From the Guidelines
For patients with meniscus tears, a trial of exercise therapy is recommended as the initial treatment, as it has been shown to be as effective as arthroscopic surgery in improving symptoms 1.
Treatment Approach
The treatment of meniscus tears depends on the severity of the tear and the presence of underlying knee osteoarthritis.
- For mild tears, the RICE protocol (Rest, Ice, Compression, Elevation) is recommended initially, along with over-the-counter pain medications like ibuprofen (400-800mg three times daily) or acetaminophen (500-1000mg every 6 hours) for pain management.
- Physical therapy exercises focusing on quadriceps and hamstring strengthening should begin once acute pain subsides, typically 2-3 weeks after injury.
- For moderate to severe tears causing persistent pain, locking, or instability, orthopedic consultation is necessary as surgical intervention may be required.
Surgical Intervention
Arthroscopic surgery is the standard procedure, with partial meniscectomy (removing damaged tissue) or meniscus repair being common approaches.
- However, arthroscopic surgery should only be considered for patients who have failed nonsurgical treatment, such as physical therapy, corticosteroid or other intra-articular injections, or other modalities 1.
- Recovery from surgery typically takes 4-6 weeks for partial meniscectomy or 3-6 months for repair procedures.
Importance of Rehabilitation
The meniscus is crucial for knee stability and shock absorption; preserving as much of it as possible is important for preventing future knee osteoarthritis.
- Proper rehabilitation regardless of treatment approach is essential for restoring full knee function and preventing re-injury.
- A comprehensive rehabilitation program should include exercises to strengthen the quadriceps and hamstring muscles, as well as activities to improve knee range of motion and functional ability 1.
From the Research
Meniscus Tear Overview
- A meniscus tear is a common injury that can lead to early osteoarthritis if not properly managed 2, 3
- The meniscus is a crucial structure in the knee joint, and preservation is accepted as the primary goal in treating meniscus tears 2
Diagnosis and Treatment
- MRI is the imaging modality of choice for diagnosing meniscus tears, but its use should be determined by a musculoskeletal specialist 2
- Arthroscopic partial meniscectomy (APM) is a common treatment, but recent studies have shown that outcomes after APM are no better than those after sham/placebo surgery 3
- Meniscus repair is a viable and effective alternative to APM, especially in young and physically active patients 3, 4
- Conservative treatment, such as physical therapy, can be effective in managing degenerative meniscopathy and should be considered as a first-line treatment 5
Rehabilitation and Return to Play
- Rehabilitation and return to play guidelines are important for patients undergoing meniscus repair surgery 4
- The goal of rehabilitation is to preserve the meniscus and prevent degenerative changes and early osteoarthritis 4
- Orthobiologics, such as platelet-rich plasma and mesenchymal stem cells, have shown promise in augmenting surgical repairs or as standalone treatments, but research is limited 6
Treatment Considerations
- The treatment paradigm for meniscus tears has shifted towards preserving or repairing the meniscus whenever possible 2, 6
- Choosing an appropriate management strategy depends on multiple factors, such as patient demographics and location of the tear 6
- Elderly patients with complex meniscus tears in the setting of degenerative arthritis may not benefit from arthroscopic surgery 6