Dr. João Ricardo Soares

Orthopedist

Menisci:
The silent protectors of your mobility

HPA Magazine 24 // 2025

The knee menisci are essential structures for the health and proper functioning of our joints. Present in each knee, they play a fundamental role in absorbing impacts, stabilizing, and protecting the joint.
In this text, we will explore what menisci are, their functions, the main types of injuries, treatment options, and how to care for these structures to ensure an active and pain-free life.

What are menisci and what are they for?
The menisci are two half-moon-shaped structures made of fibrocartilage, located between the femur (thigh bone) and the tibia (leg bone) inside the knee. Each knee has two menisci: the medial (on the inside) and the lateral (on the outside).
For a long time, it was believed that the menisci had little use, but today we know that they are true protectors of the joint.
Main functions of the menisci:
• Impact cushioning: The menisci absorb up to 60% of the forces that fall on the knee, acting as natural shock absorbers and protecting the articular cartilage.
• Knee stabilization: They help the ligaments keep the joint stable, especially during rotational movements and changes of direction.
• Improved joint congruence: The shape of the menisci allows the femur and tibia to adapt better, making movement more efficient and safer.
• Lubrication and nutrition: The menisci help distribute synovial fluid, which lubricates and nourishes the cartilage, contributing to its long-term health.
• Protection against overload: By redistributing loads, they prevent premature wear of the cartilage and the development of osteoarthritis.

Acute and degenerative pathology of the meniscus
Meniscal injuries can be divided into two main groups: acute (traumatic) and degenerative.
Acute injuries
These usually occur in younger, more active people, often during sports, due to sudden rotational, twisting, or impact movements. Typical symptoms include:
• Sudden, localized pain
• Increased knee volume
• Sensation of crepitus or locking
• Difficulty walking, squatting, or bending the knee.
In some cases, fragments of the injured meniscus can move within the joint, causing movement blockage or a sensation of “something loose”.
Degenerative injuries
Most common in people over 35, especially the elderly, these injuries develop slowly, without specific trauma. They are related to the natural wear and tear of the meniscus, which loses elasticity and resistance over time. Degenerative changes do not necessarily cause complaints, but symptoms may appear, usually gradually:
• Mild pain, which worsens with rotational movements or forced flexion
• Popping or a feeling of a catch during movement
• Swelling due to the accumulation of inflammatory fluid
• In advanced cases, there may be movement limitation
Over time, the loss of meniscal function increases the risk of osteoarthritis and deformities in the alignment of the leg.

Types of treatment: conservative and surgical
The treatment of meniscal injuries depends on several factors, such as age, type and location of the injury, symptoms, and the patient's level of activity. It should be based on the history of the injury, clinical evaluation, and, when necessary, imaging tests.
Conservative treatment
In most cases, especially in degenerative injuries or small acute injuries, the initial treatment is conservative:
• Rest and protection: Avoid activities that cause pain or overload on the knee.
• Ice and elevation: To reduce swelling and relieve pain.
• Medication: Painkillers and anti-inflammatories may be prescribed to control symptoms.
• Physiotherapy: To restore range of motion, strengthen the muscles around the knee, and improve balance and coordination.
The goal is to relieve symptoms and allow a return to normal activities while preserving as much healthy meniscal tissue as possible.
Surgical treatment
Surgery is indicated when conservative treatment does not resolve symptoms or in cases of severe injuries, with joint blockage or loose fragments.
The most common procedure is knee arthroscopy, a minimally invasive surgery that allows the injury to be viewed and treated directly. There are two main approaches:
• Meniscectomy: Partial removal of the injured meniscus, preserving as much healthy tissue as possible. Although it relieves symptoms, it can increase the risk of future wear and tear on the joint.
• Meniscal suture: When possible, the meniscus is repaired to try to promote healing. This is the best option because it maintains the function of the meniscus, but it depends on the location and type of injury.
The decision between meniscectomy and suture is made during surgery, based on the viability of the meniscal tissue.

Recommendations for maintaining healthy menisci
Maintaining the health of the menisci is essential to ensure mobility and quality of life over the years.
Some important recommendations:
• Muscle strengthening: Regularly exercise the thigh and leg muscles to provide support and stability to the knee.
• Balance and coordination training: Helps prevent falls and sudden movements that can cause injuries.
• Warming up before physical activities: Prepare the muscles and joints before sports or intense exercises.
• Proper technique: Learn and practice correct movements, especially in sports that require rapid changes of direction.
• Avoid overloading and twisting: Respect the limits of your body and avoid sudden movements or excesses during training.
• Use protective equipment: Knee pads and appropriate footwear can help protect the knee during sports activities.
• Maintain a healthy weight: Excess weight increases the pressure on the knees and accelerates the wear of the menisci.

Summary – Key points about knee menisci
• Menisci are crescent-shaped fibrocartilage structures located between the femur and tibia.
• Their main functions are: to absorb impacts, stabilize the knee, improve joint congruence, and lubricate/nourish the cartilage.
• Injuries can be acute (traumatic) or degenerative (wear and tear over time).
• Common symptoms include: pain, swelling, “popping,” blocked movement, and a feeling of instability.
• Treatment can be conservative (rest, physical therapy, medication) or surgical (arthroscopy for suturing or partial removal).
• Maintaining healthy menisci depends on muscle strengthening, good physical preparation, correct movement techniques, weight control, and prevention of overload.
• In case of persistent symptoms, seek an orthopaedic doctor for evaluation and appropriate guidance.

Caring for the menisci means caring for your freedom of movement.
Be proactive and keep your knees healthy.