Treatment for Medial Meniscus Capsule Tear
Begin with conservative management including structured physical therapy and exercise therapy for at least 3-6 months as first-line treatment, reserving surgery only for true mechanical locking from displaced tears that fail conservative care. 1
Initial Treatment Approach
- Start with conservative management as the primary treatment strategy, which includes structured physical therapy focusing on quadriceps and hamstrings strengthening exercises 1, 2
- NSAIDs (oral or topical) should be used for pain relief 2
- Apply cryotherapy (ice through a wet towel) for 10-minute periods to reduce pain and swelling 2
- Weight loss is essential for overweight patients, as it significantly reduces knee pain and improves function 1
When Surgery May Be Indicated
Surgery should only be considered after failing a proper trial of conservative management for at least 3-6 months 1
The type of tear matters critically:
- Bucket handle tears in young patients causing true mechanical locking are an exception where conservative management is generally not recommended as first-line treatment, and early surgical repair is appropriate 2
- Degenerative tears (particularly in patients over 35) respond well to conservative management and should NOT undergo arthroscopic surgery, even with mechanical symptoms like clicking or catching 1
- Peripheral stable tears during ACL reconstruction may be left in situ, though medial meniscus tears have higher rates of poor outcomes (up to 66% pain/mechanical symptoms) compared to lateral meniscus tears when managed conservatively 3
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 that do not correlate with symptoms 1
- Do not interpret clicking, catching, or intermittent "locking" sensations as requiring surgery - these mechanical symptoms respond equally well to conservative treatment in degenerative tears 1
- Arthroscopic surgery for degenerative meniscal tears shows less than 15% of patients experience small, temporary improvements at 3 months that completely disappear by 1 year 1
Escalation of Care if Conservative Management Fails
If inadequate response after 3 months of conservative management:
- Consider intra-articular corticosteroid injections, though benefits typically last only 3 months 1, 4
- Intra-articular steroid/bupivacaine injection can reduce pain symptoms in 82% of patients with degenerative posterior horn medial meniscus tears, with sustained response in 53% at follow-up 5
- For patients with mild-to-moderate knee osteoarthritis and meniscal tears who fail nonsurgical treatment, platelet-rich plasma (PRP) represents an appropriate next step before considering surgical intervention 4
Recovery Timeline if Surgery Performed
- Recovery from arthroscopic procedures typically takes 2-6 weeks 1, 2
- At least 1-2 weeks off work is required, depending on job demands 1, 2
- Early mobilization helps reduce pain and improve function post-operatively 2
Special Consideration for Root Tears
- Medial meniscal posterior root tears disrupt the "hoop" function and may lead to knee osteoarthritis, requiring specialized root repair techniques potentially combined with meniscal centralization 6