From the Guidelines
For a 39-year-old patient with meniscus tearing, arthroscopic partial meniscectomy is a viable option after failing nonsurgical treatment, such as physical therapy, corticosteroid or other intra-articular injections, or other modalities, particularly in patients with mild-to-moderate knee osteoarthritis where meniscal tears may be a notable contributor to patient symptoms 1.
Initial Management
Initially, conservative management is recommended, including rest, ice application, compression, and elevation of the affected leg. Over-the-counter pain medications such as NSAIDs can help manage pain and inflammation.
- Rest: Avoid activities that aggravate the condition
- Ice application: 15-20 minutes several times daily
- Compression: With an elastic bandage
- Elevation: Of the affected leg
Physical Therapy
Physical therapy focusing on strengthening the quadriceps and hamstrings should be pursued for 6-8 weeks, with exercises like straight leg raises, hamstring curls, and stationary cycling.
- Straight leg raises
- Hamstring curls
- Stationary cycling
Surgical Intervention
If conservative measures fail to provide relief after 6-8 weeks or if the tear is large, unstable, or causing mechanical symptoms like locking or catching, surgical intervention through arthroscopic repair or partial meniscectomy may be necessary, as supported by the AAOS clinical practice guideline summary 1.
- Arthroscopic repair
- Partial meniscectomy
Post-Treatment Care
Following treatment, maintaining appropriate body weight and avoiding high-impact activities until fully recovered will help prevent recurrence.
- Maintain appropriate body weight
- Avoid high-impact activities until fully recovered
From the Research
Treatment Options for Meniscus Tears
- Meniscal tears may be managed through conservative physical therapy and nonsteroidal anti-inflammatory medications or operative intervention 2, 3
- Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time 2
- The treatment paradigm has shifted towards preserving or repairing the meniscus whenever possible due to its importance for the structural integrity of the knee joint and the risk of early osteoarthritis associated with meniscus excision 3
Patient-Specific Considerations
- Choosing an appropriate management strategy depends on multiple factors such as patient demographics and location of the tear 3
- For a 39-year-old patient, direct meniscus repair may be an option if the patient is healthy and has tears near the more vascular periphery of the meniscus 3
- However, the use of orthobiologics such as platelet-rich plasma and mesenchymal stem cells has shown promise in augmenting surgical repairs or as standalone treatments, although research for their use in meniscal tear management is limited 3
Conservative vs. Surgical Approach
- Exercise therapy and meniscectomy have yielded comparable results on pain and function, and exercise therapy compared to no exercise therapy after meniscectomy has shown conflicting evidence at short term, but was more effective on function at long term 4
- Degenerative meniscal tears, without symptoms of locking and catching, can be successfully managed by a proper regimen of physical therapy as a first line treatment, and surgical approach might be considered in case of poor response after conservative treatment 5
- There is no significant difference between conservative treatment and arthroscopic surgery in terms of knee pain and knee function at any follow-up evaluation 5