What is a meniscus?
Each knee has two menisci, the medial on the inside and the lateral on the outside. They are tough, rubbery crescents of cartilage, and they work as shock absorbers between the femur and the tibia, spreading weight across the joint and adding stability while you move.
How do meniscus injuries happen in rugby?
A meniscus usually tears when the knee twists with the foot planted, which is something rugby asks of you constantly in sidesteps, tackles, and rucks. The medial meniscus goes more often because it is anchored to the medial collateral ligament and has less room to move. The specific mechanisms:
- Planting the foot and twisting to offload or evade a tackler
- Being tackled while the knee is flexed and the foot is fixed on the ground
- Deep squat loading in the scrum, particularly for front-row forwards
- Forced hyperflexion during a ruck or breakdown clear-out
- Combined injuries, because meniscal tears often come alongside an ACL rupture
Types of meniscus tears
| Tear Type | What It Looks Like | Common Symptoms |
|---|---|---|
| Radial tear | A split running from the inner edge outward | Pain on the joint line, may worsen with twisting. Often starts as a small tear that can extend. |
| Bucket-handle tear | A large flap that can flip into the centre of the joint | The knee locks or catches, and you may not be able to fully straighten the leg. This often needs urgent treatment. |
| Horizontal tear | A split running along the length of the meniscus | Joint line aching, intermittent swelling, pain on deep squatting. |
| Degenerative tear | Fraying and thinning from wear over time | Gradual onset of stiffness and aching, typically in older or long-career players. |
Treatment options
Treatment depends on the type, size, and location of the tear, as well as your age and activity level. Your orthopaedic surgeon and physiotherapist will recommend the best approach after clinical assessment and MRI imaging.
| Approach | When It May Be Used | Typical Recovery |
|---|---|---|
| Conservative (no surgery) | Small, stable tears in the outer zone. Mild symptoms that settle with rehabilitation. | 4–8 weeks of guided rehabilitation |
| Meniscus repair (surgical) | Tears in the outer (vascular) zone, younger patients, tears alongside ACL reconstruction | 3–6 months. Slower recovery but preserves the meniscus for long-term joint health. |
| Partial meniscectomy (surgical) | Tears in the inner (avascular) zone that cannot heal. Bucket-handle tears causing locking. | 6–12 weeks. Faster recovery, but some cushioning is permanently lost. |
Rehabilitation and return to play
After a meniscectomy the rehab moves quickly, with the focus on settling swelling, getting range of motion back, and rebuilding the quads before you go near sport-specific work. After a repair it is slower, because the repaired tissue has to knit, so weight-bearing and deep flexion are usually restricted for the first four to six weeks.