1. Introduction / Plain Theory

The menisci are two crescent-shaped fibrocartilaginous structures located between the femur and tibia in each knee joint.
They act as shock absorbers, enhance joint stability, and distribute load during movement.

Meniscal pain arises when these structures are torn, irritated, or degenerated, often leading to discomfort, stiffness, and impaired knee function.
In younger individuals, meniscal tears typically result from acute twisting or compression injuries (e.g., in sports).
In older adults, they more often occur gradually through degeneration — related to age, load imbalance, or chronic stress on the joint.

Degenerative meniscal changes are extremely common, affecting over 30% of adults above 50, even in those without significant symptoms.
Pain occurs when mechanical stress, inflammation, or reduced joint congruence alters the normal gliding motion between the femur and tibia.

2. Typical Symptoms and Functional Impact

• Localised pain or pressure in the knee joint line (inner or outer side).

• Clicking, locking, or catching sensations when bending or straightening the knee.

• Stiffness, especially after inactivity.

• Swelling or sense of fullness in the joint.

• Difficulty squatting, kneeling, or pivoting.

Functional impact:
Meniscal pain can restrict walking, running, and stair climbing.
Chronic irritation may alter gait, leading to secondary tension in the hips, pelvis, or opposite knee.

Red flags:
Sudden severe locking (knee cannot fully extend) or inability to bear weight may indicate a mechanical tear requiring imaging or surgical evaluation.

3. Contributing Factors / Underlying Causes

Meniscal irritation and degeneration occur when joint loading exceeds tissue adaptability or when movement patterns become unbalanced.

Common contributing factors include:

• Repetitive squatting, twisting, or kneeling.

• Previous knee injury or ligament instability.

• Age-related degeneration of cartilage and connective tissue.

• Poor quadriceps or gluteal strength, affecting knee stability.

• Pelvic or lumbar asymmetry, altering joint line loading.

• Foot or ankle dysfunction changing tibial rotation.

• Obesity or prolonged static posture, increasing compressive stress.

From an osteopathic viewpoint, meniscal problems often reflect impaired force transmission through the entire lower-limb chain — from pelvis to foot — rather than a purely local injury.

4. Osteopathic Approach

Osteopathic treatment aims to improve knee mechanics, relieve joint tension, and optimise load distribution across the lower limb.

An osteopathic assessment may include:

• Evaluation of knee alignment, range of motion, and joint play.

• Palpation of joint line tenderness, muscle tone, and fascial tension.

• Gentle mobilisation of the knee, hip, and ankle joints to restore mobility.

• Myofascial release of the quadriceps, hamstrings, and calf muscles.

• Indirect or functional techniques to reduce irritation and support circulation.

• Assessment and correction of pelvic and spinal mechanics influencing knee load.

• Guidance on graded exercise, stability training, and load management.

The goal is to restore functional movement and improve tissue adaptability, reducing pain and preventing further degeneration.

5. Scientific Evidence & References

Research supports manual therapy, exercise, and education as effective conservative management for degenerative meniscal pain.
High-quality trials have shown that, in most cases, structured conservative care is as effective as arthroscopic surgery for degenerative meniscal tears.

Osteopathic treatment integrates these evidence-based principles, focusing on restoring movement, load control, and functional recovery across the kinetic chain.

References

1. Khan M, et al. Surgery versus conservative management for degenerative meniscal tears: a systematic review and meta-analysis. BMJ. 2014;348:g2382. Link

2. Siemieniuk RAC, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: systematic review and meta-analysis. BMJ. 2017;357:j1982. Link

3. Thorlund JB, et al. Effect of exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear: randomized controlled trial. BMJ. 2016;354:i3740. Link

4. Logerstedt DS, et al. Knee pain and mobility impairments: meniscal and articular cartilage lesions – clinical practice guideline. J Orthop Sports Phys Ther. 2018;48(2):A1–A50. Link

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment. J Bodyw Mov Ther. 2015;19(2):254–265. Link

6. Degenhardt BF, Johnson JC, Fossum C, et al. Osteopathic manipulative treatment for degenerative knee pain: pragmatic pilot study. J Bodyw Mov Ther. 2017;21(4):857–865. Link

7. Kise NJ, et al. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tears: 10-year follow-up. Br J Sports Med. 2020;54(22):1332–1339. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for degenerative knee pain: network meta-analysis. Front Pain Res. 2024;15:1507511. Link