Meniscal Injuries (Meniscus Tears) and Meniscus Surgery in Bath & Bristol

The meniscus is a tough, rubbery “shock absorber” inside the knee. Each knee has two menisci: a medial meniscus (inner side) and a lateral meniscus (outer side). Meniscal injuries are very common and can cause pain, swelling, catching, and sometimes true locking of the knee.

Mr Simon Abram, Consultant Specialist Knee Surgeon, provides specialist assessment and treatment planning for meniscal injuries in Bath and Bristol. Treatment options range from physiotherapy and activity modification to keyhole surgery, including meniscal repair, meniscal root repair, partial meniscectomy, and, in selected cases, 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 often a 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 tear pattern where a long strip of the meniscus flips into the centre of the knee. This can cause a locked knee (difficulty fully straightening) and may require more urgent assessment. Many bucket handle tears are considered for repair when the tissue quality and blood supply are suitable.

Meniscal root tear

A meniscal root tear is a tear at the point where the meniscus attaches to bone (the “root”). Root tears can cause the meniscus to lose its ability to transmit load properly, which can lead to increased stress on cartilage and more rapid joint wear in some knees. Root tears sometimes occur after a twist, a squat, or a minor injury, especially in middle age, and can also occur with 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 can occur 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 (cannot fully straighten)
Sudden loss of extension after a twist or sporting movement
Recurrent catching with a strong mechanical block

Symptoms that may suggest a meniscal root tear

Sharp pain at the back/inner (or back/outer) side of the knee after a squat or twist
Recurrent swelling with weight-bearing
A feeling the knee has suddenly “aged” or become less tolerant of walking

Assessment and diagnosis (Bath & Bristol)

Effective meniscus treatment depends on understanding the tear pattern, tissue quality, and the overall knee environment (cartilage condition, alignment, and ligament stability). Mr Simon Abram is a specialist on meniscal injures having completed his PhD (DPhil) on the topic, and is the lead author on the current UK National Guidelines on the management of meniscal tears. Mr Abram offers specialist assessment and comprehensive treatment at his clinics in Bristol and Bath.

Assessment usually includes:

History: injury mechanism, locking/catching, swelling pattern, sport/work demands, previous knee surgery
Examination: joint line tenderness, swelling, range of motion, and meniscal provocation tests
X-rays (selected cases): to assess joint space and rule out significant arthritis
MRI scan (most cases, except advanced arthritis): commonly used to confirm tear type (including root or bucket handle tears) and assess cartilage/ligaments

If the knee is locked or there is significant loss of movement, assessment and treatment should be prioritised 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

Surgery is considered 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, the aim is often 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 of the meniscus and when the tissue quality is good.

Meniscal repair may be considered when:

The tear pattern is repairable (for example certain longitudinal tears, including some bucket handle tears)
You have a relatively healthy knee joint surface
The knee environment supports healing (including alignment, stability, and appropriate rehabilitation)

Repair often involves a more protective rehabilitation period than trimming, because healing needs time.

Meniscal root repair

Meniscal root repair aims to restore the attachment point of the meniscus to bone, helping the meniscus function properly again. Root repair may be considered when a root tear is causing significant symptoms and the knee is suitable (including cartilage condition and alignment).

Because root tears can significantly affect load distribution, repair can be an important knee-preservation strategy in appropriate patients. The latest evidence shows that many patients sustaining a meniscal root tear may suffer severe symptoms and are at risk of rapid damage to the remaining cartilage in the knee - to the extent that a knee replacement could be needed within 6 to 12 months. Mr Abram offers rapid assessment and treatment when required in these cases.

Partial meniscectomy (meniscus trimming)

Partial meniscectomy removes the unstable torn fragment while leaving as much healthy meniscus as possible. It can be helpful 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. For that reason, preserving or repairing the meniscus is often preferred where feasible.

Meniscal transplant (meniscus allograft) for selected cases

A meniscal transplant (also called meniscal allograft transplantation) uses a donor meniscus to replace meniscus tissue that has previously been removed and where the knee is now suffering from “meniscus deficiency.”

Meniscal transplant may be considered 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

Usually a more protective early phase to allow healing
Crutches and restricted weight-bearing may be advised for a period
Bracing to restrict early range of motion, depending on the tear and repair
Return to active jobs, running, and pivoting sport typically 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, cartilage health)

Your plan is tailored to your tear type, procedure, and goals, with clear milestones rather than a one-size-fits-all timeline.

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

A personalised consultation will cover expected benefits, alternatives, rehabilitation, and the specific risks that apply to your knee.

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. Surgery is more commonly considered when symptoms persist despite rehab, or when the tear causes 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. It can cause a locked knee and often needs early specialist assessment. Many bucket handle tears can be repaired if the tissue quality and tear location are suitable.

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

A root tear is a tear at the meniscus attachment point. It can reduce the meniscus’ ability to distribute load, potentially increasing stress on cartilage. In suitable knees, root repair can help restore function and protect the joint from developing more severe arthritis.

What is the difference between meniscal repair and partial meniscectomy?

Repair stitches the tear to allow it to heal and preserves the meniscus, but usually involves a longer and more protected rehabilitation. Partial meniscectomy trims the unstable fragment and can recover faster, but removes some meniscus tissue and can increase long-term cartilage load.

Can a meniscus transplant help after previous meniscectomy?

In selected patients with persistent pain due to meniscus deficiency and without advanced arthritis, a meniscal transplant can be considered as a knee-preservation option. It is carefully selected and often combined with procedures that optimise alignment or stability.

Can I be assessed for a meniscal injury in Bath or Bristol?

Yes. Mr Simon Abram offers specialist assessment and treatment planning for meniscal injuries in Bath and Bristol, including non-surgical options, meniscal repair strategies, root repair when appropriate, transplant and knee-preservation pathways for complex cases.