What is the treatment for a medial meniscus tear in a young active patient?

Treatment of Medial Meniscus Tears in Young Active Patients

Conservative management should be the first-line treatment for medial meniscus tears in young active patients, with surgery reserved only for specific circumstances such as true locked knee, complete failure of conservative management, or acute traumatic tears that significantly impact quality of life. 1

Initial Conservative Management (6-8 weeks minimum)

Conservative management is supported by high-quality evidence and should include:

1. Physical therapy program:

   • Neuromuscular and strengthening exercises under supervision
   • Young patients have shown important clinical improvements after 4-10 weeks of supervised exercise therapy 2
   • Should focus on quadriceps and hamstring strengthening, proprioception, and functional exercises

2. Pain management:

   • Oral or topical NSAIDs
   • Corticosteroid injections for short-term pain relief (up to 3 months), particularly useful for managing synovial effusion and inflammation 1
   • Caution: Steroid injections may inhibit healing and reduce tensile strength of tissue

3. Activity modification and weight management

Indications for Surgical Management

Surgery should only be considered when:

1. The patient has a true locked knee
2. Complete failure of a full course of conservative management (minimum 6-8 weeks)
3. Symptoms significantly impact quality of life
4. Young patients with acute traumatic tears (not degenerative tears) 1

For young active patients specifically, the following surgical approaches may be considered:

• Meniscal repair rather than meniscectomy whenever possible:

  • Particularly for longitudinal vertical tears in vascularized zones
  • Posterior ramp lesions, traumatic root tears, and radial lesions 3
  • Horizontal cleavage tears in young athletes 3

• Arthroscopic partial meniscectomy:

  • Only when repair is not possible
  • Should be limited to preserve as much meniscal tissue as possible 4

• Meniscal allograft transplantation:

  • A salvage procedure for young patients with previous total or subtotal meniscectomy 4

Important Considerations and Pitfalls

1. Avoid rushing to surgery:

   • Many patients improve with conservative management alone
   • A thorough trial of conservative therapy lasting at least 6-8 weeks is essential 1

2. Don't overrely on MRI findings:

   • Asymptomatic meniscal tears are common, especially in patients over 35
   • Clinical correlation is critical 1

3. Consider the type of tear:

   • Traumatic tears in young patients may benefit more from repair than degenerative tears
   • Degenerative tears often respond well to conservative management 5

4. Meniscal preservation is crucial:

   • "Save the meniscus" should be the guiding principle
   • Meniscectomy may lead to deterioration over time and increased risk of osteoarthritis 3, 4

5. Regular assessment:

   • Monitor pain levels and functional improvement
   • Consider repeat imaging only if symptoms significantly worsen or change in character 1

For young active patients, the evidence strongly supports attempting conservative management first, with a focus on preserving meniscal tissue if surgery becomes necessary. Physical therapist supervision during the conservative management phase has been shown to be important for optimal outcomes 2.