What is the treatment for an undersurface horizontal tear of the medial meniscus with Medial Collateral Ligament (MCL) sprain and pes anserine bursitis?

Treatment of Undersurface Horizontal Tear of Medial Meniscus with MCL Sprain and Pes Anserine Bursitis

Begin with conservative management as first-line treatment, including a structured physical therapy program for at least 3 months, NSAIDs for pain control, and targeted corticosteroid injections for the pes anserine bursitis if symptoms persist beyond initial management. 1, 2

Initial Conservative Management (First 3 Months)

Physical Therapy Program

• Implement a structured physical therapy program focusing on quadriceps and hamstring strengthening exercises as the cornerstone of treatment 2
• Avoid complete immobilization to prevent muscular atrophy and deconditioning 2
• The MCL sprain will typically heal with conservative management, as most grade I and II MCL injuries respond well to physical therapy and protected weight-bearing 2

Pain Management

• Use NSAIDs (oral or topical) for pain relief addressing both the meniscal tear and associated inflammation 2
• Topical NSAIDs may be preferred to avoid gastrointestinal side effects 2
• Apply cryotherapy (ice) through a wet towel for 10-minute periods to reduce pain and swelling 2

Pes Anserine Bursitis Management

• If the pes anserine bursitis does not respond to initial conservative measures (NSAIDs, ice, physical therapy), proceed with ultrasound-guided corticosteroid injection into the bursa 3, 4
• This injection is highly effective and safe for managing persistent bursitis symptoms 4

When to Consider Intra-articular Corticosteroid Injection

• If there is inadequate response after 3 months of conservative management, consider intra-articular corticosteroid injection for the knee joint itself 1

Surgical Considerations (Only After Failed Conservative Treatment)

When Surgery Should NOT Be Pursued

• Do NOT rush to arthroscopic surgery for horizontal meniscal tears, as high-quality evidence demonstrates no clinically meaningful benefit over conservative treatment for degenerative tears 1
• The presence of clicking, catching, or intermittent "locking" sensations does NOT indicate need for surgery, as these mechanical symptoms respond equally well to conservative treatment 1, 2

When Surgery May Be Considered

• Surgery should only be considered after failure of comprehensive conservative treatment lasting at least 3 months 2
• In cases of persistent objective locked knee (true mechanical locking, not just catching or clicking), surgery may be necessary 2
• For younger patients with acute traumatic tears rather than degenerative tears, surgery may be considered earlier 2

Surgical Recovery Timeline (If Needed)

• Recovery from arthroscopic procedures typically takes 2-6 weeks 1, 2
• At least 1-2 weeks off work is usually required, depending on job demands 1, 2

Critical Pitfalls to Avoid

• Do not interpret clicking or catching as indication for surgery - these mechanical symptoms do not predict surgical benefit and respond equally to conservative treatment 1
• Rushing to surgery without adequate trial of conservative management is the most common error 1, 2
• Overlooking the pes anserine bursitis component, which requires specific targeted treatment with corticosteroid injection if conservative measures fail 3, 4
• Assuming all mechanical symptoms require surgical intervention is incorrect 2

Treatment Algorithm Summary

1. Months 0-3: Structured physical therapy (quadriceps/hamstring strengthening), NSAIDs, ice, activity modification 2
2. If pes anserine bursitis persists: Add ultrasound-guided corticosteroid injection to bursa 3, 4
3. Month 3: If inadequate response, consider intra-articular corticosteroid injection 1
4. Beyond 3 months: Only consider surgery if true mechanical locking persists (not just clicking/catching) or in younger patients with traumatic tears 2