What is the initial treatment approach for a torn meniscus until surgery?

Initial Treatment for Torn Meniscus Until Surgery

For most meniscus tears, begin with conservative management including structured physical therapy, NSAIDs, activity modification, and ice therapy for 3-6 months before considering surgery. 1, 2

Conservative Management Protocol

Physical Therapy and Exercise

• Implement a structured exercise program focusing on quadriceps and hamstring strengthening to stabilize the knee and reduce pain 3, 2
• Include both cardiovascular and resistance land-based exercises to improve function 4
• Consider aquatic exercises for patients who are aerobically deconditioned or have difficulty with weight-bearing activities 4
• Avoid complete immobilization to prevent muscular atrophy and deconditioning 3

Pain Management

• Use oral or topical NSAIDs as first-line pharmacologic treatment for pain relief 3, 4, 2
• Apply cryotherapy (ice) through a wet towel for 10-minute periods to reduce pain and swelling 3
• Consider acetaminophen or tramadol as alternative analgesics 4
• Intra-articular corticosteroid injections may be used if inadequate response after 3 months of conservative management 1

Activity Modification

• Reduce mechanical stress on the knee by modifying high-impact activities 4
• Implement patellar taping for short-term pain relief and functional improvement 4
• For overweight patients, weight loss is essential to reduce joint loading and improve outcomes 1, 4, 2

When Surgery Becomes Appropriate

Indications for Surgical Intervention

• True mechanical locking (not just clicking or catching sensations) that persists despite conservative treatment 1, 5
• Bucket handle tears in young patients causing genuine mechanical obstruction 3
• Persistent pain with failure of at least 3-6 months of proper conservative management 1, 2
• Acute traumatic tears with clear evidence of trauma in younger, active patients 2

Important Distinctions

• Degenerative tears (common in patients >35 years) respond well to conservative management and should NOT be rushed to surgery 1, 5, 2
• Traumatic tears in young patients, especially bucket handle tears, may require earlier surgical intervention 3
• The presence of clicking, catching, or intermittent "locking" sensations does NOT automatically indicate need for surgery, as these mechanical symptoms respond equally well to conservative treatment 1

Critical Pitfalls to Avoid

• Do not rush to surgery based on MRI findings alone - meniscal tears are common incidental findings in middle-aged and older patients and most do not cause symptoms 1, 5
• Do not interpret all mechanical symptoms as surgical indications - only true mechanical obstruction (genuine locking where the knee cannot fully extend) warrants consideration of surgery 1
• Do not assume prior arthroscopy indicates need for repeat surgery - progressive degenerative changes suggest the underlying disease process will not be altered by additional surgery 1
• Avoid arthroscopic surgery for degenerative meniscal tears with osteoarthritis - high-quality evidence shows no meaningful benefit over conservative treatment, with less than 15% experiencing small, temporary improvements at 3 months that disappear by 1 year 1

Expected Timeline

• Conservative management should be trialed for at least 3-6 months before considering surgical options 1, 4
• If surgery becomes necessary, recovery from arthroscopic procedures typically takes 2-6 weeks 1, 3
• Patients usually require at least 1-2 weeks off work, depending on job demands and recovery progress 1, 3