Meniscus tears: Diagnosis and Treatment in the Injured Worker

Written by Anand Panchal, DO

One of the more common knee injuries we encounter in work-related cases is the meniscus tear. Though it may sound minor compared to fractures or severe ligament injuries, a meniscus tear can be significantly disruptive—not just to the worker’s physical health, but also to their ability to return to work, perform job duties, and maintain quality of life. In this article I will walk you through an overview of meniscus tears, focusing on how they’re diagnosed, the treatment pathways available, and what considerations are particularly relevant in the workers’ compensation setting.

What Is the Meniscus?

The meniscus is a C-shaped piece of fibrocartilage in the knee that acts as a cushion between the femur and the tibia. Each knee has two menisci: the medial meniscus on the inside of the knee and the lateral meniscus on the outside. Their primary functions are shock absorption, load distribution, and joint stabilization, in addition to proprioception and acting as secondary stabilizers of the knee joint. A tear in the meniscus can impair these functions, resulting in pain, swelling, instability, and limited mobility. In workers’ compensation cases, this often translates into lost work time, restricted duty, and sometimes long-term disability.

Causes of Meniscus Tears in the Workplace

In younger, more active workers, meniscus tears are often traumatic, resulting from twisting or turning quickly, especially with the foot planted and the knee bent—common in jobs requiring manual labor, lifting, or sudden movements. They can also occur in conjunction with more severe ligament injuries such as falling off a scaffold or ladder. In older workers, the tears may be degenerative, occurring gradually over time due to wear and tear. In such cases, a relatively minor movement—squatting, kneeling, or even stepping awkwardly—can result in a tear. These workers may have underlying arthritis that has to be taken into consideration in diagnosis and treatment.

This distinction is key in the workers' compensation setting, where we often need to determine causation: Did the injury arise out of and in the course of employment? Or was it the natural progression of a pre-existing condition? It is not always a straightforward answer, as sometimes there may be underlying chronic conditions with a superimposed acute injury.

Signs and Symptoms

Recognizing a meniscus tear involves noting the following common symptoms:

• Pain, particularly when twisting or rotating the knee

• Swelling that may develop over hours or days (also know as an effusion)

• Stiffness or tightness

• Catching or locking of the knee joint

• Instability, a feeling that the knee might give way

• These symptoms can vary in intensity, depending on the type and extent of the tear.

Diagnosis: Clinical and Imaging

The initial step is a clinical evaluation by a Musculoskeletal-trained healthcare provider. This includes:

• A detailed history, including mechanism of injury, occupation, and past knee issues

• A physical examination, often involving specific tests like the McMurray test or Apley’s compression test However, clinical exams can be limited, especially if there’s swelling or guarding. That’s where imaging comes in:

  •  X-rays are typically ordered first to rule out fractures or arthritis but do not show meniscal tissue.

  • MRI (Magnetic Resonance Imaging) is the gold standard for diagnosing meniscus tears. It offers a detailed view of soft tissues and can help distinguish between different types of tears: horizontal, vertical, radial, complex, or flap tears.

MRI can also ascertain for concomitant ligament injuries and/or subtle cartilage injuries. From a workers’ comp perspective, accurate and early diagnosis is crucial—not only for guiding treatment but also for validating the claim and reducing unnecessary delays.

TYPES OF MENISCUS TEARS

Understanding the type of tear helps determine treatment options:

1. Peripheral (Red Zone) Tears – These have good blood supply and may heal on

their own or with surgical repair.

2. Inner (White Zone) Tears – These are less likely to heal naturally due to poor

vascularization and may require trimming or partial meniscectomy.

3. Complex Tears – Often seen in older workers with degenerative changes.

TREATMENT OPTIONS

1. Conservative Management

For minor or degenerative tears, especially in older patients:

• Rest and activity modification

• Ice and anti-inflammatory medications

• Physical therapy, focusing on strengthening the quadriceps and improving joint mobility

• Knee braces to offload stress

In workers’ comp, conservative management is typically the first-line approach unless there are mechanical symptoms like locking or severe instability.

2. Injections

• Corticosteroid injections can reduce inflammation and pain temporarily but are not curative. In many cases workers reducing underlying inflammation pain can render a small meniscus tear inconsequential.

• Viscosupplementation is sometimes considered in degenerative cases, especially if there is a combination of underlying arthritis with meniscus pathology.

3. Surgical Intervention

When conservative measures fail, or the tear is severe:

• Arthroscopic Meniscectomy: Removes the damaged part of the meniscus. This is common but may increase the risk of future arthritis if a larger portion of the meniscus has to be removed.

• Meniscus Repair: Involves suturing the tear, ideal for younger patients or those with tears in the red zone.

• Meniscus Transplantation: Rare and generally not used in workers’ comp cases.

The surgical choice depends on age, activity level, tear location, and overall joint

condition.

Post-Treatment Recovery and Return to Work

• Conservative treatment may allow a return to light duty within a few weeks.

• Post-surgery, recovery times vary:

  • Meniscectomy: 4–8 weeks for light-duty jobs

  • Repair: 3–6 months, especially for jobs requiring physical labor

Physical therapy plays a pivotal role in recovery and functional return. It’s vital that rehab is goal-oriented and aligned with the patient’s job requirements. In the workers’ comp context, communication between providers, employers, and case managers is essential. Modified duty programs can support a smoother return to work and prevent re-injury.

Challenges in the Workers’ Comp Environment

A few considerations unique to the work comp arena:

• Pre-existing Conditions – Many workers may have degenerative meniscal changes prior to a work-related event. The injury might “light up” a previously asymptomatic condition.

• Determining apportionment—what percentage of the condition is work-related—can be complex and may involve medical legal evaluation.

• Delayed Reporting – A worker may not report knee pain immediately, especially if symptoms develop gradually. This can complicate claim approval and may lead to disputes.

• Return-to-Work Barriers – Fear of reinjury, job dissatisfaction, or secondary gain concerns can hinder recovery. It’s important to identify and address these psychosocial factors early on.

To sum up: Meniscus tears, while often seen as routine orthopedic injuries, carry a wide range of implications in the workers’ compensation space. Timely diagnosis, evidence-based treatment, and coordinated return-to-work efforts are key to achieving optimal outcomes for injured workers—and for managing costs and litigation risks effectively.