From the Research
For a patient with multifocal medial meniscal tears, parameniscal cyst, and grade 1 MCL sprain, initial treatment should focus on conservative management including rest, ice, compression, and elevation (RICE protocol) for 1-2 weeks, followed by physical therapy for 6-8 weeks, as this approach has been shown to be effective in managing meniscal tears and MCL sprains, with the potential to avoid surgical intervention 1. The patient should take NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for pain and inflammation for 1-2 weeks.
- Key aspects of physical therapy include:
- Quadriceps strengthening
- Range of motion exercises
- Proprioception training A hinged knee brace should be worn during daily activities for 3-4 weeks to protect the MCL while it heals. If symptoms persist after 6-8 weeks of conservative treatment, surgical intervention may be necessary, typically arthroscopic partial meniscectomy or repair for the meniscal tears and cyst decompression, as meniscal repair has been shown to have better functional outcomes and less severe degenerative changes over time compared to partial meniscectomy 1. The conservative approach is preferred initially because grade 1 MCL sprains typically heal well without surgery, and some meniscal tears may respond to non-operative management, with the goal of preserving the meniscus and preventing early osteoarthritis 2. The parameniscal cyst, which forms from synovial fluid leaking through the meniscal tear, often resolves when the underlying tear is addressed. It is essential to note that the treatment paradigm has shifted towards preserving or repairing the meniscus whenever possible, given its importance for the structural integrity of the knee joint and the risk of early osteoarthritis associated with meniscus excision 2. In making treatment decisions, it is crucial to consider the patient's demographics, the location of the tear, and the potential benefits and risks of surgical intervention, with the ultimate goal of improving patient outcomes and reducing morbidity and mortality.