Does rest help meniscal tears?

Does Rest Help Meniscal Tears?

Rest alone is insufficient for managing meniscal tears—most patients require a structured rehabilitation program with physical therapy, and complete immobilization should be actively avoided to prevent muscle atrophy and deconditioning. 1

Treatment Algorithm Based on Tear Type and Patient Characteristics

For Degenerative Meniscal Tears (Middle-Aged to Older Patients)

Initial conservative management is the standard of care for degenerative meniscal tears, as most patients experience significant improvement without surgery. 1

• Begin with a home exercise program focusing on quadriceps and hamstring strengthening, as this provides equivalent outcomes to supervised physical therapy for degenerative tears 2
• Allow activities that do not worsen pain while avoiding complete rest or immobilization 1
• Apply ice through a wet towel for 10-minute periods to reduce acute pain and swelling 1, 3
• Use NSAIDs or acetaminophen for pain relief during the rehabilitation phase 1

The evidence is clear that arthroscopic surgery provides no meaningful benefit for degenerative meniscal tears—less than 15% of patients experience small, short-term improvements that disappear by one year. 1 The BMJ guideline panel, which included orthopedic surgeons and patients with lived experience, concluded that most patients improve substantially with conservative management alone. 1

For Acute Traumatic Tears (Younger, Active Patients)

Peripheral, well-vascularized tears have significant healing potential with modified activity rather than complete rest. 4, 5

• Stable vertical longitudinal tears in the peripheral vascular zone can heal spontaneously in up to 65% of cases when left alone 5
• Reduce swelling and pain initially with relative rest (not complete immobilization), ice, and NSAIDs 4, 6
• Progress to tri-planar functional retraining within days to weeks, avoiding prolonged immobilization 4
• Tensile loading through controlled exercise stimulates collagen production and guides proper alignment of healing tissue 1

The Only Exception: True Locked Knee

The sole clear indication for immediate surgical intervention is objective inability to fully extend the knee (true mechanical locking from a displaced bucket-handle tear). 1 This represents a mechanical obstruction requiring arthroscopic intervention, not a condition amenable to rest or rehabilitation.

Why Complete Rest Is Harmful

Complete immobilization causes muscular atrophy, deconditioning, and impairs the natural healing process of meniscal tissue. 1

• Tensile loading through controlled movement stimulates collagen production and proper fiber alignment 1
• Even stable tears benefit from early mobilization to maintain joint nutrition and prevent stiffness 3, 7
• Recovery timelines are actually shorter with early mobilization: weight-bearing within 2-7 days, return to sedentary work in 1-2 weeks 3

When Conservative Management Fails

For patients with mild-to-moderate osteoarthritis and persistent symptoms after 3-6 months of appropriate conservative treatment, consider escalation to intra-articular corticosteroid injection or platelet-rich plasma before surgery. 1, 8

• Corticosteroid injections provide approximately 3 months of benefit 1
• PRP has stronger evidence than hyaluronic acid for pain reduction and functional improvement 8
• Arthroscopic partial meniscectomy may be considered only after failed conservative management in select patients with mild-to-moderate osteoarthritis 1

Common Pitfalls to Avoid

• Do not prescribe prolonged rest or immobilization—this worsens outcomes through muscle atrophy 1
• Do not rush to arthroscopy for degenerative tears—surgery provides no sustained benefit and exposes patients to unnecessary surgical risks 1
• Do not assume mechanical symptoms require surgery—the evidence shows no difference in outcomes for patients with clicking, locking, or catching treated conservatively versus surgically 1
• Do not ignore the context of osteoarthritis—meniscal tears in patients with moderate-to-advanced osteoarthritis are degenerative consequences, not surgical targets 1