Sports with a me­nis­cus tear – what is pos­si­ble and when is sur­gery needed?

Not ne­ces­s­a­rily. With a fresh me­nis­cus tear, it makes sense to in­iti­ally rest the knee and tem­po­r­a­rily pause sport­ing ac­ti­vi­ties – espe­ci­ally if there is pain, swel­ling or rest­ric­ted mo­ve­ment. Ho­we­ver, light exer­cise wi­t­hout stress can even be be­ne­fi­cial in many ca­ses. Af­ter a me­di­cal ex­ami­na­tion, a joint de­cis­ion can be made as to which ac­ti­vi­ties are pos­si­ble again and when you can start. 

That de­pends on the lo­ca­tion and type of tear. Te­ars in the well-per­fu­sed outer area of the me­nis­cus (Red-Red-Zone) have a chance of he­al­ing on their own – espe­ci­ally with smal­ler, sta­ble in­ju­ries. Te­ars in the in­ner area (White-White-Zone), which has little blood flow, usually do not heal on their own. Sur­gery may be ne­ces­sary here if sym­ptoms persist. 

Sur­gery makes sense if the tear cau­ses pain, blocka­ges or rest­ric­ted mo­ve­ment, or if con­ser­va­tive me­a­su­res do not lead to the de­si­red suc­cess. An ope­ra­tion may also be re­com­men­ded for peo­ple who are very ac­tive in sports or for more com­plex tear forms (e.g. unsta­ble bu­cket handle te­ars). The aim is al­ways to pre­serve as much func­tional me­nis­cus as possible. 

With sta­ble, low-sym­ptom te­ars, joint-fri­endly sports are of­ten possible:

• Cy­cling (not too high gears)
• Swim­ming (pre­fer­a­bly crawl, no strong breaststroke)
• Hi­king on flat paths
• Mus­cle buil­ding with con­trol­led movements
• Yoga or Pi­la­tes (ad­apted exercises)

Sports with jum­ping, im­pact or twis­ting loads should be avo­ided, e.g. foot­ball, ten­nis, ski­ing or jog­ging on hard ground.

Yes, sport is usually pos­si­ble again af­ter me­nis­cus sur­gery. Ho­we­ver, the re­turn de­pends on whe­ther the me­nis­cus was su­tured (me­nis­cus su­ture) or par­ti­ally re­mo­ved (par­tial re­sec­tion). With a su­ture, he­al­ing ta­kes lon­ger, sport is pos­si­ble at the ear­liest af­ter 10–12 weeks. Af­ter a par­tial re­sec­tion, sport­ing ac­ti­vity can be star­ted again af­ter 4–6 weeks – al­ways un­der phy­sio­the­ra­peu­tic guidance. 

That de­pends on the type of surgery:

• Af­ter par­tial re­sec­tion: Re­turn to sport usually af­ter 4–6 weeks, start­ing with joint-fri­endly activities.
• Af­ter me­nis­cus su­ture: Load build-up much slower. Full sport­ing ability of­ten only af­ter 10–12 weeks, even la­ter with cont­act sports.

Im­portant is an in­di­vi­du­ally tail­o­red re­ha­bi­li­ta­tion phase with strength buil­ding and coor­di­na­tion training.

An unt­rea­ted me­nis­cus tear can en­large and lead to per­ma­nent da­mage in the knee. Over a lon­ger pe­riod of time, the joint can be ad­di­tio­nally stres­sed by the al­te­red bio­me­cha­nics – which si­gni­fi­cantly in­crea­ses the risk of pre­ma­ture os­teo­ar­thri­tis. The­r­e­fore, every tear should be me­di­cally cla­ri­fied and re­gu­larly che­cked – even if the sym­ptoms are in­iti­ally minor. 

Yes – but only with pro­fes­sio­nal gui­dance and ad­apted to the in­di­vi­dual si­tua­tion. Exer­ci­ses should be gentle on the joints and have a sta­bi­li­zing ef­fect, e.g. iso­me­tric trai­ning or tar­ge­ted buil­ding of the thigh mus­cles. Squats or leg pres­ses may be pos­si­ble un­der cer­tain cir­cum­s­tances if they are per­for­med cor­rectly and wi­t­hout pain.

Cy­cling is con­side­red one of the best sports for me­nis­cus pro­blems – both con­ser­va­tively and post­ope­ra­tively. The even, cy­cli­cal mo­ve­ment streng­thens the mus­cles, re­li­e­ves the joint and im­pro­ves mo­bi­lity. Im­portant is a well-ad­jus­ted saddle and a low ca­dence to avoid over­loa­ding the knee. 

Jog­ging is one of the last sports that should be star­ted again af­ter a me­nis­cus pro­ce­dure – de­pen­ding on the he­al­ing pro­cess at the ear­liest af­ter 10–12 weeks. Be­fore re­tur­ning, the knee should be com­ple­tely pain-free, sta­ble and re­si­li­ent. Tar­ge­ted trai­ning on the bicy­cle or cross trai­ner can help as pre­pa­ra­tion. More joint-fri­endly al­ter­na­ti­ves such as Nor­dic wal­king or aqua jog­ging can be used as a transition.