Meniscal Injuries (Meniscus Tears) and Meniscus Surgery in Bristol

Meniscal injuries are one of the most common reasons people come to see me. The meniscus is a tough, rubbery "shock absorber" inside the knee – each knee has two, one on the inner side (medial) and one on the outer side (lateral). A tear can cause pain, swelling, catching, and sometimes true locking of the knee. But not all tears are the same, and how I manage a meniscal injury depends entirely on the tear pattern, the tissue quality, and the condition of the rest of the knee.

I completed my PhD (DPhil) on meniscal injuries and I am the lead author on the current UK national guidelines for the management of meniscal tears. This is an area where I have both clinical and research expertise, and I treat the full range – from physiotherapy-led rehabilitation through to meniscal repair, root repair, partial meniscectomy, and meniscal transplant.

What does the meniscus do?

The meniscus helps the knee by:

Spreading load across the joint to reduce peak pressure on cartilage
Acting as a shock absorber during walking, running, and jumping
Contributing to stability, especially with twisting movements
Helping joint lubrication and smooth movement

Because the meniscus protects cartilage, preserving it when possible is almost always the priority.

Types of meniscal injury

Meniscal tears

A meniscal tear is a split or flap in the meniscus tissue. Tears vary in pattern and location, and these factors strongly influence whether a tear can be repaired or whether trimming (partial meniscectomy) is more appropriate.

Bucket handle tear

A bucket handle tear is a specific pattern where a long strip of the meniscus flips into the centre of the knee. This can cause a locked knee – you literally cannot fully straighten it – and it often needs urgent assessment. Many bucket handle tears can be repaired when the tissue quality and blood supply are suitable, and I prioritise seeing these patients quickly.

Meniscal root tear

A meniscal root tear is a tear at the point where the meniscus attaches to bone. Root tears can be devastating for the knee: the meniscus loses its ability to transmit load properly, which can lead to increased stress on cartilage and, in some cases, rapid joint deterioration. Root tears sometimes occur after a twist, a squat, or a seemingly minor injury – especially in middle age – and can also occur alongside ligament injuries.

Common causes of meniscus tears

Trauma – twisting injuries in sport, sudden direction changes
Degenerative change – age-related wear making the meniscus more prone to tearing
Associated ligament injury – for example ACL injury, which commonly occurs alongside a meniscus tear
Deep squat or kneeling load – sometimes linked with root tears

Symptoms of a meniscal injury

Symptoms vary with tear type and knee condition. Common features include:

Joint line pain (inner or outer side)
Swelling after activity, sometimes delayed by several hours
Catching, clicking, or a "stuck" sensation
Giving way (sometimes due to pain, swelling, or mechanical interference)
Reduced ability to squat, twist, or pivot comfortably

Symptoms that suggest a bucket handle tear

A locked or blocked knee – you cannot fully straighten it
Sudden loss of extension after a twist or sporting movement
Recurrent catching with a strong mechanical block

Symptoms that may suggest a root tear

Sharp pain at the back and inner (or back and outer) side of the knee after a squat or twist
Recurrent swelling with weight-bearing
A feeling the knee has suddenly "aged" – it becomes much less tolerant of walking or standing

Assessment and diagnosis

Effective meniscus treatment depends on understanding the tear pattern, tissue quality, and the overall knee environment – cartilage condition, alignment, and ligament stability all matter.

When I assess a meniscal injury, I take a detailed history – how the injury happened, whether there is locking or catching, the swelling pattern, your sport and work demands, and any previous knee surgery. On examination, I check joint line tenderness, swelling, range of motion, and perform meniscal provocation tests. X-rays help assess joint space and rule out significant arthritis. MRI is used in most cases (except advanced arthritis) to confirm the tear type – including root and bucket handle tears – and to assess the cartilage and ligaments.

If the knee is locked or you have significant loss of movement, I prioritise assessment and treatment to avoid prolonged stiffness and ongoing mechanical damage to the meniscus and remaining cartilage.

Non-surgical treatment (often appropriate first)

Not every meniscus tear needs surgery. Many tears, particularly degenerative tears without true locking, can be managed with:

Physiotherapy to strengthen the knee and improve movement control
Activity modification and graded return to sport
Anti-inflammatory strategies when appropriate
Weight management if relevant

I consider surgery when symptoms persist despite appropriate rehabilitation, or when the tear pattern is causing mechanical symptoms such as true locking.

Surgical options: preserving the meniscus when possible

When surgery is appropriate, my strong preference is to preserve as much meniscus as possible because of its long-term protective role.

Meniscal repair

Meniscal repair stitches the torn meniscus back together so it can heal. It is most successful when the tear is in the better-blood-supplied zone and when the tissue quality is good.

I consider meniscal repair when:

The tear pattern is repairable – for example certain longitudinal tears, including some bucket handle tears
The knee joint surface is in reasonable condition
The knee environment supports healing – alignment, stability, and appropriate rehabilitation

Repair involves a more protective rehabilitation period than trimming, because healing needs time. But the long-term payoff of keeping the meniscus intact is substantial.

Meniscal root repair

Meniscal root repair restores the attachment point of the meniscus to bone, helping it function properly again. I consider root repair when a root tear is causing significant symptoms and the knee is suitable – meaning the cartilage condition and alignment support a good outcome.

This is an area I feel strongly about. The latest evidence shows that many patients who sustain a meniscal root tear are at risk of rapid cartilage damage – to the extent that a knee replacement could be needed within 6 to 12 months of the injury. That urgency is not always recognised. I offer rapid assessment and treatment for root tears because the window of opportunity for repair is often narrow.

Partial meniscectomy (meniscus trimming)

Partial meniscectomy removes the unstable torn fragment while leaving as much healthy meniscus as possible. It is appropriate when:

The tear pattern is not repairable
The tissue quality is poor – commonly with degenerative or longstanding tears
A small unstable flap is causing catching and pain

While trimming can improve symptoms, removing meniscus reduces shock absorption. That is why I prefer repair where it is feasible.

Meniscal transplant (meniscus allograft)

A meniscal transplant uses a donor meniscus to replace meniscus tissue that has previously been removed and where the knee is now suffering from "meniscus deficiency."

I consider meniscal transplant when:

You have persistent compartment pain after previous meniscectomy
You are relatively young and active and want a knee-preservation option
The knee alignment and stability can be optimised (sometimes requiring combined procedures)
Arthritis is not advanced

In many cases, meniscal transplant is part of a combined preservation plan – sometimes alongside alignment correction (osteotomy) or cartilage treatment – to protect the graft and improve long-term outcomes.

Recovery and rehabilitation

Rehabilitation depends on the procedure performed:

After partial meniscectomy

Often a quicker recovery
Focus on swelling control, restoring movement, and rebuilding strength
Return to sport is guided by comfort, strength, and function

After meniscal repair or root repair

A more protective early phase to allow healing
Crutches and restricted weight-bearing for a period
Bracing to restrict early range of motion, depending on the tear and repair
Return to active jobs, running, and pivoting sport takes longer than trimming

After meniscal transplant

Structured, staged rehabilitation is essential
Return to high-impact activity is cautious and individualised
Success depends heavily on treating contributing factors – alignment, stability, and cartilage health

I plan rehabilitation around your tear type, procedure, and goals, with clear milestones rather than a fixed calendar.

Risks and limitations

All surgery carries risks. Specific meniscus surgery risks vary by procedure, but can include:

Infection, blood clots, stiffness, swelling, or ongoing pain
Re-tear or non-healing after meniscal repair or root repair
Ongoing symptoms if there is significant cartilage wear elsewhere in the knee
Further surgery in the future, particularly if arthritis progresses

I cover expected benefits, alternatives, rehabilitation, and the specific risks relevant to your knee in clinic.

Frequently asked questions

Do all meniscus tears need surgery?

No. Many meniscus tears improve with physiotherapy, load management, and time – especially degenerative tears without true mechanical locking. I recommend surgery when symptoms persist despite good rehabilitation, or when the tear is causing locking or significant mechanical symptoms.

What is a bucket handle tear?

A bucket handle tear is a tear where a strip of meniscus flips into the centre of the knee, often locking it. I prioritise seeing these patients early because many bucket handle tears can be repaired if the tissue quality and location are suitable, and delay can reduce the chances of a successful repair.

What is a meniscal root tear and why does it matter?

A root tear is a tear at the meniscus attachment point. It can dramatically reduce the meniscus's ability to distribute load, increasing stress on cartilage. In suitable knees, root repair can help restore function and protect the joint. I treat these with some urgency because the risk of rapid cartilage deterioration is real.

What is the difference between meniscal repair and partial meniscectomy?

Repair stitches the tear to allow it to heal and preserves the meniscus, but requires a longer and more protected rehabilitation. Partial meniscectomy trims the unstable fragment – recovery is faster, but removing meniscus tissue increases long-term cartilage load. I repair wherever the tear pattern and tissue quality allow.

Can a meniscus transplant help after previous meniscectomy?

For younger, active patients with persistent pain due to meniscus deficiency and without advanced arthritis, transplant can be a valuable knee-preservation option. I often combine it with procedures that optimise alignment or stability to give the graft the best chance of success.

Can I be assessed for a meniscal injury in Bristol?

Yes. I offer specialist assessment and treatment for meniscal injuries at my clinics in Bristol, covering non-surgical care, meniscal repair, root repair, and transplant and knee-preservation pathways for complex cases.