From the Guidelines
Therapeutic options for a nondisplaced longitudinal medial meniscus tear should initially focus on conservative management, as the benefits of arthroscopy may not outweigh the burden and risks, according to a clinical practice guideline published in the BMJ in 2017 1. The initial treatment includes rest, ice, compression, and elevation (RICE protocol), along with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) for pain and inflammation reduction.
- Physical therapy focusing on quadriceps and hamstring strengthening exercises is essential, usually recommended for 6-8 weeks.
- For patients with persistent symptoms, a corticosteroid injection into the knee joint may provide temporary relief. If conservative measures fail after 6-12 weeks, surgical intervention may be considered, with arthroscopic partial meniscectomy or meniscal repair being the primary options.
- Meniscal repair is preferred when possible as it preserves meniscal tissue and reduces long-term osteoarthritis risk. The choice between conservative and surgical management depends on several factors including the patient's age, activity level, tear location, and symptom severity, as highlighted in a randomized controlled trial published in The BMJ in 2016, which found that knee arthroscopy was no better than exercise therapy for patients with a degenerative medial meniscus tear 1. Longitudinal tears in the peripheral "red zone" of the meniscus have better healing potential due to better blood supply, making them more amenable to repair compared to tears in the central "white zone."
From the Research
Therapeutic Options for Nondisplaced Longitudinal Medial Meniscus Tear
- Platelet-rich plasma (PRP) injections: Studies have shown that PRP injections can achieve significant clinical and functional improvement in patients with stable meniscal injuries, including nondisplaced longitudinal medial meniscus tears 2, 3, 4.
- Intra-meniscal PRP injection: This technique has been shown to be a promising modality for managing low-grade meniscal injuries, with significant improvement in clinical and radiological outcomes 3.
- Meniscus-targeted injections: Corticosteroid injections targeted at the meniscus have been shown to produce substantial pain relief, with an average duration of 5.68 weeks 5.
- Conservative management: This approach is commonly implemented and may be the only option for certain patients, but it may not be effective for all cases 6.
- Surgical options: Partial meniscectomy and meniscal repair are also available, but these may have limitations and side effects, and are not always the first-line therapy 6.
Key Considerations
- Patient characteristics, comorbidities, and overall function and satisfaction should be carefully assessed when determining the optimal management plan 6.
- The type and location of the tear, as well as the patient's activity level and symptoms, should also be taken into account when selecting a therapeutic option 2, 3, 6.
- Further research is needed to validate the results of PRP injections and other therapeutic options, and to determine which patient populations will benefit most from these treatments 2, 3, 4.