What is the treatment for an acute meniscal tear?

Treatment of Acute Meniscal Tears

Conservative management should be the first-line treatment for acute meniscal tears, with structured exercise therapy, pain management, and activity modification for at least 6-8 weeks before considering any surgical intervention. 1

Initial Assessment and Classification

When evaluating a patient with an acute meniscal tear, consider:

• Patient age (younger vs. older than 35 years)
• Mechanism of injury (traumatic vs. degenerative)
• Presence of mechanical symptoms (true locking vs. pain with motion)
• Location and type of tear (peripheral vs. central, pattern of tear)

Treatment Algorithm

First-Line Treatment: Conservative Management

For all acute meniscal tears, especially degenerative tears in patients over 35 years:

• Structured exercise program including:

  • Range of motion exercises
  • Weight-bearing exercises
  • Low-impact aerobic activities 1

• Pain management:

  • Oral or topical NSAIDs 1
  • Activity modification
  • Bracing if needed

• Duration: Minimum 6-8 weeks of conservative treatment before considering surgery 1

Second-Line Treatment: Corticosteroid Injections

• May provide short-term pain relief (up to 3 months)
• Use with caution as they may inhibit healing and reduce tissue tensile strength 1

Surgical Intervention Considerations

Surgery should only be considered in specific circumstances:

1. Failure of conservative management after 6-8 weeks
2. Significant impact on quality of life
3. True mechanical symptoms like locked knee (not just pain or clicking)
4. Patient factors: younger age, higher activity demands, specific tear patterns amenable to repair 1

Surgical Options:

1. Meniscal repair (80% success rate at 2 years):

   • Best for younger patients
   • Peripheral tears (red-red or red-white zone)
   • Horizontal or longitudinal tears
   • Reducible tears 2

2. Partial meniscectomy:

   • For tears not amenable to repair
   • More suitable when peripheral rim is intact
   • May be appropriate for specific patients with mild-to-moderate knee osteoarthritis where meniscal tears contribute to mechanical symptoms 1, 3

Important Caveats

• Arthroscopic surgery is NOT recommended for degenerative knee disease as it provides no clinically meaningful improvement over conservative management 4, 1
• Asymptomatic meniscal tears are common, especially in patients over 35, so MRI findings must be correlated with clinical symptoms 1
• Meniscal repair shows better long-term outcomes than partial meniscectomy and should be considered for appropriate tears, especially in younger patients 5, 6
• Post-repair rehabilitation often requires bracing and non-weight bearing for 4-6 weeks, requiring good patient compliance 2

Monitoring and Follow-up

• Regular assessment of pain levels and functional improvement
• Patient education about the condition and self-management strategies
• Progression of physical therapy as tolerated
• Consider repeat imaging only if symptoms significantly worsen or change in character 1

The evidence strongly supports starting with conservative management for acute meniscal tears, with surgical intervention reserved for specific cases that fail to respond to non-operative treatment. This approach prioritizes patient outcomes while minimizing unnecessary surgical risks.