Treatment of Medial Meniscus Tear
Conservative management is strongly recommended as the first-line treatment for medial meniscus tears, with arthroscopic surgery specifically not recommended due to lack of clinically meaningful benefits over conservative approaches. 1
Initial Management Approach
The treatment of medial meniscus tears should follow a stepwise approach:
First-Line Conservative Management (6-8 weeks minimum)
- Physical therapy focusing on quadriceps and hamstring strengthening
- Weight management for overweight patients
- Activity modification to reduce knee loading
- Pain control with oral or topical NSAIDs
- Corticosteroid injections for short-term pain relief (up to 3 months), particularly useful for managing synovial effusion and inflammation 1
Conservative Treatment Components
- Supervised exercise programs focusing on:
- Quadriceps strengthening
- Range of motion exercises
- Proprioception training
- Core stability exercises
- Weight loss interventions for patients with BMI >25
- Bracing or taping for temporary symptom relief during activities
Evidence Against Arthroscopic Surgery
High-quality evidence strongly recommends against arthroscopic knee surgery for degenerative meniscus tears. The BMJ guidelines explicitly state that arthroscopic surgery provides no clinically meaningful improvement in long-term pain or function compared to conservative management, while introducing potential surgical complications and unnecessary healthcare costs (over $3 billion annually in the US alone) 2, 1.
Special Considerations
When Surgery Might Be Considered
Surgery should only be considered in very specific circumstances:
- True locked knee (not just catching or clicking)
- Complete failure of a full course of conservative management (minimum 6-8 weeks)
- Symptoms that significantly impact quality of life
- Young patients with acute traumatic tears (not degenerative tears) 2, 1
Common Pitfalls to Avoid
- Rushing to surgery: Many patients improve with conservative management alone
- Overreliance on MRI findings: Asymptomatic meniscal tears are common, especially in patients over 35
- Inadequate trial of conservative therapy: Conservative management should be thorough and last at least 6-8 weeks
- Ignoring associated osteoarthritis: Many meniscal tears occur in the context of early degenerative knee disease
Monitoring and Follow-up
- Regular assessment of pain levels and functional improvement
- Progression of physical therapy as tolerated
- Consider repeat imaging only if symptoms significantly worsen or change in character 1
By following this evidence-based approach, most patients with medial meniscus tears can achieve satisfactory outcomes without the risks and costs associated with surgery.