What are the initial treatment recommendations for a patient presenting with symptoms of a meniscus tear?

From the Guidelines

Initial treatment for a meniscus tear should prioritize conservative management with the RICE protocol, over-the-counter pain medications, activity modification, and physical therapy, as these measures can effectively reduce inflammation and promote healing, especially for degenerative tears in older adults or partial tears with minimal symptoms 1.

Key Components of Initial Treatment

• Rest the affected knee
• Apply Ice for 15-20 minutes every 2-3 hours
• Use Compression with an elastic bandage
• Elevate the leg when possible

Pain Management

• Over-the-counter pain medications such as ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily with food) can help manage pain and reduce inflammation for 1-2 weeks 1
• Topical agents for OA of the knee (e.g., NSAIDs and capsaicin) may also be considered

Activity Modification and Support

• Avoid movements that cause pain, particularly deep squatting, pivoting, or twisting
• A knee brace may provide stability during daily activities

Physical Therapy

• Focusing on quadriceps and hamstring strengthening exercises should begin once acute pain subsides, typically within 1-2 weeks
• Physical therapy can help improve function and reduce pain

Considerations for Surgical Intervention

• If symptoms persist beyond 6-8 weeks of conservative treatment, or if mechanical symptoms like locking or catching are present, orthopedic consultation for possible surgical intervention may be necessary 1
• Arthroscopic partial meniscectomy may be an option for patients with mild-to-moderate knee osteoarthritis and meniscal tears that do not respond to conservative treatment 1

From the Research

Initial Treatment Recommendations for Meniscus Tear Symptoms

The initial treatment recommendations for a patient presenting with symptoms of a meniscus tear include:

• Conservative management with physical therapy and nonsteroidal anti-inflammatory medications 2
• Reduction of swelling and pain, followed by rehabilitation stressing tri-planar functional retraining 3
• Use of the RICE protocol (rest, ice, compression, elevation) and therapeutic ultrasound to decrease pain and increase range of motion (ROM) of the knee 4

Surgical Intervention

Surgical intervention may be necessary for certain types of meniscus tears, such as bucket handle tears or non-vascularized meniscal injuries 3

• Meniscal repair is currently preferred over partial meniscectomy to avoid premature osteoarthritis 3, 2
• Preservation of the meniscus should be considered as the first line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to meniscus repair 5

Rehabilitation Protocols

Rehabilitation protocols should be tailored to the individual patient's needs and may include:

• Functional progression to sports or work-specific activities 3
• A specific rehabilitation protocol related to the surgical procedure performed 6
• Therapeutic ultrasound and physical therapy to promote functional gains and progress in the rehabilitation program 4