What is the management and prognosis for a medial meniscus tear?

Management and Prognosis for Medial Meniscus Tears

Conservative management should be the first-line approach for medial meniscus tears, particularly in patients with degenerative knee disease, as arthroscopic surgery does not provide meaningful improvements in long-term pain or function compared to non-surgical treatments. 1

Initial Management Approach

• Conservative management is recommended as the first-line treatment for medial meniscus tears, especially for degenerative tears in patients over 35 years old 2, 3
• A structured physical therapy program focusing on strengthening exercises for the quadriceps and hamstrings forms the cornerstone of treatment 2
• NSAIDs (oral or topical) are effective for pain relief, with topical options preferred to avoid gastrointestinal side effects 2
• Cryotherapy (ice) applied through a wet towel for 10-minute periods helps reduce pain and swelling 2
• Weight loss should be recommended if the patient is overweight 1, 3
• Intra-articular corticosteroid injections may be considered for pain management 3

Types of Meniscal Tears and Their Management

• Medial meniscus is more vulnerable to injury due to its attachment to the medial collateral ligament 4
• Different types of tears include:
  • Vertical complete bucket handle lesions
  • Vertical incomplete lesions
  • Longitudinal tears
  • Oblique tears
  • Complex, flap and degenerative lesions
  • Radial lesions
  • Horizontal lesions 5
• The location of the tear in relation to the vascular zones affects healing potential:
  • Peripheral, well-vascularized tears have better healing potential with conservative management 4
  • Tears in avascular zones typically have poorer healing potential 6

Surgical Considerations

• Surgery should only be considered after failure of a comprehensive conservative treatment program lasting at least 3 months 2
• Specific indications for surgical intervention include:
  • Persistent objective locked knee (true mechanical locking) 2
  • Younger patients with acute traumatic tears rather than degenerative tears 2, 6
• Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time 6
• If surgery becomes necessary, recovery typically takes 2-6 weeks with at least 1-2 weeks off work depending on job demands 1

Prognosis

• Conservative management can lead to good outcomes, particularly for degenerative tears in older adults 7
• For surgically treated cases, the International Knee Documentation Committee score improves from a mean preoperative score of 52.52% to 81.81% at one month and 92.92% at six months post-arthroscopic partial medial meniscectomy 5
• Long-term outcomes are better with meniscal repair compared to partial meniscectomy 6
• Partial meniscectomy can lead to premature osteoarthritis in the long term 4

Common Pitfalls to Avoid

• Rushing to surgery without an adequate trial of conservative management 2
• Assuming all mechanical symptoms require surgical intervention 2
• Overlooking the importance of physical therapy and rehabilitation 2
• Performing arthroscopy for patients with primary diagnosis of symptomatic osteoarthritis of the knee 3
• Complete immobilization should be avoided to prevent muscular atrophy and deconditioning 2

Special Considerations for Older Adults

• The British Medical Journal strongly recommends against arthroscopic knee surgery for degenerative knee disease, which is common in older adults 3
• While some patients may experience small improvements in pain or function at three months post-surgery, these benefits are not sustained at one year 3
• Surgical treatment subjects older patients to increased risks including anesthetic complications, infection, and thrombophlebitis 3