Hein Viljoen
Physiotherapy
If you've just been told you might have a meniscus tear, your first thought is probably: "Do I need surgery?"
Not always. Some tears do need surgical input, especially if the knee is properly locked or the tear is more complex. But many people recover well with physiotherapy alone, particularly when the knee is painful, swollen, or stiff but still moving.
The meniscus is a C-shaped piece of cartilage in your knee that works like a shock absorber. You've got two in each knee — one on the inside, one on the outside. Between them, they spread the load through the joint, protect it, and keep your movement smooth.
When it's irritated or torn, everyday activities like walking, climbing stairs, squatting, or getting in and out of the car can feel uncomfortable. Some tears happen suddenly, usually from a twist, pivot, or awkward landing. Others build up slowly, as the cartilage wears down with age and repeated strain.
Sometimes, depending on where the tear is and what type it is.
The outer part of the meniscus gets a decent blood supply, so tears there have a better chance of healing on their own. The inner part barely gets any blood flow, so it's much harder for tears there to heal naturally.
That's why two people can get the same diagnosis and end up with very different recoveries. A small, stable tear might settle with the right care, while a displaced tear, or one causing real locking, might need more than physiotherapy.
Worth knowing too: recovery doesn't always mean the cartilage grows back together. For a lot of people, especially with age-related tears, the actual goal is less pain, better movement, more strength, and a knee that feels dependable again.
In many cases, yes.
Physiotherapy can help calm pain and swelling, improve knee movement, strengthen the muscles around the joint, and rebuild confidence in the knee. This is especially helpful for many degenerative meniscus tears, which are more common in middle-aged and older adults.
Research supports this approach, too. In a recent trial (Noorduyn et. al) people aged 45 to 70 with degenerative meniscus tears were treated with either surgery or exercise-based physiotherapy. After five years, both groups had similar knee function.
In simple terms, many people who did physiotherapy recovered just as well as those who had surgery.
That doesn't mean surgery is unnecessary — it still matters in the right cases. But it does suggest physiotherapy is usually worth trying first, as long as there's no true locking or urgent surgical issue.
Your physiotherapist will asses how your knee moves, where the pain is, how much swelling there is, and how well the surrounding muscles are supporting the joint.
The treatment usually involves reducing pain and swelling, getting your knee to bend and straighten comfortably again, strengthening the quads, hamstrings, glutes, and calves, working on balance and control, and gradually building back up to walking, running, the gym, work, or sport.
Surgery might be the better option if your knee is truly locked and won't fully straighten, if there's a displaced or bucket-handle tear, if swelling keeps returning despite proper rehab, or if there's another injury alongside it, such as ligament damage.
Even then, physiotherapy is important — before surgery to get the knee ready, and after surgery to rebuild movement, reduce swelling, restore strength, and help you return to activity safely.
Don’t let a meniscus tear tear you down. Let Hein Viljoen Physiotherapy help you to heal properly.
