Treatment of Medial Meniscus Tear
Conservative management with structured physical therapy is the first-line treatment for most medial meniscus tears, particularly degenerative tears in patients over 35 years old, and arthroscopic surgery should only be considered after failing at least 3-6 months of conservative treatment. 1
Treatment Algorithm Based on Tear Type and Patient Age
For Degenerative Tears (Most Common in Patients >35 Years)
Start with conservative management for at least 3-6 months before considering any surgical intervention. 1
- Physical therapy with structured exercise programs focusing on quadriceps and hamstring strengthening is effective for managing symptoms and improving function 1
- NSAIDs (oral or topical) for pain management 2, 3
- Weight loss for overweight patients can significantly reduce knee pain and improve function 1
- Activity modification to reduce mechanical stress on the knee 1
- Cryotherapy (ice applied through wet towel for 10-minute periods) helps reduce pain and swelling 2
If inadequate response after 3 months of conservative management, consider intra-articular corticosteroid injections. 1 Recent evidence shows combined intra- and perimeniscal corticosteroid injections with structured physiotherapy results in 83% surgery-free survivorship at 5 years 4
For Traumatic Bucket Handle Tears (Especially in Young Patients)
Arthroscopic surgery is the recommended first-line treatment for bucket handle tears, particularly in young patients with traumatic tears causing true mechanical locking. 2, 5
- These tears differ significantly from degenerative tears and require surgical intervention because they cause mechanical obstruction 2, 5
- Meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time 6
- Recovery typically takes 2-6 weeks with at least 1-2 weeks off work depending on job demands 2, 5
Critical Distinction: When Surgery Is NOT Indicated
Arthroscopic surgery is explicitly NOT recommended for degenerative meniscal tears, even in the presence of mechanical symptoms such as catching or locking. 1
- High-quality evidence demonstrates no clinically meaningful benefit over conservative treatment for degenerative tears 1
- Less than 15% of patients experience small, temporary improvements at 3 months that disappear by 1 year 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
When to Consider Surgery for Degenerative Tears
Surgery should only be considered after failing conservative treatment in the small subset of patients with:
- Truly obstructing displaced meniscus tears causing persistent mechanical symptoms 1
- Acute tears with clear evidence of trauma 3
- Persistent pain with documented failure of nonoperative treatment for at least 3-6 months 1, 3
Post-Treatment Rehabilitation (If Surgery Performed)
- Early mobilization to reduce pain and improve function 2, 5
- Structured physical therapy focusing on quadriceps and hamstring strengthening 2, 5
- Avoid complete immobilization to prevent muscular atrophy 2, 5
- NSAIDs for pain management 2
- Cryotherapy applied through wet towel for 10-minute periods 2
Common Pitfalls to Avoid
- Do not rush to surgery without adequate trial of conservative management - this is the most common error 1
- Do not assume MRI findings alone indicate need for surgery - degenerative meniscal changes are common age-related findings that do not benefit from arthroscopic intervention 1
- Do not treat all meniscal tears the same way - traumatic bucket handle tears in young patients require different management than degenerative tears in older patients 2
- Do not assume all mechanical symptoms require surgical intervention - clicking and catching respond equally to conservative treatment 1
- Do not delay treatment for truly locked knees - this can lead to cartilage damage 2