What are the treatment options for a knee meniscus (fibrocartilage structure in the knee joint) tear?

From the Guidelines

Treatment for a knee meniscus tear should initially focus on conservative measures, including the RICE protocol, physical therapy, and pain management with over-the-counter medications, before considering surgery, as recommended by the most recent and highest quality study 1.

Conservative Measures

• Follow the RICE protocol: Rest the knee, apply Ice for 15-20 minutes every 2-3 hours, use Compression with an elastic bandage, and Elevate the leg when possible
• Physical therapy should focus on strengthening the quadriceps and hamstrings through exercises like straight leg raises, hamstring curls, and gentle range-of-motion activities
• A structured PT program typically lasts 6-8 weeks with 2-3 sessions per week

Pain Management

• Take over-the-counter medications like ibuprofen (Advil, Motrin) 400-800mg three times daily or naproxen (Aleve) 220-440mg twice daily with food
• Consider oral nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, as they have been shown to be effective in managing knee osteoarthritis pain 1

Surgical Intervention

• If conservative treatment fails after 6-12 weeks or if you have a severe tear causing locking or significant instability, arthroscopic surgery may be necessary
• Arthroscopic partial meniscectomy is an option for patients with mild-to-moderate knee osteoarthritis and meniscal tears that do not respond to nonsurgical treatment 1

Key Considerations

• The treatment of knee meniscus tears should be tailored to the individual patient, taking into account factors such as age, comorbidity, and the presence of inflammation 1
• Sustained weight loss has been shown to benefit pain and function in overweight and obese patients with knee osteoarthritis, and should be considered as part of the treatment plan 1

From the Research

Treatment Options for Knee Meniscus Tears

• Preservation of the meniscus is considered the primary goal in the treatment of meniscus tears, as it helps prevent early osteoarthritis 2
• Meniscus repair is a viable alternative to partial meniscectomy, especially in young and physically active patients, as it aims to achieve meniscal healing while avoiding the adverse effects of partial meniscectomy 3
• Arthroscopic partial meniscectomy (APM) is currently the most performed orthopedic procedure, but recent studies have shown that outcomes after APM are no better than those after sham/placebo surgery 4, 3
• Physical therapy (PT) is also an effective treatment option, especially when combined with hyaluronic acid injection (HAI), although HAI has no additional effect on pain and functional results 5

Indications for Meniscus Repair

• Meniscus repair is recommended for repairable tears, especially in young and physically active patients 2, 3
• The decision to perform meniscus repair should be based on the type and location of the tear, as well as the patient's overall health and activity level 6
• Meniscus repair can lower the rate of degenerative changes compared to meniscectomy, especially when performed early 2, 6

Diagnostic Imaging

• MRI is the imaging modality of choice for diagnosing meniscal tears, although its use should be determined by a musculoskeletal specialist 2
• MRI can help identify concomitant pathologies and guide treatment decisions 2

Outcomes and Prognosis

• The prognosis for meniscus tears varies depending on the type and location of the tear, as well as the treatment approach 2, 5
• Meniscus repair has been shown to have better long-term outcomes compared to partial meniscectomy 2, 3
• Physical therapy can improve range of motion and functional results, although it may not be as effective in reducing pain and improving quality of life compared to APM or meniscus repair 5