What is the initial treatment for a mild meniscus tear?

Initial Treatment for a Mild Meniscus Tear

Conservative management should be the first-line treatment approach for mild meniscus tears, particularly for degenerative tears in patients over 35 years old. 1

Conservative Treatment Options

• Physical therapy and structured exercise programs are effective for managing symptoms and improving function in patients with mild meniscus tears 1
• NSAIDs (oral or topical) are effective for pain relief 2
• Cryotherapy (ice) should be applied through a wet towel for 10-minute periods to reduce pain and swelling 3
• Weight loss is strongly recommended for overweight patients to reduce joint loading 2
• Self-management educational programs should be encouraged to improve patient understanding and compliance 2

Exercise Therapy Components

• Structured exercise program focusing on strengthening exercises for the quadriceps and hamstrings 3
• Both cardiovascular and resistance land-based exercises to improve function and reduce pain 2
• Aquatic exercises may be considered, particularly for patients who are aerobically deconditioned or have difficulty with weight-bearing exercises 2
• Early mobilization helps reduce pain and improve function 3

When to Consider Surgery

• Surgery should be considered only after failing conservative treatment 1
• Specific indications for surgical intervention include:
  • Truly obstructing displaced meniscus tears causing persistent mechanical symptoms (true locking) 1
  • Bucket handle tears in young patients (which differ significantly from degenerative tears) 3
  • Persistent pain with failure of nonoperative treatment 4

Important Considerations

• Degenerative tears (common in patients over 35) respond well to conservative management 1
• The British Medical Journal guidelines strongly recommend against arthroscopic surgery for degenerative knee disease including meniscal tears in older adults 5
• Recovery from arthroscopic procedures typically takes 2-6 weeks, and patients usually require at least 1-2 weeks off work 5
• Meniscal repair (when indicated) is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time 6

Common Pitfalls to Avoid

• Rushing to surgery without adequate trial of conservative management is a common pitfall 1
• Assuming all mechanical symptoms require surgical intervention 1
• Attempting meniscus repair in the setting of advanced osteoarthritis is unlikely to be successful 2
• Multiple studies show that arthroscopic partial meniscectomy did not improve functional activity or reduce pain compared with conservative treatment in knees with mild or no osteoarthritis 7

Treatment Algorithm

1. Begin with 6-8 weeks of conservative management including physical therapy, NSAIDs, and activity modification 1, 4
2. If symptoms persist, consider advanced imaging (MRI) to better characterize the tear 8
3. For persistent symptoms despite conservative management, consider surgical options based on:
   • Patient age (younger patients may benefit more from surgery) 3
   • Tear pattern (bucket handle, flap, or displaced tears more likely to benefit) 4
   • Presence of true mechanical symptoms (locking) 1
   • Absence of significant osteoarthritis 7