Meniscus vs Ligament Injury: Symptoms, Diagnosis, & Treatment

The knee is one of the most complex and heavily used joints in the body. Every day, it helps you walk, climb stairs, and stay active. Because it does so much work, knee injuries are quite common, especially if you play sports or lead an active lifestyle.

Two of the more common types of knee injuries are ligament and meniscus injuries. While both are important parts of your knee, they serve different purposes and require different approaches to treatment.

Anatomy of the knee

There are three main bones that make up your knee:

• Thigh bone (femur)

• Shin bone (tibia)

• The smaller bone next to your shin (fibula)

These bones are held together and protected by ligaments and menisci, which work together to handle the forces your knee faces every day.

The four ligaments

Your knee has four main ligaments that work like strong bands to provide stability in all directions. Think of them as your knee's security system:

• MCL (Medial Collateral Ligament):

  • Protects the inner side of your knee from bending inward

• LCL (Lateral Collateral Ligament):

  • Protects the outer side of your knee from bending outward

• ACL (Anterior Cruciate Ligament):

  • Prevents your shinbone from sliding too far forward and controls rotation

• PCL (Posterior Cruciate Ligament):

  • Prevents your shinbone from sliding too far backward

The meniscus

The menisci are two crescent-shaped pieces of cartilage-like tissue that sit between your thigh bone and shin bone. You have one on the inner side (medial meniscus) and one on the outer side (lateral meniscus) of your knee.

What do the menisci do?

• It acts as a natural shock absorber during activities like running, walking, and jumping

• It cushion your knee joint t protect the bone surfaces

• It helps distribute your body weight evenly across the joint

• It prevents your bones from grinding against each other

Key differences: meniscus vs. ligament injuries

Meniscus and ligament injuries are both knee problems, but they affect different parts of the knee and cause different symptoms.

What causes injury to knee ligaments or the meniscus?

Knee injuries can happen to anyone, but knowing the common causes can help you be more aware and take steps to protect yourself when possible.

• Sports and physical activities:

  • Playing sports that involve pivoting, jumping, or sudden changes in direction (like basketball, soccer, or skiing)

  • Contact sports where collisions with other players can occur

  • Landing awkwardly from a jump or fall

• Everyday activities:

  • Sudden directional changes while walking or running

  • Slipping, falling, or stepping awkwardly

  • Getting up from a squatting position too quickly

• Age-related changes:

  • Natural wear and tear over time, especially affecting the meniscus in adults over 40

  • The cartilage becomes less flexible and more prone to tearing with normal activities

• Repetitive stress:

  • Jobs or activities that require frequent kneeling, squatting, or heavy lifting

  • Overuse from repetitive motions without adequate rest

  • Gradual breakdown from years of regular activity

It's important to remember that knee injuries can happen to both athletes and non-athletes. Sometimes even simple movements can cause injury if your knee is in a vulnerable position.

How to know if it’s a meniscus or ligament injury?

While only a healthcare professional can give you a definitive diagnosis, certain signs and symptoms can help you understand what type of injury you might have experienced.

• Listen for sounds during the injury:

  • When you hear a distinct "pop" sound during your knee injury, it often indicates a ligament tear, especially an ACL injury. This popping sound happens when the ligament suddenly tears under stress.

• Pay attention to how your knee feels:

  • Unstable or giving way:

    • If your knee feels wobbly or like it might buckle when you try to walk or change direction, this usually suggests a ligament injury. Your ligaments are responsible for keeping your knee stable.

  • Locking or catching:

    • If your knee gets stuck in one position, won't fully straighten, or feels like something is catching inside the joint, this typically points toward a meniscus tear. Torn pieces of meniscus can sometimes get in the way of normal joint movement.

• Notice where the pain is:

  • Pain along the inner or outer edges of your knee could indicate either a meniscus tear or an injury to the collateral ligaments (MCL or LCL) that run along the sides of your knee.

• Watch how swelling develops:

  • Rapid swelling that appears within a few hours of injury often suggests a ligament tear, as these injuries can cause bleeding inside the joint

  • Delayed swelling that shows up the next day or develops gradually over time is more characteristic of a meniscus tear

Remember, these are general guidelines, and some injuries can have overlapping symptoms. It's always best to have your knee evaluated by a healthcare professional for an accurate diagnosis. You may contact Thomson Medical to arrange a consultation for personalised guidance on your issue.

How are these diagnosed?

Proper care or treatment depends on an accurate diagnosis. Your doctor will use a few different methods to figure out exactly what’s wrong with your knee.

Physical examination

Your doctor will perform specific tests to identify which structure is injured. These tests are designed to stress different parts of your knee in controlled ways:

• Lachman test:

  • Checks for ACL tears by gently moving your shinbone forward while your knee is slightly bent

• McMurray's test:

  • Detects meniscus tears by rotating your leg while bending and straightening your knee

• Valgus and varus stress tests:

  • Test the stability of your collateral ligaments (MCL and LCL) by applying gentle pressure to the sides of your knee

These tests might cause some discomfort, but they're important for understanding what's happening inside your knee joint.

Medical imaging

Depending on your symptoms and physical exam results, your doctor may order imaging tests:

• MRI (Magnetic Resonance Imaging):

  • This is considered the reliable method for diagnosing soft tissue injuries like ligament and meniscus tears. It provides detailed pictures of all the structures inside your knee without using radiation.

• X-rays:

  • While X-rays don't show soft tissues like ligaments or meniscus, they're useful for ruling out bone fractures or other bone-related problems that might be causing your symptoms.

Your healthcare provider will combine the results from your physical exam, your description of symptoms, and any imaging tests to make an accurate diagnosis and develop the best treatment plan for you.

What are treatments to heal these injuries?

There are effective treatments available for both meniscus and ligament injuries. Your treatment plan will depend on several factors, including the type and severity of your injury, your age, activity level, and personal goals.

Non-surgical treatment (conservative management)

Many knee injuries can heal well without surgery, especially when caught early and treated properly.

• Initial care - RICE method:

  • Rest:

    • Avoid activities that cause pain and give your knee time to heal

  • Ice:

    • Apply ice packs for 15-20 minutes several times a day to reduce swelling

  • Compression:

    • Use an elastic bandage or knee sleeve to provide support and control swelling

  • Elevation:

    • Keep your leg raised when sitting or lying down to help reduce swelling

• Ongoing support:

  • Bracing:

    • Special knee braces can provide extra stability and support during healing and return to activities

  • Physical therapy:

    • A structured program focusing on rebuilding strength, improving flexibility, and restoring balance and coordination

  • Anti-inflammatory medications:

    • Over-the-counter medications can help manage pain and reduce inflammation

Surgical treatment

When conservative treatment isn't enough or the injury is severe, surgery may be recommended.

• For meniscus tears:

  • Meniscus repair:

    • When the tear is in an area with good blood supply, surgeons can stitch the torn pieces back together. This preserves more of your natural meniscus.

  • Meniscectomy:

    • When repair isn't possible, the damaged portion of the meniscus is carefully removed, leaving as much healthy tissue as possible.

• For ligament tears (such as ACL):

  • Reconstruction:

    • Since ligaments don't heal well on their own, surgeons replace the torn ligament with a graft. This graft can come from your body (autograft) or from a donor (allograft).

When and how is ligament or meniscus repair surgery done?

If surgery is a likely recommendation for your knee injury, it's helpful to know what to expect so you can feel prepared and a little more positive about what's to come.

Meniscus surgery

It’s an arthroscopic surgery, which means it’s done through a small incision, and it’s minimally invasive.

Your surgeon makes small incisions (about the size of a pencil eraser) and uses a tiny camera and specialised instruments to repair or remove the damaged tissue. This approach results in less pain, smaller scars, and faster recovery compared to traditional open surgery.

When is surgery recommended?

• Conservative treatments like physical therapy and rest haven't provided adequate relief after several weeks.

• The tear is located in the "red zone", the outer part of the meniscus that has a good blood supply and can heal well when repaired.

• Your knee continues to lock, catch, or cause significant functional problems.

Most people can return to full activity within 3 to 6 months, though this varies depending on the extent of the surgery and your individual healing process.

ACL and other ligament surgery

Ligament reconstruction involves replacing the torn ligament with a tendon graft. This graft acts as a scaffold for new ligament tissue to grow on. The surgery is typically done arthroscopically, using the same minimally invasive approach as meniscus surgery.

When is surgery recommended?

• You're young and active and want to return to sports or physically demanding activities.

• Your knee feels unstable during daily activities like walking up stairs or changing direction.

• You've tried conservative treatment, but your knee continues to give way or feel unreliable.

• You have additional injuries to other structures in the knee.

Recovery from ligament reconstruction typically takes 6 to 9 months and often longer if you're planning to return to competitive sports. The extended timeline allows for proper healing and comprehensive rehabilitation to restore strength, stability, and confidence in your knee.

FAQ

Is a meniscus or ligament tear worse?

Neither injury is necessarily "worse" than the other; it depends on your specific situation. ACL tears often require surgery and longer rehab. Meniscus tears can sometimes heal on their own, but complex or degenerative tears may worsen over time.

How can I tell if I tore my ACL or meniscus?

Which injury causes more pain: an ACL tear or a meniscus tear?

Pain levels vary from person to person, but ACL tears usually cause more intense, immediate pain along with a feeling that something is seriously wrong with your knee. While meniscus tears may start with less pain, they often cause persistent discomfort and frustrating mechanical problems like catching or locking that interfere with daily activities.

Can I walk with a torn ligament or meniscus?

Yes, many people can still walk, especially with partial tears. However, the joint may feel unstable (ligament) or lock and swell (meniscus), making movement difficult or risky.

How can I prevent meniscal injury?

Do all meniscus or ligament injuries need surgery?

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations based on your medical conditions, arrange a consultation with Thomson Medical.