Meniscus tear

What it is

Two C-shaped wedges of tough cartilage, the medial and lateral menisci, sit between the thigh bone and the shin bone. They spread load across the joint, deepen the surface, and help the knee track. They tear either suddenly, from twisting on a bent and loaded knee, or gradually, as the tissue becomes more brittle with age. The outer third has a blood supply and can heal, while the inner two thirds mostly cannot, and that single fact drives most of the difference between treatment plans.

How volleyball causes it

The mechanism is twisting on a planted, bent knee. In volleyball that is most often a defensive movement: dropping into a low dig, the foot fixed, and the body rotating over it to play a ball that is not quite where you wanted it. The plant step of a slide approach does the same thing at speed, and so does spinning to chase a ball into the back court. Menisci also tear at the same instant as an ACL, because the landing that ruptures the ligament pinches the cartilage in the same movement. In players over about 35, the tear can be almost trivial in origin, a deep squat to pick up a ball is enough.

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What it feels like

• Pain along the joint line, the crease you can feel on the inside or outside of the knee between the two bones
• Swelling that comes on gradually over the following day rather than in the first hour
• Catching, clicking or a sense that something snags as the knee moves through a certain point
• Difficulty squatting all the way down or sitting back on your heels
• The knee feels unreliable going down stairs or coming out of a low defensive position
• A deep ache at the back of the knee at full bend

Stop and get it seen if

• The knee is stuck bent and cannot be straightened, with a firm block at the end of the range. That is likely a torn fragment jammed in the joint and needs seeing quickly.
• There was also a pop with the knee giving way and the joint swelled within a couple of hours. That points to an ACL injury alongside the meniscus.
• Cannot take weight through the leg, or there is bony tenderness on the kneecap or the top of the shin. Suspect fracture.
• The knee is hot, red, and increasingly swollen with fever or feeling unwell. Joint infection is an emergency.
• Repeated episodes of the knee collapsing under you, especially if they are getting more frequent.

What recovery usually looks like

Stages, not a schedule. Everyone moves through these at their own pace, and the ranges are wide because real recoveries are.

1. 1. Settle the joint and restore range

   1 to 4 weeks, and similarly after any surgery

   Reduce the swelling and get full straightening and bending back, whether the plan is surgical or not.

   • Full straightening compared with the other knee
   • Swelling reduced and the joint no longer feels tight
   • Walking without a limp
   • Catching episodes less frequent or gone

2. 2. Strength and control

   4 to 12 weeks

   Rebuild quadriceps, hamstring and hip strength and re-establish squat control without provoking the joint.

   • Can squat to roughly parallel without joint line pain
   • No swelling the morning after training days
   • Single-leg control steady without the knee falling inward
   • Strength gap between the legs narrowing

3. 3. Twist, land and return

   6 weeks to 4 months if the tear was managed conservatively or trimmed surgically, and 4 to 6 months or longer if it was repaired with stitches, because repaired tissue needs protected healing time

Ready to play again when

• No catching, locking or giving way for several weeks
• Full bending range compared with the other knee
• Deep squat and single-leg squat without pain along the joint line
• No swelling the morning after a full session including jumping and defensive movement

Keeping it from coming back

This is ordinary training, so unlike the rest of this page it does tell you what to do.

• Build strength through the range you actually use on court. Goblet squats and rear-foot-elevated split squats taken to a genuinely deep position prepare the joint for low digging positions instead of leaving deep range untrained.
• Hip and glute strength: single-leg Romanian deadlifts, banded lateral walks, hip thrusts. Rotation should come from the hip, not be ground out through the knee.
• Practise pivoting off the ball of the foot rather than twisting on a planted heel, and drill defensive footwork so your feet get to the ball and your knee is not asked to rotate to make up the difference.
• Ankle mobility work, particularly knee-to-wall dorsiflexion. A stiff ankle stops the shin travelling forward and pushes the twist up into the knee.
• Landing and deceleration drills, the same ones that reduce ACL injuries. A large share of meniscus tears happen in exactly that event.