don’t do them…and very few of my partners do either. It’s a rare patient who is a good candidate for this, and they’re usually young patients with otherwise pristine knees. Sure you can have the surgery, and pay dearly for it, and when you’re still having pain a year later, it’s “Oh well, guess you just had too much arthritis. Time for total knee replacement.” If it was my knee, I wouldn’t even consider it.

  42. Jason

    I am going to prove you wrong, im the man who will eat lots of anti inflamatory foods, brocoli, buckwheat, brown rice, pineapple, plums, kiwi, nuts, mango, fish, strawberrys, blueberrys, ginger, garlic, coconut oil.

    Im the man who will take devils claw, tumeric, bromelain, glucosamine, omega 3

    Im the man who will strengthen his quads, glutes, hip stabalizors and work on his balance.

    Im the man who will still be running marathons at the age of 70, 38 years after being diagnosed with this degenerative disease.

    I found your post to be very much defeatist, time will of course tell with me, but I wont give up my lifestyle without a fight.

    Its clear from how you wrote this article that you are not and never have been a very active person yourself and clearly are not into your sports.

    Do all of what ive suggested above, avoid excessive sugar, avoid alcohol, stay active..keep moving…there is hope, you can still do sports, you can squat, you can lunge, jump, run, hop…

    Fight fire with fire and believe….

    I know I do.

    1. Barbara

      Haha!I love the vitriol. And I do hope the positive attitude and all the veggies work for you. Really I do. Let’s see. I am the 65 year old woman who just finished the last two years winning 6 first place year end awards in a very difficult horse back riding sport called reining…in age, earnings, and horse earnings categories, meaning that I compete against all comers, at all ages, including men and women. I still practice orthopedic surgery full time, and am a singer songwriter, so you’ll often find me running around town, toting my guitar and equipment with me, and singing in bars at all hours of the day and night. I birthed a couple of kids, have been active most of my life, except when I’ve had to recover from ACL reconstructions, fractures I’ve sustained as a result of horseback riding accidents, C-sections and what have you. Never make assumptions. Most of the time, you can’t fight fire with fire. I know what makes my house payments. If I wanted to make more money, I’d recommend more squats, veggies devil’s claw.

  43. Angela Wilson

    Hi all, I’m a 44 yr old ex long-distance runner, mother of five and pre-school teacher. I have M.E and Fibromyalgia. My right knee started hurting about 3 months ago, unexpectedly. The last 3 weeks have been unbearable. I’m taking anti-inflammatory meds which has reduced the pain a little. Now waiting to see a surgeon. I’m so worried about this. I really don’t want to have time off work but I really can’t work right now. Thank you for the blog. I understand so much more.

  44. Greg

    Wow, that was the best article I have seen on this subject, and I have read a lot.
    Im a 58 year old male not overweight and very active, (hiking, hunting, canoe trips tennis, cross country skiing, dog walking, etc. Outdoor recreation is my life. I hurt my knee while on on a canoe trip in August 2109, twisting while carrying a heavy load. I did conservative treatment and it improved dramatically during the fall of 2019. Even so much as to complete a hike to the Bottom of the Grand Canyon in October. I reinjured the knee in December 2019, by stepping in a hole while hunting and I was also playing quite of bit of tennis at the time. Needless to say I am not playing tennis anymore. My standing x ray shows normal joint space, but unfortunately my MRI shows severe chrondomylacia on the medial component and mild to moderate on the lateral. Also mild under my kneecap. Torn lateral meniscus body, and root tear on the medial. Did conservative treatment with PT and it helped a little bit. Had a cortisone injection and it did reduce the swelling and increased my mobility. I can ride a recumbent bike with low resistance without any trouble, and walk a reasonable distance on flat ground, but I have a limp. I have no pain when resting or at night. My problem is that I have a intermittent catch in my knee that can be extremely painful at times, it starts under my kneecap, and radiates to the lateral side. It feels as is something is floating around in there. I can shake it out, but it sometimes is enough that I think I might fall. Orthopedic surgeon said in my case partial meniscectomy may or may not help, as he can’t predict a consistent result. I feel I am too young for TKR and my symptoms do not warrant it yet, but I would certainly like to get back to my active lifestyle. Any comments as to whether or not you think Arthroscopic surgery would help, or at least buy me some time. Thank you very much

    1. Barbara

      Greg, you ARE in that grey (no pun intended) zone of folks who are too young to happily recommend TKR, whose X-rays look a little too good for the same reason, but who truly fail a conservative course of treatment. And to me it sounds like you’ve really made an effort. You’re still having mechanical symptoms and pain. It’s not good to limp. I would consider knee scope if it were my knee. Sure, it might not help, but in my experience, in these circumstances, I think it will. You’ve really got very little to lose. Low potential for complications, although there is always that. I think the problem is that root tear. It really lets that meniscus flop around too much. Some of my patients with your circumstances get many years, even 10, of relief. Men seem to do better. I don’t know why that is. Women are more likely to get stress reactions in the bone, probably due to osteopenia. I’ve seen guys get over a decade of relief after this surgery. Even a few years is better than having a TKR too young. Word of advice: once you have the surgery, DO NOT go hog wild with the exercise. That seems to be something else which might affect women to the negative. They seem really drawn back into aggressive exercise programs. It’s our culture of weight loss through exercise instead of diet. I can’t explain it. I just know what I see. Take it easy and remember, after TKR, you cannot go cray cray on exercise either, so accept a lighter program now! Light hiking, walking, swimming, cycling…good. Jumping up and down, swinging 25 lb kettle bell…bad.

  45. Colin Pettorsson

    I’m 74, about 7 months in to a medial meniscus tear, which appeared to occur hyper extending the knee golfing. I always walk when golfing and would like to continue doing this into my 90’s, if alive! Have underlying knee arthritis, but acc. to doc knees look very good on xray. Next up, considering prp shot. Would like to continue golf walking. Your article seems to suggest I give up on that idea? Given interest in staying active to include golf when do you think I should seriously consider replacement?

    1. Barbara

      Without having examined your knee or seen your MRI results, it’s hard to give specific recommendations. Your meniscus tear is without a doubt, a degenerative tear. Even though your xrays “look good,” I’m sure you have some wear and tear if your articular cartilage. I guess I look at it a little differently, especially since there is about a 20-25% rate of dissatisfaction with total knee replacement. I would modify activities as much as possible, in order to stay out of the operating room. Not sure about PRP. Have you tried cortisone and hyaluronic acid injections already? They are pretty effective. If you love to golf, continue to golf, but take a cart for some or all of it, depending on the difficulty of the course, namely hills and irregular terrain. If that, plus a few shots, keeps you out of a big operation, then why not. Go walk on a flat surface. You might not be able to walk that hilly course after a total joint replacement!

  46. Laurie A Scarpulla

    Hello Barbara….thank you so much for this article. I just heard from my doctor yesterday with the MRI results. Degenerative Meniscus, Arthritis and Cyst. Had a cortisone shot March 9th along with fluid extraction. Thought the knee was getting better but I am in rough shape. Swelling, fluid, sharp pains, dull pain, weight bearing issues. I am not a whimp. A very active 60 year old mom and mima. I work full time, love to walk and do yard work and I must say, this is debilitating at most times.

    I will be fitted for a brace. Surgery not recommended. On prescription anti-inflammatory and Tylenol. She did not recommend physical therapy yet. My question is this…

    Does having fluid and the cyst cause more pain than the meniscus and arthritis?
    Can the cyst be removed or drained?
    Why does my pain lessen in a bent position rather than completely straight? Especially when squats can cause additional issues in these cases.

    Your thoughts?

    Thanks so much….Laurie Scarpulla
    Rochester, NY

    1. Barbara

      Sounds like your doc is on right track. It would be really hard for me to comment on your specifics. I am doing telemedicine visits and would be happy to give you a second opinion. A lot of my readers have very specific questions regarding their conditions, and it’s hard, as a professional, to ignore their complaints and not dig in, but it’s becoming overwhelming for me, and I just have to back off. I’ve given a lot of information on that blog about meniscus tears. In general, we don’t remove cysts. They can be aspirated but usually come back.

  47. Karyn

    Hello Barbara! I am an active (but overweight) woman who is 49 years young. I have a very active job which requires me to be on my feet for up to 12 hours a day, bending, pushing and pulling, and lifting. You guessed it, I’m a nurse! About a month ago, I went jogging and heard a pop in my knee and had to limp home. X-ray and physical exam revealed what they thought was a lateral meniscal tear Conservative treatment was put in place – rest, ice, hinged knee brace (which I did not like as I felt it cut off circulation), and a prescribed course of PT which included mini squats, straight leg raises on all planes, and stretching. I also received a cortisone shot. Four weeks later, my knee feels 75% better and I can work a 12 hour shift. My issue is that I now have medial pain as well and my gait just does not seem right. Do you have any advice for me? What exercises/rehabilitation/modifications would you suggest? Any help would be appreciated.

    1. Barbara

      Seventy-five percent could, unfortunately, become a norm for you, depending on the amount of arthritis you have in your knee. However, more time may be needed. Sometimes it takes months for things to calm down. The majority of patients with degenerative tears of their meniscal cartilages, reach a relatively pain-free existence. Continue to modify activities such as squats, deep knee bends and lunges, as well as high impact activities, like running. Attempt to lose weight…ugh…sorry for that one. I struggle with it too. But the bottom line is that it will help. Again, depending on the X-rays, maybe even an MRI, you might benefit from hyaluronic acid injections and even occasional cortisone injections. Physical therapy can help. Read my post called 10 tips to decrease pain of knee arthritis. I’ve added a couple of tips, so it’s actually 12 tips. These things can really help.

  48. Steve

    This was a wonderful article–thank you so much for your insight, candor and clarity. Considering seven years of high-level football when I was younger, many years of snow skiing, climbing over fifty of the highest peaks in the country, traveling millions of miles across six continents, and doing seven major home rehab jobs for family members, these sixty-three year old knees have held up reasonably well. I had one knee scoped in my early forties, then the other knee about ten years later. Both were successful and I continued to ski and climb many more mountains–one just 5 weeks after the second surgery. But the last major home rehab job, as my mom’s executor, involved about 1,000 hours of hard labor and thousands of pounds of hauling materials. Both knees took a beating, and I developed a nasty Baker’s cyst behind my left knee that burst and created a lump and intense pain in my lower leg. That finally dissipated, and both knees gradually recovered. Then that same left knee flared up again several weeks ago. Had it drained and got a cortizone shot, but it is still variably painful–even with naproxen. The X-ray (no MRI taken) showed narrowing of gaps in both knees and early development of arthritis. I really don’t want to get a knee replacement at my age, and am willing to give up the more rigorous activities. Have added Smarter Curcumin for inflammation and Glucosamine/Chondroitin MSM for joint health, but looks like I am going to need more help than that. Am also looking at Supartz injections, and possibly stem cell therapy. Am otherwise in excellent health and BMI. Any additional insights would be very much appreciated.

    1. Barbara

      You are fast approaching an age at which you could reasonably accept total knee replacement, should all attempts at conservative treatment fail. You will have a good result. That being said, putting it off as long as possible is always the best thing to do. You can use NSAIDs like over-the-counter Aleve, or prescription doses, like meloxicam. You shouldn’t take them at full doses, every single day, but using them as needed is fine, if you are otherwise healthy. I have many patients who believe natural anti-inflammatories are healthier, but I can tell you that they too have side effects, so be sure to read about them. Injections such as cortisone, hyaluronic acid (Supartz) and biologics (PRP, Stem cells, etc.) can certainly help. I would definitely try cortisone and hyaluronic acid injections. Biologics are expensive, and insurance doesn’t cover them. And then modify activities which aggravate your knee (squats and high impact exercises). When you have done all this, and none of it helps anymore, it’s time for surgery. You might be a candidate for arthroscopy, depending on the condition of your knee. You will be glad you made every attempt to keep yourself out of the OR, and then you will be ready for that surgery. Best-

  49. Peter

    Informative article. I’m a 44/yo male with what I presume are degenerative meniscus tears that showed up in both knees around the same time. Xrays showed healthy joint line. I won’t get into my past lifestyle, but let’s just say that I’m not surprised to be in this predicament.
    Just wanted to ask a few questions since I’m coming across so many conflicting opinions.

    -is it better for your knees in the long run to avoid arthroscopic surgery?

    -How long should I stick to conservative treatment before resorting to surgery?

    -If squatting is out of the question, what do you suggest for strengthening the quads?


    1. Barbara

      There are no concrete answers to your questions. Everything depends on your response to treatment, and your and your physicians assessment of your condition.
      -is it better for your knees in the long run to avoid arthroscopic surgery?
      Not necessarily. While it is always better to avoid elective surgery when possible, if your symptoms are severe enough, your arthritic changes are limited, and you fail to improve with conservative treatment, then surgery is an option.
      -How long should I stick to conservative treatment before resorting to surgery? As long as it takes for you and your surgeon to determine whether or not you are improving and if surgery can be expected to yield a better result.

      -If squatting is out of the question, what do you suggest for strengthening the quads? Straight leg raises, knee extensions, walking, swimming, riding a bike.

      Thanks for reading my blog! I hope this helps.

  50. Nancy

    What a fabulous article! Thank you so much. I am a 67 yo woman. I’ve just had X-rays and MRI which show a 4 mm meniscus tear “with inferiorly directed flap fragment”. “Mild lateral compartment osteoarthritis” and popliteal cyst. I do not have any knee pain and walk daily (no incline) on a treadmill. However, 4 times in the past 12 months I have had sudden, excruciating pain on the outside of my knee. I am able to manually flex my knee (with pain), but cannot put any weight on it. (I was once stuck for 5 hours, unable to move.) Advil and ice seem to completely resolve the problem in an hour. I now have a better understanding of the meniscus tear, thanks to your article. It seems to me that my problem is more from the meniscus flap than the arthritis. I am hesitant to do either arthroscopic surgery or knee replacement (both of which were offered by my doctor). Any suggestions? I’m just concerned that this will happen more frequently and in a place where I am unable to get assistance. Thanks for your thoughts.

    1. Barbara

      Your right. You probably are experiencing what we would call “mechanical symptoms,” meaning symptoms related to a shifting of the knee, or something catching inside, as opposed to the more chronic pain associated with the arthritic changes in your knee. It might be your floppy meniscus. It could also be a flap of articular cartilage, catching somewhere along your lateral joint line. Last but not least, you might have a little loose body in there, which works its way into a tight spot, resulting in pain and locking. Mechanical symptoms can often drive the patient and doctor into surgery, because they are intolerable, unpredictable, and often cannot be eliminated by any other means. To choose total knee replacement or knee arthroscopy is a complicated question. I just did surgery on a patient with your exact symptoms last week. She had a large mensical fragment, which was twisting around in her knee. Her degenerative changes were not bad enough to warrant total knee replacement. She failed a course of conservative treatment…for over a year! I also had her do what I will recommend for you, and what most often works for my patients. Be mindful. Pay attention to when this occurs. Look for patterns. If you can identify them, try to avoid them. Square up your movements. Get in and out of chairs straight ahead, before changing directions. In other words, try to avoid twisting or rotating on that knee. Avoid squatting at all costs, as this often squirts that meniscus out of place, and tears it further. Try wearing a knee sleeve if it occurs mostly when walking. If these things don’t work, then you have choices. Understand that if you choose arthroscopy, there is always a chance that pain could persist, leading you to total knee replacement in a short period of time. But frankly, when I’ve made decisions to operate on these, and do knee arthroscopy, I would say that 95% of the time, the pain/mechanical symptoms are relieved for an extended time, allowing me to use injections of cortisone or hyaluronic acid to help with arthritic pain, and giving the patient more time with their own knee. Hope this helps. I’m doing telemedicine visits. You’re always welcome to set one up through my office, if you want a second opinion! 512-439-1001

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