What is the treatment for a lateral meniscus tear?

Treatment for Lateral Meniscus Tear

The treatment approach for lateral meniscus tears depends critically on whether the tear is traumatic or degenerative: traumatic tears (especially bucket-handle tears in younger patients) require arthroscopic surgery, while degenerative tears in patients over 35 should be managed conservatively with physical therapy and exercise, avoiding arthroscopic surgery entirely. 1, 2

Treatment Algorithm Based on Tear Type

For Traumatic Lateral Meniscus Tears (Younger Patients, Acute Injury)

Arthroscopic surgery is the first-line treatment for traumatic lateral meniscus tears, particularly bucket-handle tears, because they cause true mechanical locking and risk cartilage damage if treatment is delayed. 1

Surgical Options:

• Meniscal repair is superior to partial meniscectomy, providing better functional outcomes and less severe degenerative changes over time 3
• Partial meniscectomy (removal of damaged portion) may be performed when repair is not feasible 1
• Repair is especially appropriate in younger patients with good blood supply to the meniscus 1
• Recovery typically requires 2-6 weeks with at least 1-2 weeks off work depending on job demands 1

Post-Surgical Rehabilitation:

• Early mobilization to reduce pain and improve function 1, 2
• Structured physical therapy focusing on quadriceps and hamstring strengthening 1
• Avoid complete immobilization to prevent muscular atrophy 1
• NSAIDs (oral or topical) for pain management 1
• Cryotherapy applied through wet towel for 10-minute periods 1

For Degenerative Lateral Meniscus Tears (Patients >35 Years)

Conservative management with structured physical therapy and exercise is the only recommended treatment—arthroscopic surgery provides no meaningful long-term benefit and should be avoided. 4, 5, 2

Conservative Management Components:

• Structured physical therapy with quadriceps and hamstring strengthening 5, 2
• Exercise therapy programs for at least 3-6 months 5
• NSAIDs for pain management 5
• Weight loss for overweight patients 5
• Activity modification to reduce mechanical stress 5
• Intra-articular corticosteroid injections may be considered after 3 months if inadequate response 5

Why Surgery Should Be Avoided:

• High-quality evidence demonstrates arthroscopic surgery provides no clinically meaningful improvement in long-term pain or function compared to conservative treatment 4, 2
• Less than 15% of patients experience small, temporary improvements at 3 months that disappear by 1 year 5
• This applies even when mechanical symptoms like clicking, catching, or locking are present 5, 2
• The BMJ clinical practice guideline explicitly recommends against arthroscopic knee surgery in patients with degenerative knee disease 4, 5

Key Distinguishing Features

Traumatic Tears Requiring Surgery:

• Acute onset after significant knee trauma 1
• Bucket-handle tear pattern causing true mechanical locking (not just clicking or catching) 1
• Younger patient age 1
• Associated with ACL injuries 1, 6

Degenerative Tears Requiring Conservative Management:

• Age >35 years 4, 5
• Insidious onset without major trauma 7
• Imaging evidence of osteoarthritis 4
• Complex tear patterns with fraying 7

Critical Pitfalls to Avoid

• Do not treat all meniscal tears the same way regardless of tear pattern or patient characteristics 1
• Do not assume guidelines for degenerative meniscal tears apply to traumatic bucket-handle tears 1
• Do not rush to surgery based on MRI findings alone in patients >35 years—degenerative changes are common age-related findings that do not benefit from surgery 5
• Do not interpret clicking, catching, or intermittent "locking" sensations as indications for surgery in degenerative disease—these mechanical symptoms respond equally well to conservative treatment 5, 2
• Delaying treatment for true locked knees (traumatic tears) can lead to cartilage damage 1

Special Considerations

• Lateral meniscus tears are often associated with ACL injuries and may require concurrent treatment 1, 6
• Lateral meniscus oblique radial tears (LMORT) in acute ACL injuries should be surgically repaired based on tear grade, as repair demonstrates biomechanically superior results compared to partial meniscectomy 6
• Patient age is the most important consideration for treatment decisions, with younger patients more likely to benefit from surgical repair 1