From the Guidelines

No, not all meniscal tears require surgery.

The current evidence suggests that arthroscopic partial meniscectomy provides no significant benefits over conservative management, such as exercise therapy, for patients with degenerative meniscal tears 1.
A randomized controlled trial found that arthroscopic partial meniscectomy provided no clinically relevant difference in Knee Injury and Osteoarthritis Outcome Score compared with a 12-week supervised exercise programme 1.
The BMJ Rapid Recommendations panel recommends against arthroscopic surgery for patients with degenerative knee disease, including those with meniscal tears, and suggests that conservative management should be the first line of treatment 1.
The evidence applies to patients with any severity of mechanical symptoms, with the only possible exception being those who are objectively unable to fully extend their knee 1.
Surgery may be considered as a second-line treatment when non-surgical measures have failed or in certain subgroups of patients who have been identified as “responders” to surgical treatment 1.
The choice of intervention should be based on a discussion between the patient and the healthcare provider, considering the patient's values and preferences, as well as the potential benefits and harms of each option 1.

From the Research

Not all meniscal tears require surgery, as evidenced by studies comparing surgical and non-surgical approaches 2, 3, 4
A study published in 2022 found that among young, active adults with meniscal tears, a strategy of early meniscal surgery was not superior to a strategy of exercise and education with the option of later surgery 2
Another study from 2018 found no significant differences in clinical outcomes between arthroscopic meniscal surgery and conservative management for degenerative meniscal tears in patients aged 40 years and older 3

Age is not considered a contraindication for meniscus repair, and meniscal repair should be performed if technically possible, as it is associated with better functional outcomes and similar failure rates 5, 6
Patient-, joint-, limb-, and meniscus-specific factors, including physiological age, should guide the surgeon toward successful treatment 6
Conservative treatment, including exercise, physiotherapy, and pain medication, should be offered as a first management approach for patients with symptomatic degenerative meniscal tears 4

Meniscal repair and partial meniscectomy are two common surgical options for treating meniscal tears 5
A study from 2023 found that meniscal repair was associated with better functional outcomes and similar failure rates compared to partial meniscectomy in patients aged 40 years and older 5
Arthroscopic meniscal surgery should not be recommended as a first choice of treatment for degenerative meniscal tears, and should only be considered when there has not been a satisfactory response to conservative management 3