Part of Patellar tendinopathy
Patellar tendonitis or a meniscus tear: how to tell them apart
Warning signs, and when to get help
Patellar tendonitis or a meniscus tear?
Start with what each one is, because the two problems are built differently and that is what you are feeling.
The patellar tendon is a rope. It carries the pull of your thigh muscles from the bottom of the kneecap to the top of the shin, it sits outside the joint, and when it is irritated it hurts at one point and in proportion to the work it is asked to do. Malliaras and colleagues (2015) put those two features together as the hallmark: pain at the bottom tip of the kneecap, and pain that climbs with the demand on the knee extensors, particularly in jumping and landing.
The meniscus is a cushion inside the joint. A torn piece can get in the way of the joint moving, so a tear produces behavior as well as pain: catching, locking, giving way, and swelling that collects inside the knee. The patellar tendinopathy program and the meniscus tear program are separate for that reason, and following the wrong one wastes months.
Where each one hurts
Two spots, a couple of finger widths apart, and you can check which is yours in about ten seconds.
For the tendon, sit with the leg straight and the thigh relaxed, push the kneecap gently toward the shin, and press just under its bottom tip. Jumper's knee is tender at that point and often nowhere else. Where jumper's knee hurts goes through that in more detail, including the three other places people mistake for it.
For the meniscus, bend the knee to a right angle and run a finger into the crease at the side of the joint, inner or outer. That crease is the joint line, and tenderness along it is a meniscal pattern rather than a tendon one. Where a meniscus tear hurts covers the versions that are felt at the back of the knee instead.
One press on each spot is enough to answer the question. Keep checking and both areas stay sore, which muddles the one piece of information you had.
What were you doing when it started?
This question separates them more reliably than the pain does.
A tendon creeps. People describe a few weeks of a niggle at the end of training, then a niggle that arrives earlier, then a session they had to stop. There is usually a change behind it: a jump back into a sport after a break, a new court or a harder floor, more games in a week, or a new strength program with squats in it. There is no moment to point to.
A meniscus tear usually has one. OrthoInfo describes a pivoting or cutting injury, and says you might feel a pop at the time. Most people can still walk on the knee afterward, which is exactly why they talk themselves out of it, and over 2 to 3 days the knee gradually becomes stiffer and more swollen. The pop itself, though, is not a wait and see sign, because a ligament and a kneecap make the same noise, which is why it sits on the emergency list at the foot of this page.
If you can name the second you felt it, think joint. If you can only name the month, think tendon.
Swelling, locking and giving way
These three belong to the joint, and a tendon does not produce them.
The NHS lists the symptoms of a meniscus tear as knee pain or tenderness, stiffness or swelling, difficulty bending, straightening or moving the knee, the knee giving way when you try to stand, and a crunching or clicking feeling. It also makes the point about timing that catches people out: the swelling may not start for a few hours or days.
A sore patellar tendon can look slightly thicker than the other side, and that is not the same thing as a knee filling with fluid. If your knee has visibly lost its shape, feels tight at the back, or will not bend as far as the other one, the swelling is inside the joint and the question has moved on. Swelling, locking and giving way covers those three properly, and a swollen knee and a knee that gives way go through the other causes of each.
Speed matters as much as the symptom. A knee that filled up within a few hours of a twist or a blow is on the emergency list at the foot of this page, not on the list of things to watch, and so is a pop or a snap at the moment of injury, however well you walked away from it. Swelling that fast is usually blood inside the joint, which comes from something torn or broken rather than from a cushion that has frayed.
What each one does when you squat
Both hurt when you squat, so the useful question is which part of the squat and what else happens.
A tendon hurts in proportion to the load and the depth. It bites on the way down and on the way back up, it is worse with weight, worse on one leg, and worse on a decline, which is why a single leg decline squat is used as a test for it. The pain stays at the same single point throughout.
A meniscus tends to complain at the bottom. Deep squatting and kneeling compress the back of the cushion, so the pain shows up at the end of the range, often with a catch, a clunk or a feeling that something is in the way. Squatting and kneeling with a meniscus tear is the page for that, and knee pain when squatting covers the movement in general. A knee that clicks painfully as it bends or straightens has its own same-day line below, and knee clicking and cracking explains why painless clicking does not.
Can you have both at once?
Yes. One knee is allowed to have two problems in it, and plenty do.
Nothing about a tendon problem protects the joint, and nothing about a tear protects the tendon. In middle age and beyond, a worn meniscus and a tendon that has been grumbling for a year can sit in the same knee, and a knee that has been guarded for months is often weaker in the thigh, which sets the tendon up to be the thing that hurts when training restarts.
Two practical consequences follow. Treating one and getting a partial improvement does not mean you picked the wrong one, and it does not mean the other diagnosis was wrong either. And an examination that reproduces each pain separately is worth more than any symptom list, which is a reason to be assessed rather than to keep reading.
A meniscus tear with no injury at all
A tear does not need a dramatic moment, which is why no story rules one out.
OrthoInfo describes meniscus tears happening either from acute trauma or from degenerative changes over time, and gives the example of an awkward twist while getting up from a chair being enough to tear an aging meniscus. So a reader in their fifties who cannot remember doing anything has not ruled out a tear by remembering nothing. A meniscus tear without an injury is the page for that version, and worn knees come with their own picture, which the knee osteoarthritis program covers.
The reverse trap is just as common. A single bad landing can be the session that finally tips a tendon over after months of build-up, so having a moment does not prove the joint is involved.
Patellar tendon pain after meniscus surgery
Enough people arrive with this exact sequence that it needs an answer of its own.
Your surgical team's instructions come first, ahead of anything on this page. The two operations on a meniscus are not the same recovery: OrthoInfo explains that the outer third of the meniscus has a rich blood supply, so a tear there may heal on its own or be repaired, while a tear in the inner two thirds cannot heal, so one that keeps causing symptoms and does not settle with other treatment is usually trimmed. A repair is protected for longer than a trim, and only the team that operated knows which you had, what the restrictions are, and where you should be by now. Meniscus surgery or physio covers that decision.
A repair is protected in two ways, and both of the numbers belong to your own surgeon: how much weight goes through the leg, and how far the knee is allowed to bend. There is no standard version of either. Cong and colleagues (2024) surveyed surgeons in the American Orthopaedic Society for Sports Medicine and found no agreement on either restriction, different limits for different tear patterns, and most surgeons bracing the knee after a repair. So a week number from a page, this one included, tells you nothing about your own knee, and the limits you were given are the ones to work inside.
Why the tendon starts hurting afterward is usually about the size of the steps. The knee extensors do much less for several weeks, then rehab and sport come back, and the tendon meets a demand it has not seen since before the operation. Malliaras and colleagues frame the whole treatment of this condition around what the tendon can currently tolerate and the jump in load that outruns it, and a return to training after surgery is one of the biggest jumps there is.
What to do with it is not complicated. Tell the surgical team, because a new pain in an operated knee gets checked rather than explained away, and because they may be happy for you to carry on. If they are, the tendon side of it is a dose problem, and the staged approach on the parent page is the same whether or not you have had surgery, as long as it stays inside the bend and weight limits your surgeon set.
Four signs in an operated knee are on the warning list below with a same-day route, and none of them is tendon pain: a wound that is more red, hot, swollen or painful, or leaking; a knee that is getting hotter, redder or more painful rather than settling; a knee that locks, catches, gives way or swells again after an operation on the meniscus, which can mean a repair has come apart before the tear healed or a trimmed meniscus has torn again; and a sudden loss of the ability to straighten the knee or lift the leg out straight. Read those lines rather than this paragraph, because they say what to do.
Do you need a scan to tell them apart?
Often not, and a scan answers a narrower question than people expect.
Both of these are diagnosed mostly from the history and the examination. For the meniscus, OrthoInfo describes the McMurray test, where the examiner bends the knee and then straightens and rotates it to put tension on the torn part, and pain, clicking or a clunking sensation can indicate a tear. For the tendon, the examination is the sore point plus what load does to it.
A scan earns its place when the diagnosis is genuinely unclear, when a tear that might be repairable is suspected, or when surgery is on the table. It does not sort out a tendon by itself: Malliaras and colleagues point out that tendon changes appear on imaging in people with no pain, and that symptoms often improve without the pictures changing. Does patellar tendonitis show up on MRI goes through what a report does and does not tell you.
An operated knee is a different question, and it is not one for this page. If you have had a meniscus repair and the knee has started locking, catching or swelling again, the team that did the operation decides whether a scan is worth doing, because they are reading it against what they saw inside the joint. Schoenecker and colleagues (2025) pooled the studies that compared examination findings and MRI with what a second look inside the knee actually showed, and neither the scan nor any single test told them reliably whether a repair had healed, though a joint line with no tenderness in it usually meant it had. A scan report after a repair is part of the answer rather than the answer.
What to do while you are waiting to be seen
What you hold back depends on which story you are in, so the waiting advice is not the same for both.
Where there was a moment, and the knee has swollen, catches or feels unreliable, leave running, sport and loaded squatting out until someone has looked at it. Where the leg feels as though it might not hold you, borrow a stick or crutches instead of finding out on the stairs. A strengthening program is the wrong thing to begin on a knee that locks, swells fast or gives way, because load on a joint that is mechanically blocked makes the blockage the problem.
Where it crept up over weeks and the knee behaves normally, the handling is the opposite of rest. Keep moving, cut the jumping and the deep loaded work right back for now, and keep the sessions short and flat.
Make a note of four things for the appointment, because they are hard to recall accurately once you are in the room. Whether there was a single moment, and what you were doing in it. The sore point, found with one fingertip. Whether the knee has caught, locked, swollen or given way, and how quickly the swelling appeared. And what provokes it today: a depth, a direction, a distance or a surface.
Exercises that are safe either way
There is a small overlap, and it helps to know it while you are waiting. None of it is for a knee that locks, gives way under you or swells within hours of being used, for the reason in the section above: that knee needs looking at before it needs loading.
One limit comes before the rest of this section, and it belongs to anyone whose knee has been operated on. A wall sit and a squat hold are both loaded knee bending, which is the movement a meniscus repair protocol restricts, so neither is a starting point for you until your surgeon or physical therapist has cleared that exercise by name. The same go-ahead is needed before any hopping, landing or twisting, and before any deep or loaded bending such as a full squat, a lunge or kneeling. Those limits often run for months after a repair and are lifted later than the ones on walking, so being allowed to put your weight through the leg says nothing about being allowed to hold a bent knee under load. If you have had a hip replacement, get the go-ahead from your surgeon or physio before you try a wall sit or a squat hold, because dropping below a right angle at the knee takes the hip past a right angle as well, and many surgeons ask you to avoid that for the first months after some operations.
Held positions that load the thigh without moving the knee much are usually the gentlest starting point for a sore tendon, and they ask little of the joint. Our wall sit page starts with holds of 10 to 30 seconds, 3 to 5 of them with a rest between, high up the wall before going lower, and the squat hold page uses a similar dose. Your physio will adjust this, and the depth matters more than the number. Set up where something solid is within reach, a worktop or the back of a chair, so that you can stand up out of the hold without the knee having to catch you. Keep breathing through every hold, since straining with a held breath can raise your blood pressure, and if you have high blood pressure or a heart condition, ask your doctor or physio about long holds first.
Begin at the shorter hold and the smaller number. A range like that is where to start, not a target to reach on the first day, and with a tendon the useful measure arrives the next morning rather than during the session. Malliaras and colleagues judge a level of loading by two things: minimal pain while you are doing it, and pain on your load test back to its usual level within 24 hours. A knee that is sorer or stiffer the following morning was given too much, and the answer is to drop back a step rather than to abandon the exercise. Keep in view what these two exercises are for, as well: they keep the leg working while you wait for an appointment, and they are not the loading program that treats a tendon, which is heavier and longer than this and gets set once somebody has examined the knee.
Two limits apply to both conditions. Stay out of the range that provokes the catch or the pinch, since there is nothing to gain from forcing a joint that is blocking. And stop the exercise, rather than pushing on, if the knee swells afterward, because swelling is the joint's answer and it overrules a program. A knee brace is a separate question with its own evidence, which knee braces for a meniscus tear and straps and braces for jumper's knee each cover.
When a knee will not wait
Skip the rest of the page if you need to, but not this section.
Four patterns do not wait, and the first of them is an emergency rather than an appointment. A knee that swelled inside a few hours of a twist, a fall or a blow, or where you felt a pop or a snap, goes to an emergency department straight away. The other three need medical advice the same day. A knee locked bent, which you cannot fully straighten even after gently trying. A knee that keeps giving way under you, or gave way after a recent injury. And a knee that is hot, red and swollen, or comes with a temperature or shivering.
There is a fifth, and it is the one most often taken for a locked knee. Where somebody else can straighten the knee fully but you cannot lift the straight leg off the bed or hold it up against gravity yourself, that points to the mechanism that straightens the knee, the kneecap itself and the tendons above and below it, rather than to the meniscus. OrthoInfo states that a completely torn patellar tendon leaves you unable to straighten the knee, and that people needing surgery do better when the repair is done soon after the injury. That one goes to an emergency department rather than to an appointment.
A locked knee has a window on it as well. The warning line below says that when a tear caught in the joint can be repaired, it should be done as early as possible, which is a reason to be seen now rather than to find out whether it frees itself. Everything is listed at the foot of the page in order of how soon it needs attention, including lines that belong to neither of these conditions but matter for anyone reading about a sore knee: a calf that is newly swollen, warm and tender, a knee that swells for no reason while you are on blood thinning medicine, and pain at night that keeps building. The NHS advice to see a doctor when knee pain is not improving within a few weeks still holds, and outer knee pain: IT band, meniscus or ligament is the better page if your pain sits on the outside of the knee rather than at the front.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: you felt a sudden pop or tearing feeling just above or below your kneecap, you can see or feel a dip there, the kneecap seems to have moved up toward the thigh or to sag lower than usual, or you suddenly cannot straighten your knee or lift your leg out straight. Stop exercising and go to an emergency department straight away, even if you can still walk, as this can be a torn tendon at the front of the knee, either below the kneecap (patellar tendon) or above it (quadriceps tendon). Do not drive yourself. A repair usually does better if it is done soon after the injury.
- Emergency: the knee has moved out of place, looks misshapen or is pointing at an odd angle, or you have tingling or no feeling in the knee, leg or toes, or your foot turns cold, pale or blue. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance.
- Emergency: the knee became very swollen very quickly, within a few hours of a twist, fall or blow, or you felt a pop or snap. Go to an emergency department straight away. Do not drive yourself: ask someone to drive you or call an ambulance.
Get help now, day or night
- Your tendon pain or swelling started while you were taking a fluoroquinolone antibiotic, such as ciprofloxacin or levofloxacin, or in the months after a course. Contact your doctor straight away. The UK medicines regulator (MHRA) advises stopping the antibiotic at the first sign of tendon pain or swelling and talking to your doctor. Hold off the knee exercises until you have been checked.
Get help today
- Same day: the pain started with a fall, a twist or a blow to the knee, or you cannot put weight on the leg. Get medical advice the same day.
- Same day: the knee is locked, which means it is stuck bent and you cannot fully straighten it, even after gently trying to move it, or you cannot bend or straighten the leg at all. Get assessed the same day by a doctor, at urgent care or at an emergency department. A torn piece of meniscus can get caught in the joint and block it, and when a tear like this can be repaired, it should be done as early as possible. A knee that catches for a moment and then frees itself can happen with a meniscus tear. That is not the same as a locked knee, but tell your physio or doctor about it.
- Same day: the knee keeps giving way under you, or it gave way after a recent injury, or it gives way and is also very painful or swollen. Get medical advice the same day. If it only happens now and then, with no recent injury and no swelling, it is not an emergency, but book an assessment with a physio or doctor in the next few days.
- Same day: the knee clicks painfully when you bend or straighten it. Get medical advice the same day. Painless clicking on its own is common.
- Same day: the knee swells up with no clear reason, especially if you take medicine to thin your blood. Get medical advice the same day.
- Same day: the knee is hot, red and swollen, or you have knee pain with a high temperature or feel hot, cold or shivery. Get medical advice the same day, and go to an emergency department if you feel very unwell. This can be a sign of infection in the joint, which needs treatment quickly.
- Same day: your wound becomes more red, hot, swollen or painful, starts to leak or ooze, is still leaking in the second week or has never stopped, has pus coming out of it or its edges start to come apart, or you have a high temperature or feel hot, cold or shivery. Contact your surgical team or get medical advice the same day. Redness can be harder to see on brown or black skin. If you feel very unwell, go to an emergency department. If you have a very high or very low temperature, shivering you cannot control, you are breathing very fast or finding it hard to breathe, you are confused or your speech is slurred, your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), or you have a rash that does not fade when you press it, call emergency services, as this can be sepsis.
- Same day: you suddenly cannot straighten your knee or lift your leg straight when you could before, often after a pop, a tearing feeling or a stumble, or you notice a dip just above or below your kneecap, or you suddenly cannot put weight on the leg, even without a fall. Keep your weight off it and contact your surgical team the same day. If you cannot reach them that day, go to an emergency department. A tendon at the front of the knee may have torn, and a repair works better when it is done soon.
- Same day: since an operation on your meniscus, the knee locks, catches or gives way again, or you feel a pop or a shift inside it, or it swells up or becomes much more painful after a twist, a kneel or a deep bend. Keep your weight off it and contact your surgical team, or get assessed the same day at urgent care or an emergency department. A repair can come apart before the tear has healed, and a trimmed meniscus can tear again. If the knee is only a little achy after a busy day, with no swelling and no catching, it is not an emergency, but tell your physio or surgeon in the next few days.
- Same day: a calf or thigh that is newly swollen or getting more swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that does not fit your injury or condition, or that feels different from normal muscle soreness after exercise. This can be a sign of a blood clot (deep vein thrombosis), especially after surgery, an injury, time in a cast or boot, a long trip or a spell of being much less mobile than usual. Get medical advice the same day. If you are also short of breath or have chest pain, call emergency services.
- Same day: pain at night or at rest that keeps getting worse. If you are being treated for cancer now, contact your cancer team the same day.
Book an appointment
- Within a day or two: pain at night or at rest that keeps getting worse. If you have had cancer, now or in the past, see your doctor sooner, within a day or two, and mention it, even if the pain is not getting worse. Do the same if you have knee pain and are losing weight without trying, even if it does not hurt at night.
- Within a few days: pain at night or at rest that keeps getting worse. See your doctor within a few days.
Common questions
Can patellar tendonitis cause a meniscus tear?
There is no evidence that one causes the other, and the two live in different places. The meniscus is a cushion inside the joint and it tears from a twist, a deep squat or, in a worn knee, from very little at all. OrthoInfo gives the example of an awkward twist getting up from a chair being enough in an aging meniscus. A sore tendon can change how you move and how much the thigh muscles are doing, which is a reason to get both looked at together, but it is not a mechanism for tearing cartilage.
Does a meniscus tear hurt below the kneecap?
Not usually as its main spot. Meniscal pain is felt along the joint line, which is the crease you can feel at either side of the knee with the knee bent, and it can also be felt at the back. Pain whose center is the bottom tip of the kneecap is tendon territory. The overlap that catches people out is a swollen knee, because a joint full of fluid aches everywhere and makes the front of the knee feel involved as well.
Why does my patellar tendon hurt after meniscus surgery?
Usually because the demand on the tendon changed twice: it dropped for several weeks while the knee was recovering, and then it came back, often in bigger steps than anyone planned. A tendon complains about the size of the step up rather than about the total. It is still worth telling your surgical team, because they are the only people who know which operation you had and what it is meant to feel like at this point, and because a new pain in an operated knee is checked rather than assumed.
Do you need an MRI to tell patellar tendonitis from a meniscus tear?
Often not. Both diagnoses are made mostly from the history and the examination, and a scan is useful when the picture is unclear, when a tear is suspected that might need repairing, or when an operation is being considered. Malliaras and colleagues (2015) also warn that tendon changes show up on scans in people with no pain at all, so an abnormal tendon on a report does not prove the tendon is the problem.
References
- Malliaras P, Cook J, Purdam C, Rio E. Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. Journal of Orthopaedic and Sports Physical Therapy. 2015;45(11):887-898. https://doi.org/10.2519/jospt.2015.5987
- Cong T, Reddy RP, Hall AJ, Ernazarov A, Gladstone J. Current Practices for Rehabilitation After Meniscus Repair: A Survey of Members of the American Orthopaedic Society for Sports Medicine. Orthopaedic Journal of Sports Medicine. 2024;12(2):23259671231226134. https://doi.org/10.1177/23259671231226134
- Schoenecker JH, Tollefson LV, Solaiman RH, Monson JK, Homan MD, Dornan GJ, Kennedy NI, Ronnblad E, LaPrade RF. A Lack of Joint Line Tenderness Is Consistent With a Healed Meniscus, But Positive Clinical Examination Findings and MRI Scans Are Inconsistent in Identifying Failure After Meniscal Repair: A Systematic Review and Subgroup Meta-analysis. The American Journal of Sports Medicine. 2025;53(7):1750-1760. https://doi.org/10.1177/03635465241295709
- American Academy of Orthopaedic Surgeons. Meniscus Tears. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/meniscus-tears/
- American Academy of Orthopaedic Surgeons. Patellar Tendon Tear. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/patellar-tendon-tear/
- NHS. Meniscus tear (knee cartilage damage). Page last reviewed 02 September 2026. https://www.nhs.uk/conditions/meniscus-tear/
- NHS. Knee pain. Page last reviewed 21 December 2023. https://www.nhs.uk/symptoms/knee-pain/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-21.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.