From the Guidelines
Management of a lateral meniscal tear should initially focus on conservative treatment, including rest, ice, compression, and elevation (RICE protocol), as well as physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs), before considering arthroscopic surgery. This approach is supported by the most recent and highest quality study, which emphasizes the importance of conservative management before proceeding to surgical interventions 1. The study highlights that meniscus tears in patients with knee osteoarthritis are often a result of the degenerative process, and surgical treatment may not provide significant improvement for these patients. However, for patients with mild-to-moderate knee osteoarthritis, meniscal tears may be a notable contributor to symptoms, and arthroscopic partial meniscectomy may be considered after failing nonsurgical treatment.
Key components of conservative management include:
- Rest, ice, compression, and elevation (RICE protocol) to reduce pain and swelling
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 1-2 weeks to manage pain and inflammation
- Physical therapy focusing on quadriceps and hamstring strengthening exercises to improve knee stability and function, typically recommended for 6-8 weeks
For patients with persistent symptoms despite conservative management, arthroscopic surgery may be necessary, with partial meniscectomy or meniscal repair being viable options 1. The choice between these surgical options depends on the tear location, pattern, and blood supply, with meniscal repair being preferred when possible to preserve the meniscus and its shock-absorbing function. Post-surgical rehabilitation is crucial, with weight-bearing restrictions and specific exercises based on the procedure performed. Most patients can return to normal activities within 4-6 weeks after partial meniscectomy or 3-4 months after meniscal repair, though this varies based on individual healing and rehabilitation progress.
From the Research
Lateral Menisceal Tear Management
- The management of lateral menisceal tears involves preservation of the meniscus as the primary goal, with treatment options including non-operative, meniscectomy, or meniscal repair 2, 3.
- A study found that stable left in situ lateral meniscus tears appear to show a better prognosis than medial tears, and repair should be performed as early as possible when required 2.
- Meniscal repair is suitable for younger patients with reducible tears that are peripheral and horizontal or longitudinal in nature, with a success rate of 80% at 2 years 3.
- Partial meniscectomy is suitable for symptomatic tears not amenable to repair, and can still preserve meniscal function especially when the peripheral meniscal rim is intact 3.
Treatment Options
- Non-operative treatment, such as physical therapy, can be effective for degenerative tears in older patients without mechanical symptoms 3, 4, 5.
- Arthroscopic partial meniscectomy (APM) can be considered for symptomatic tears not amenable to repair, but may result in limited range of motion 4.
- Hyaluronic acid injection (HAI) has no significant effect on treatment outcomes when combined with APM or physical therapy 4.
- Conservative treatment, such as exercise therapy, can be as effective as surgical treatment for degenerative meniscopathy, and may be considered as a first-line treatment 5.