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Meniscus irritation / age-related tear

A meniscus tear sounds dramatic, but in people over about 40 it’s often more like wrinkles inside the knee than a ripped piece of fabric. Age-related meniscus changes are extremely common on MRI – even in people with little or no pain – and are often seen alongside knee osteoarthritis.

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This page explains how degenerative meniscus irritation typically behaves, why not every tear needs surgery, when scans are useful, and what current evidence says about exercise-based physio versus arthroscopy. It’s written for adults 45–70 in Camberwell and Melbourne’s inner east who want clear, evidence-informed guidance without pressure or false promises

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What you’ll learn on this page

  • Typical symptom patterns for age-related meniscus problems

  • When an MRI or arthroscopy is useful (and when it usually isn’t)

  • Why exercise-based physiotherapy is now preferred over routine “clean-out” surgery for most degenerative tears

Typical symptoms & patterns

The meniscus is a C-shaped cartilage “shock absorber” inside your knee. With age-related or degenerative changes, people commonly report:

  • Pain around the joint line (medial or lateral side of the knee), often aching rather than sharp

  • Pain aggravated by twisting, squatting, kneeling, or deep bending

  • A feeling of catching, clicking, or grating – sometimes noisy but not always dangerous

  • Stiffness or discomfort with stairs, hills, or getting up from low chairs

  • Swelling that comes and goes, especially after heavier use

  • Occasional brief “pseudo-locking” (a momentary block to movement that eases when you wiggle the knee)

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A true locked knee – where the joint physically cannot straighten due to a mechanical block – is less common and is treated differently.

Why it happens

Degenerative meniscus lesions typically:

  • Occur in people over 35–40, often without a big trauma

  • Are frequently associated with knee osteoarthritis and other age-related joint changes

  • Can be present on MRI in many people with no knee pain at all

 

In other words, a tear on the scan in a middle-aged knee is often part of the normal ageing process rather than a fresh injury. The meniscus may fray and split gradually, like a well-used cushion rather than a brand-new one being ripped.

 

Pain usually comes from a combination of factors – sensitised joint structures, surrounding osteoarthritis, deconditioning, and loading habits – not just the imaging label. That’s why focusing only on “fixing the tear” surgically often doesn’t solve the whole problem.

When to see someone – and when to scan

When to see a physio or GP

Book an assessment if:

  • Knee pain has persisted for more than a few weeks

  • You’re noticing recurrent swelling, catching, or giving way

  • Twisting, squatting, or stairs are becoming harder or more painful

  • You’ve been told you have a tear on MRI and are unsure what to do next

 

A physio can help determine whether your pattern fits degenerative meniscus irritation, osteoarthritis, tendon issues, or something else, and can screen for red flags.

Red flags – when to seek urgent medical review

 

See a GP or emergency department promptly if you have:

  • A truly locked knee – you cannot fully straighten the knee after an acute incident

  • Significant trauma (fall, direct blow, high-force twist) with marked swelling and inability to weight-bear

  • Fever, redness, or feeling unwell with a very hot, swollen knee (possible infection)

 

These situations may need urgent imaging and medical or surgical input.

 

Do I need an MRI?

For atraumatic, non-locking knee pain in over-40s, multiple guidelines and consensus statements advise that an MRI is not routinely required before starting conservative management.

 

MRI is more likely to be useful when:

  • The history is unclear or atypical

  • There is suspicion of other significant pathology (e.g. ligament rupture, root tear, stress fracture, tumour, infection)

  • Symptoms are not improving after a good trial of appropriate rehab, and the results would change management

 

Even when MRI shows a meniscus tear, it does not automatically mean you need surgery. The decision is based on symptoms, function, and response to rehab – not the scan in isolation.

How we assess & plan at The Hip and Knee Physio (Camberwell)

​In your first consultation, we’ll typically:

  • Talk through your story – where the pain is, what brings it on, what you’ve tried so far, and what you want to get back to

  • Check how your hip and knee move under load – stairs, squats, step-downs, and walking or jogging patterns, within your tolerance

  • Test strength and control around the hip, knee, and ankle

  • Screen for other causes of knee pain (like fat pad irritation, tendon issues, or arthritis) and for any red flags that might need GP or specialist input

 

From there, you’ll leave with:

  • A clear explanation of what’s most likely driving your pain

  • A prioritised plan (not a long list of exercises) focused on load tweaks, key strength work, and technique changes

  • An idea of what progress might look like over the coming weeks, acknowledging that everyone responds at a different pace

 

If scans or a surgical opinion are appropriate, we’ll discuss that openly and liaise with your GP or orthopaedic specialist.

 

You can read more about broader knee care on the Knee Physiotherapy page and related blogs, then come back here when you’re ready to book.

FAQs –
Age-related meniscus irritation / tear

1. Do I need a scan (MRI) for a suspected meniscus tear?

Not always. For over-40s with gradual onset, non-locking knee pain, high-quality guidelines and position statements suggest starting with conservative care, not routine MRI and arthroscopy.

 

MRI becomes more relevant if your symptoms are atypical, severe, failing to improve despite good rehab, or if your clinician suspects another problem that would change treatment.

 

2. What if my knee clicks or grinds – is that the tear?

Clicking, popping, and grinding are very common in knees with or without meniscus tears or osteoarthritis. Noisy joints can be unnerving but are often not a sign of something being “destroyed”.

 

We pay more attention to pain, swelling, and function than to sounds alone. A painless click is usually low concern; a painful catch that repeatedly blocks movement needs more careful assessment.

 

3. When is surgery considered for a meniscus tear?

In middle-aged and older adults with degenerative tears, surgery is typically considered only when:

  • There is a true locked knee or clear mechanical block, or

  • There has been a significant acute tear in an otherwise healthy joint, or

  • You’ve had a thorough trial of good physio and medical care and still have disabling symptoms

 

Even then, surgery is a choice – and rehab is still required before and after.

 

4. Will a degenerative meniscus tear cause arthritis or make it worse?

Degenerative meniscus tears are strongly associated with osteoarthritis, and both likely reflect shared age-related joint changes. Some studies suggest that meniscectomy (removal of tissue) may be linked to increased OA risk over time, which is one reason routine “trimming” is now questioned.

 

The focus is on protecting function – strengthening muscles, managing load, and avoiding unnecessary tissue removal where possible.

 

5. Can an age-related meniscus tear heal?

The inner portions of the meniscus have limited blood supply, so a degenerative tear doesn’t “heal” like a cut in the skin. However, pain and function can improve significantly as the joint calms down and surrounding muscles get stronger, even though the MRI picture might not change much.

 

In practice, what matters is whether you can walk, climb, kneel, and live your life more comfortably, not whether the tear is still visible on a scan.

Local practicals – Camberwell clinic

​The Hip and Knee Physio consults from 1/3 Prospect Hill Road, Camberwell, a short walk from Camberwell Junction and public transport. The building offers good access and facilities, including accessible entry and amenities, and there is parking available nearby.

Book Now

If you’ve been told you have a “meniscus tear” or you recognise this pattern of joint line pain, catching, or clicking, and it’s starting to impact your walking or daily life, a structured assessment can help clarify your options.

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  • Book a meniscus injury consult in Camberwell – Book Now Hip and Knee Physio

  • Prefer to talk first? You can contact the clinic to discuss whether an appointment is appropriate for your situation

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