Can People Function with a Small Minimal Tear of the Knee?
Yes, most people with small meniscal tears can function normally without surgery, as meniscus tears are common incidental findings that are usually not the cause of knee pain, and symptoms typically improve over time with conservative management. 1
Key Evidence Supporting Functional Capacity
Meniscal tears are frequently asymptomatic and do not require intervention. The BMJ guidelines explicitly state that meniscus tears are common, usually incidental findings, and are unlikely to be the cause of knee pain, aching, or stiffness. 1
Natural History and Prognosis
Degenerative knee disease is a chronic condition where symptoms fluctuate naturally, and pain tends to improve over time after seeing a physician, even without surgical intervention. 1
Many people with meniscal tears identified on MRI remain completely asymptomatic and maintain full function. 2
The presence of a meniscal tear on imaging does not predict functional limitation or the need for treatment. 3
Conservative Management as First-Line Treatment
Conservative management should be the default approach for degenerative meniscal tears, regardless of mechanical symptoms. 1, 3
Recommended Non-Surgical Approach
Exercise therapy for 4-6 weeks is the appropriate first-line treatment for most meniscal tears. 3
Self-directed exercise programs, supervised rehabilitation, and activity modification all allow patients to maintain function without surgery. 1
Physical therapy focusing on quadriceps and hamstring strengthening helps maintain knee stability and function. 4, 5
Evidence Against Routine Surgery
Arthroscopic surgery provides less than 15% probability of small or very small improvement in short-term pain and function that does not persist to one year. 1
Eight recent randomized studies showed non-superiority of arthroscopy over non-operative treatment for degenerative meniscal lesions. 2
Surgery requires 2-6 weeks recovery with inability to weight bear for 2-7 days, creating temporary functional impairment. 1, 4
Important Exception: True Mechanical Locking
The only clear indication for urgent surgery is objective inability to fully extend the knee (true locked knee), typically from bucket-handle tears. 4, 6
Distinguishing True Locking from Other Symptoms
True mechanical locking means the patient cannot physically extend the knee fully due to displaced meniscal tissue blocking motion. 4, 6
Symptoms like clicking, catching, or subjective "giving way" do NOT constitute true locking and do not require surgery. 6
Bucket-handle tears causing true locking require urgent arthroscopic surgery with repair or partial meniscectomy. 6
Clinical Pitfalls to Avoid
Do not equate MRI findings with clinical significance. Meniscal tears on imaging are extremely common in asymptomatic individuals, particularly over age 40. 1, 3
Do not rush to surgery for "mechanical symptoms." Unless there is objective inability to extend the knee, conservative management remains appropriate even with clicking or catching. 1, 3
Age and activity level matter. Older patients with lower activity levels typically tolerate meniscal tears well without functional instability. 1
Functional Expectations
Most patients can return to normal daily activities, including sedentary work within 1-2 weeks with conservative management. 4
Physical labor may require activity modification but does not necessarily require surgery. 1
Jogging and return to sports typically occurs 3-6 months after injury with appropriate rehabilitation, even without surgery. 7