Treatment for Meniscus Tear
Primary Treatment Recommendation
For degenerative meniscus tears (typically in patients >35 years old), conservative management with structured physical therapy and exercise is the first-line treatment, and arthroscopic surgery should be avoided as it provides no meaningful benefit over non-operative treatment. 1, 2
Treatment Algorithm Based on Tear Type and Patient Characteristics
For Degenerative Tears (Age >35, Atraumatic Onset)
Conservative management is mandatory as initial treatment: 1, 2
- Structured physical therapy program focusing on quadriceps and hamstring strengthening exercises for at least 3-6 months 2, 3
- NSAIDs (oral or topical) for pain management; topical formulations preferred to avoid gastrointestinal side effects 2, 3
- Weight loss for overweight patients, which significantly reduces knee pain and improves function 2
- Cryotherapy applied through wet towel for 10-minute periods to reduce pain and swelling 3
- Activity modification to reduce mechanical stress 2
Avoid complete immobilization as this causes muscular atrophy and deconditioning 3
If inadequate response after 3 months: Consider intra-articular corticosteroid injections 2
Arthroscopic surgery is NOT recommended even with mechanical symptoms like clicking, catching, or intermittent locking sensations, as these respond equally well to conservative treatment 1, 2
For Traumatic Tears (Young Patients, Acute Injury)
Surgical intervention is appropriate for: 4, 5
- Bucket handle tears causing true mechanical locking of the knee 4
- Acute traumatic tears in younger patients with good tissue quality 4, 5
- Reducible peripheral tears (near capsular attachment) that are horizontal or longitudinal in nature 5
Surgical options prioritized by outcome: 6, 7
- Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time 6
- Repair shows 80% success at 2 years and preserves meniscal function 5
- Partial meniscectomy reserved only for tears not amenable to repair, particularly when peripheral rim can be preserved 5, 8
- Recovery typically 2-6 weeks 1, 4
- At least 1-2 weeks off work depending on physical demands 1, 4
- Meniscal repair requires bracing and non-weight bearing for 4-6 weeks with strict rehabilitation compliance 5
Critical Decision Points
True mechanical locking (persistent objective locked knee) is the ONLY mechanical symptom that may warrant surgery in degenerative disease 2, 3
Clicking, catching, or intermittent "locking" sensations do NOT indicate need for surgery as these respond equally to conservative treatment 2
MRI findings alone should never drive surgical decisions - degenerative changes and meniscal tears are common age-related findings that do not benefit from arthroscopic intervention 2
Common Pitfalls to Avoid
- Do not rush to surgery without adequate 3-6 month trial of conservative management 2, 3
- Do not assume all mechanical symptoms require surgical intervention - only persistent objective locked knee qualifies 2, 3
- Do not treat all meniscal tears the same way - degenerative tears in older patients and traumatic tears in young patients require completely different approaches 4, 8
- Do not perform repeat arthroscopy for progressive degenerative changes - less than 15% of patients experience small, temporary improvements at 3 months that disappear by 1 year 2
Evidence Quality Note
The 2017 BMJ clinical practice guideline 1 provides the strongest recommendation against arthroscopic surgery for degenerative knee disease, explicitly stating this applies to patients with or without imaging evidence of osteoarthritis, mechanical symptoms, or sudden symptom onset. This guideline was triggered by high-quality randomized controlled trials demonstrating no benefit of arthroscopy over exercise therapy. The 2025 guidelines 4, 2 reinforce this position while clarifying that traumatic bucket handle tears in younger patients represent a distinct entity requiring surgical management.