What are the symptoms and treatment options for a known meniscal (cartilage of the knee joint) tear?

From the Guidelines

A meniscal tear should be initially managed with conservative treatment, including physical therapy, exercise, and pain management with oral nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, as surgical intervention is not always necessary and may not provide significant improvement in symptoms for patients with degenerative knee arthritis and meniscal tears. The symptoms of a meniscal tear can vary, but common complaints include pain, swelling, and mechanical symptoms such as locking or catching of the knee joint. When considering treatment options, it is essential to weigh the potential benefits and risks of each approach. According to the most recent and highest quality study 1, conservative management strategies, such as exercise therapy, injections, and drugs, can be effective in managing symptoms and improving function in patients with meniscal tears. Some key points to consider when managing a meniscal tear include:

• Resting the affected knee and avoiding activities that exacerbate symptoms
• Applying ice and using compression to reduce pain and inflammation
• Elevating the leg to reduce swelling
• Taking over-the-counter pain relievers, such as ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours), to manage pain and inflammation
• Engaging in physical therapy exercises to strengthen the quadriceps and hamstring muscles and improve knee stability
• Considering intra-articular injections, such as corticosteroids, for patients who do not respond to conservative management For patients with severe tears or persistent symptoms, surgical intervention, such as arthroscopic partial meniscectomy, may be necessary, especially for larger tears or those in the outer portion of the meniscus where blood supply is better 1. However, the decision to proceed with surgery should be made on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and response to conservative management. It is also important to note that meniscus tears in patients with knee osteoarthritis are often a result of the degenerative process, and surgical treatment of the meniscus tear may not provide significant improvement in symptoms for these patients 1. Ultimately, the goal of treatment is to alleviate symptoms, improve function, and prevent long-term joint damage and arthritis, and the most effective approach will depend on the individual patient's needs and circumstances.

From the Research

Symptoms of Meniscal Tears

• Pain and swelling in the knee joint 2, 3
• Limited range of knee motion 2
• Mechanical symptoms such as locking or catching of the knee joint 4

Treatment Options for Meniscal Tears

• Non-operative treatment:
  • Physical therapy and nonsteroidal anti-inflammatory medications 5, 4
  • Structured physical therapy program as a first line of treatment for degenerative tears in older patients without mechanical symptoms 4
• Operative treatment:
  • Meniscectomy (partial or total) 4, 2, 3
  • Meniscal repair, which is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time 5, 4, 3
  • Meniscal repair is more suitable in younger patients with reducible tears that are peripheral and horizontal or longitudinal in nature 4
• Other treatment options:
  • Arthroscopic partial meniscectomy (APM) 2, 3
  • Partial meniscal implants, which have shown excellent outcomes in long-term studies but require further research in acute settings 3
  • Meniscal regeneration techniques, which look promising and may be the way forward in the treatment of meniscal tears 3

Factors Influencing Treatment Outcomes

• Patient factors:
  • Age 4, 2, 3
  • Co-morbidities 4
  • Compliance with treatment 4
• Tear characteristics:
  • Location of tear 4
  • Age of tear 4
  • Reducibility of tear 4
  • Type of tear (degenerative or traumatic) 4, 3