By Oxford Orthopaedics
By Oxford Orthopaedics
Movement usually feels certain. You can sprint forward, cut to change direction, pivot during movement, or plant the foot to stop, and the knee absorbs the force without hesitation. The same expectation applies to daily tasks because getting up from a chair or going down stairs shouldn’t require conscious control. Be it high or low load demand, the knee is expected to complete movement cleanly without interruptions. This assumption holds until a simple step produces a brief hesitation, as if the knee pauses before completing the motion even though there is no pain or weakness.
When this same pause starts to repeat itself, with one step feeling smooth and the next producing a small catch, it becomes difficult to ignore. As the knee bends further, the joint might need a moment before straightening, and this extra moment signals that more pressure is being placed inside the joint. This pressure brings greater demand on the parts that manage contact and rotation. The meniscus is one of them, helping the knee handle pressure when it bends or turns. When the meniscus is irritated, that control can feel different, and if a tear is present, it can cause the torn tissue to interfere with normal movement, so the knee might not move the way it usually does. Because different parts of the meniscus handle pressure in different ways, a tear in one area can behave differently from a tear in another.
A meniscus tear can split the cartilage in different directions, and the shape of that split determines how much surface remains available to help the knee handle load. These are the common tear patterns seen in practice:
A vertical tear runs along the curve of the meniscus, almost like opening a straight line that follows its shape. It’s commonly linked to twisting or quick directional changes. The split breaks the smooth arc of the meniscus, so the cartilage no longer presents one continuous surface to help the knee absorb load.
A bucket handle tear is a larger vertical split in which a long section of the meniscus folds inward. The shape resembles the handle of a bucket, because the torn strip stays attached at both ends while the middle section lifts up. The folded segment occupies space that’s normally open for movement, and that displaced strip sits between surfaces that usually move past one another.
A radial tear starts at the inner border of the meniscus and runs outward to the thicker rim, similar to how a spoke travels from the centre of a wheel to the tyre. This slices through fibres that normally share pressure around the ring, so the meniscus cannot work as one circular surface.
A horizontal tear separates the meniscus into an upper and lower section, running flat across the cartilage like a slice through its middle. The two layers now move separately instead of functioning as a single surface.
An oblique tear forms at an angle and produces a curved, hook-shaped segment of the meniscus, which is why it’s known as a parrot-beak tear. The pointed edge can extend into the area where joint surfaces move, which interferes with smooth motion.
A flap tear leaves a loose piece of the meniscus attached at one edge, which can move when the knee bends. It shouldn’t be confused with a loose body. A loose body is a fully detached fragment of cartilage or bone that moves freely inside the joint. A flap tear can progress into a loose body if the separated segment detaches completely.
A complex tear combines more than one tear pattern in the same region, often mixing vertical, horizontal, or radial splits. Instead of one direction of separation, the edges branch in several directions and create an uneven outline. The cartilage surface no longer presents one continuous contour for joint contact.
A degenerative tear develops gradually as the meniscus weakens with age or repeated use. The fibres fray rather than separating in one dominant line, and several small splits appear across the surface. The tissue loses uniform thickness and structural integrity rather than failing in one direction.
Tear shape alone can’t explain how the knee handles force because each region of the meniscus is loaded at a different stage of movement. As the knee bends, straightens, or turns, pressure shifts from the front to the back and from the inner to the outer side. A tear in one of these regions therefore represents a different mechanical change from a tear in another. Common locations include:
Meniscus related symptoms are usually noticed when the knee is moving rather than as pain that lingers at rest. Early on, everyday actions such as walking, standing up from a chair, or going down stairs remain manageable, even if certain movements cause discomfort. Because these activities can still be performed, the issue is often brushed aside. Over time, repeated bending, turning, or weight bearing makes the knee’s movement feel noticeably different. Common symptoms include:
Localised discomfort along the inner or outer joint line of the knee
Pain that appears during bending, squatting, or straightening movements
Swelling or stiffness that develops after activity or later in the day
Clicking or popping felt during knee movement
A brief catch or resistance when bending or turning
Difficulty fully straightening or bending the knee
Episodes where the knee locks and temporarily gets stuck
Meniscus tears develop when the knee must manage forces it cannot fully absorb or control. This most often happens when the knee is bent and rotating while carrying load, as pressure concentrates through the cartilage during movement. In some cases, that stress occurs suddenly in a single motion, while in others it builds gradually as similar demands repeat over time without enough recovery. Common contributors include:
Sudden twisting or pivoting with the foot planted
Contact or impact that forces the knee to rotate while bent
Repetitive squatting, kneeling, lifting, or prolonged standing
Ordinary movements performed under uneven or unexpected load
joint control after previous knee injuries, including anterior cruciate ligament (ACL) injury
Muscle weakness or imbalance that limits control around the knee
Increased joint load associated with excess body weight or high demand activity
Age related changes that reduce meniscal strength and elasticity
A clear diagnosis often involves a review by a specialist who can identify whether the meniscus is involved and how the tear is affecting knee movement. The assessment typically begins with a clinical examination, followed by imaging when more details are needed.
In Singapore, the following methods are commonly used to evaluate meniscus injuries:
Treatment is guided by how the meniscus tear behaves during movement, the extent to which it interferes with daily activity or sport, and whether the tissue can still support stable knee motion. The following are the treatment options commonly available in Singapore, with care typically planned by a specialist to restore controlled movement while preserving as much healthy meniscus tissue as possible.
For meniscus tears that remain stable during daily activity or sport, non-surgical care is often the starting point. These approaches focus on reducing stress through the knee, improving movement control, and supporting the joint while symptoms are monitored over time.
When non-surgical measures are no longer sufficient, or when imaging shows a tear that disrupts normal knee mechanics, surgical treatment is recommended. The aim is to preserve as much functional meniscus tissue as possible while restoring its role in load distribution and joint stability. However, the choice of approach depends on the tear pattern, its location, and how the knee behaves under load.
In selected situations, additional procedures are incorporated alongside repair to support tissue quality and long-term durability, based on specialist assessment.
Meniscus injuries don’t always present themselves as constant pain. Instead, they often manifest through changes in how the knee behaves during movement, particularly when bending, turning, or moving under load. Because these changes can come and go early on, it’s common for them to be dismissed or managed subconsciously rather than addressed directly.
As this pattern persists, the cost of waiting becomes clearer. When catching, restriction, or a sense of knee buckling occur repeatedly, it shows that the meniscus is no longer managing load smoothly during movement. With time, everyday activity begins to shift stress onto surrounding cartilage and supporting structures. As this stress accumulates, the range of effective treatment options narrows, and the risk of secondary joint damage increases. For this reason, treatment should be considered when any of the following begin to appear or persist:
For this reason, treatment should be considered when any of the following begin to appear or persist:
At this stage, review by a specialist helps determine whether the meniscus can be managed with targeted conservative care or whether timely surgical intervention is needed to preserve joint mechanics and protect surrounding cartilage.
Once tear pattern and location are identified, the next consideration is how the knee handles movement while bearing load. In some knees, the meniscus continues to manage bending, turning, and weight bearing without disrupting joint mechanics. In others, that response begins to change, and load is no longer absorbed as effectively through the meniscus. As this happens, movement might still feel manageable, yet more strain is gradually transferred to the cartilage that lines the knee joint surfaces. Because these changes aren’t always apparent from symptoms alone, further assessment is required to understand how the meniscus is coping.
At Oxford Cartilage & Sports Centre, this assessment begins by observing how the knee moves and bears load during everyday activity. This initial examination will provide context for any imaging that is being reviewed, helping clarify how the meniscus is contributing within the joint. Dr Francis Wong then brings these findings together, explaining what they mean for day-to-day movement and longer-term knee health. Based on these findings, the next step is to determine the best options for the knee, including continued monitoring with clear guidance, targeted non-surgical treatment, or surgery aimed at preserving meniscus function and maintaining stable knee mechanics. To speak to our specialist, please contact the clinic to arrange for a consultation.
Meniscus tears tend to develop when the knee is bent while bearing load, particularly during movements that involve turning or twisting. In everyday settings, this includes actions such as squatting, kneeling, lifting, or changing direction while carrying weight. As these movements are repeated over time, the meniscus becomes less tolerant of the same load, which explains why similar actions can start to cause knee problems even without a single injury. The same mechanics also apply during higher intensity activity, where movements occur more quickly and under greater load, as seen in sports such as football, basketball, and rugby.
Meniscus tears are often recognised through changes in how the knee moves rather than constant pain. Initially, stiffness or swelling can appear after activity or later in the day. As this pattern continues, movement often feels less smooth or complete. With ongoing use, some people notice catching, resistance, or difficulty fully bending or straightening the knee. Because these changes overlap with other knee conditions, relying on symptoms alone is rarely enough, which is why assessment by a specialist is needed to determine whether the meniscus is involved and how the tear is behaving.
Many are able to walk, particularly when the tear remains relatively stable, because straight-line walking is less taxing on the knee. On level ground, the knee moves through a predictable range without deep flexion or rotation, which places less strain on the meniscus. As movement shifts towards deeper bending, directional control, sustained loading, or rotation, symptoms become more noticeable, such as the climbing or descending of stairs, walking on uneven ground, or with repeated bending. This is why the ability to walk on flat ground doesn’t reliably reflect how well the knee is coping overall.
When the meniscus is torn and its ability to function is compromised, load is no longer distributed evenly through the knee. Instead, the task of withstanding load shifts from the meniscus to the cartilage lining the knee joint and to stabilising structures such as the ACL and other supporting ligaments. Over time, this places added strain on tissues that aren’t designed to handle load in the same way. As knee mechanics continue to change, that strain builds even when symptoms feel manageable. This is why a meniscus tear can have wider implications for knee health if it’s left unaddressed.
Over time, a meniscus tear can increase the risk of arthritis developing in the knee. The type in question is osteoarthritis, which refers to the gradual wear of the joint’s cartilage lining rather than an inflammatory form caused by the immune system (i.e. rheumatoid arthritis). Under normal conditions, the meniscus helps spread load across the knee during everyday movement. When a tear disrupts that role, the joint’s cartilage lining is required to tolerate a greater share of force with each step. As this imbalance persists, wear tends to progress more quickly, which explains why certain meniscus tears are linked to earlier joint degeneration.
Some meniscus tears can settle without surgery, particularly when the tear is small, mechanically stable, and located in the outer portion of the meniscus where some blood supply is present, often referred to as the red zone. In these cases, symptoms tend to ease as swelling settles and knee control improves with physiotherapy, usually over six to eight weeks. Recovery is less predictable when a tear lies in the inner portion of the meniscus, known as the white zone, where there is little to no blood supply. Because tissue in this area lacks the biological support needed for repair, symptoms are more likely to persist or fluctuate despite rehabilitation, which explains why surgical treatment is sometimes required to address the damaged portion of the meniscus.
Surgery is considered when a meniscus tear continues to interfere with how the knee handles load despite appropriate rehabilitation. This is typically the case when symptoms such as catching, locking, or a sense of mechanical blockage persist rather than improve, particularly when the tear is unstable or occurs in parts of the meniscus that don’t respond well to healing. Decisions are then guided by how the tear behaves over time and the demands placed on the joint. When surgery is recommended, the aim is to repair the meniscus when suitable, or remove only the unstable portion of the tear while preserving healthy meniscal tissue, to support long-term knee function.
By Oxford Orthopaedics