On Saturday, November 9, 2024, the third episode of “Sky Sport Doctor” aired, during which Dr. Fabrizio Tencone explained how to handle a meniscus injury in a football player. The episode is available online on the Sky Sport website.
What exactly are the menisci?
The menisci are two semi-disks of “rubbery” cartilage, two for each knee: the inner or medial meniscus and the outer or lateral meniscus.
They cushion the weight between the two bones of the knee, the femur and the tibia, and provide stability to the knee itself.
How do menisci tear?
Menisci tear mainly in two ways: suddenly, due to a single movement, often involving knee rotation and bending, or progressively, as they wear down from repetitive movements or degenerate over the years with aging.
This type of injury is called a meniscal tear and resembles a kind of “cut or crack” in the meniscus.
Does a torn meniscus always require surgery?
In general, it can be said that when the meniscus tears suddenly — the so-called acute injury — then yes, surgery is almost always necessary.
When it’s a progressive, degenerative injury, however, a conservative, non-surgical approach can be attempted. Rest, medication, and especially a comprehensive rehabilitation program may enable a return to sports.
To demonstrate how this decision — whether to operate or not — is a complex one, there are two recent, well-known examples in the sports world.
The first example is Pogba. In the summer of 2022, at the start of the season, he tore his meniscus during a game and, somewhat against the advice of his medical staff, decided to “try to avoid surgery”.
After more than a month, he seemed to be doing well and started running again, but when he began rotational movements and changes in direction — all his characteristic moves — he felt pain again and, at that point, underwent surgery.
But by then, his knee had developed a chronic inflammatory condition, and it took Paul many months to return.
The other example is Djokovic, in tennis.
In early June 2024, he injured his meniscus at the French Open during a match that he still finished and won in the 5th set. He had surgery three days later, and after about a month, he was able to resume intense training and preparation, reaching the Wimbledon final and winning the gold medal at the Paris Olympics about two months after his meniscus surgery.
The takeaway is:
if the meniscus tear is extensive, and your sport involves rotations and changes in direction, then meniscus surgery is almost always recommended.
What is the recovery time?
Return-to-sport times vary greatly depending on the choice of non-surgical, conservative treatment or the type of surgery performed.
The “so-called simple” arthroscopic meniscectomy, like the one Djokovic underwent, has relatively short recovery times—about 1–2 months. However, it’s important to note that the damaged portion of the meniscus is removed.
In the case of a meniscus suture or “repair,” the knee must initially remain still and protected for several weeks, and return-to-sport times are over 3–4 months.
In young people and athletes, meniscus suture surgery is recommended because it repairs and thus preserves the meniscus. The meniscus is not removed but rather stitched back together.
Even though recovery times are longer, the medium- and especially long-term benefits for knee health are enormous.
At 16–18 years old, having the patience to delay a return by 2–3 months to avoid having an arthritic knee at 30–40 is an excellent compromise. I say this especially to parents, who sometimes are in more of a hurry for recovery than their children are.
How important is good rehabilitation?
Rehabilitation, as always, is essential and generally consists of three distinct stages: an initial phase, an intermediate phase, and a final phase. This approach applies to almost all injuries.
In the initial phase, the knee must “rest,” reduce swelling, regain proper bending ability, and the pain should subside.
In this phase, rehabilitation still includes a series of exercises that “do keep the knee at rest,” but engage other parts of the body to maintain good muscular fitness in the thigh and overall conditioning.
The intermediate phase, which can last from 2 to 6 weeks, aims to resume running and return to the rehabilitation field.
During this period, various tests are conducted to measure the quality of the rehabilitation itself — “no guesswork involved!”
Strength recovery is measured using the isokinetic test, general physical condition is assessed by measuring lactic acid produced during running, and the athlete’s movements are studied during a series of sports exercises to determine if there is a predisposition to injury—and especially to reinjury.
The final phase is the one that “tests” the entire treatment process completed up to that point, and this phase can also last from 2 to 6 weeks.
It includes sessions on the rehabilitation field, performing jumps, sprints, and changes of direction—in short, all the typical movements of the athlete’s specific sport—and concludes with the doctor’s approval for a full return to regular sports activities.
We’ve understood that a meniscus injury requires a great deal of attention.
It deserves the proper attention; there are sports injuries with longer and more complex rehabilitation programs, but let’s not underestimate recovery after meniscus surgery. At this point, we should no longer say, “Oh, it’s just a meniscus!”
