Meniscus tear: exercise or surgery?

The menisci are two shock-absorbing cartilage discs in each knee joint, one on the inside and one on the outside. They distribute load, absorb shock and contribute to stability [1]. The inner meniscus is injured most often, because it is less mobile than the outer one [1].

The injury can happen acutely, usually through a forceful twist when the knee is bent and the foot is fixed to the ground. This is common in football and handball [1]. It can also develop gradually as wear over years [1][3]. More than half of people over 65 have such changes, but most have no symptoms [1].

An acute injury often brings sharp, stabbing pain, usually on the inside of the knee, that increases with loading and rotation [1][3]. Swelling typically comes within the first day, and some notice clicking [1][3]. It can hurt to squat, climb stairs or turn over in bed [1][3].

The knee can also suddenly lock so that it cannot be straightened. This is painful and should be assessed by a doctor [1][2].

Wear-related tears often cause no symptoms. Some get pain in the middle of the knee, recurring swelling or a feeling that something catches or gives way [1].

The diagnosis is made from the history and a clinical examination of the knee [1][3]. With severe pain and swelling the examination can be limited, and it can be repeated after a few days [1][3]. The examination should also include the cruciate and collateral ligaments [3].

With an acute injury, imaging is often not necessary. X-ray can rule out a fracture, and MRI is used if needed [1]. Lægehåndbogen recommends MRI only when the result will affect treatment, since many people without symptoms have changes in the meniscus on MRI [3]. In middle-aged and older people without an injury, NHI recommends standing X-ray, and MRI usually gives no useful additional information [1].

Many acute meniscus tears improve after a period of offloading and adapted activity [1][2]. For an acute injury the RICE principle is recommended: rest, ice, compression and elevation [1]. Crutches and reduced loading are often used for a while, followed by gradual rehabilitation focused on the muscles around the knee. A physiotherapist can guide this without a referral [1][2].

For wear-related tears, exercises for the muscles around the knee are central [2]. The Danish guideline says that offering non-surgical treatment first can be considered, also when MRI shows a tear without mechanical symptoms, and that arthroscopy can be considered if treatment has no effect after about three months [4]. Lægehåndbogen describes that structured physiotherapy for degenerative tears with mild osteoarthritis can give better muscle function and symptoms than surgery, and that the effect is assessed after three to four months [3].

With overweight and long-standing knee symptoms, weight reduction can ease load-related symptoms [1][2].

Surgery is considered for a locked knee, larger injuries, multiple simultaneous injuries in the knee, injury to the meniscus root and persistent symptoms despite rehabilitation [1][2][3]. For a locked knee, NHI recommends seeing an orthopaedic surgeon straight away [2]. The Danish guideline suggests considering arthroscopy within two weeks if it is suspected that the injury is trapped in the joint [4].

The operation can be a repair of the meniscus, which is preferred in younger people and with recent injuries, or a partial removal where as little as possible is taken out [1][2][3]. In people over 40 the meniscus is rarely suitable for repair [1][2].

For wear-related tears, surgery is as a rule not useful, and is rarely recommended except for persistent locking [1][2]. After partial removal, the Danish guideline recommends considering supervised rehabilitation rather than home exercises or no exercise [4].

Small acute injuries usually pass after weeks to a few months [1][2]. After surgery for an acute injury, normal function is usually reached after about 6 to 12 weeks according to NHI [1][2], while Lægehåndbogen states that normal function is often expected after four to six weeks following partial removal [3]. The sources thus give somewhat different time frames, and it depends on the procedure.

After a repair, recovery is longer. Full weight bearing is not recommended until at least four to six weeks, and sports with twisting movements at the earliest after two months [2][3]. Meniscus injuries increase the risk of osteoarthritis later in life, and NHI writes that regular exercise, preferably knee exercises one to two times a week, can help prevent wear [1].

If the knee locks and cannot be straightened, you should see a doctor or an orthopaedic surgeon straight away [1][2]. Large and rapid swelling can indicate a more extensive injury, for example together with the cruciate ligament [1][3]. If function remains reduced despite rehabilitation, you should have the knee assessed again [2].

A physiotherapist can examine the knee, identify what triggers the symptoms and set up a plan for rehabilitation. The physiotherapist can also assess whether you should be referred on to a doctor or an orthopaedic surgeon. You can read more about physiotherapy and about osteoarthritis in the knee.

Can a meniscus tear heal by itself?

Smaller tears can often resolve by themselves [4], and many acute tears improve after offloading and adapted activity [1][2]. How it goes depends on the injury, and the knee should be assessed by a healthcare professional.

What are the symptoms of a meniscus tear?

Typical signs are pain on the inside or outside of the knee, swelling, clicking and pain when squatting and on stairs. The knee can also lock [1][3].

Does a meniscus tear need surgery?

Not always. Many are first treated with offloading and exercise. Surgery is considered for, among other things, a locked knee, larger injuries and symptoms that persist [1][2][3]. The choice is made together with a doctor or an orthopaedic surgeon.

How long do you use crutches after meniscus surgery?

After partial removal, crutches are often used for about a week [2]. After a repair, full weight bearing is recommended only after at least four to six weeks [2]. The plan depends on the procedure, and the surgeon advises in each case.

The page about osteoarthritis in the knee covers wear in the knee joint, and the page about Active with osteoarthritis describes an exercise programme. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Meniskskade i kneet (Meniscus injury of the knee). NHI.no. Last updated 29 January 2025. Link

2. Meniskskade i kneet: behandling (Meniscus injury of the knee: treatment). NHI.no. Last updated 29 January 2025. Link

3. Lind M, Søndergaard A. Meniskskade i knæet. Lægehåndbogen, sundhed.dk. Professionally updated 14 August 2026. Link

4. Nationale kliniske retningslinje for meniskpatologi i knæet (Danish national clinical guideline on meniscal pathology of the knee). Sundhedsstyrelsen. Version 1.1, 2019. Link