Meniscus Tears: Treatment Options

Meniscus Tears: Treatment Options

Patients with a meniscus tear have several treatment options. While choosing to do nothing is always an option, symptoms are unlikely to resolve and the risk of developing arthritis increases over time.

This progression can be seen on knee x-rays of patients without a healthy, intact medial meniscus, where the joint space gradually narrows over the course of a year, leading to arthritis and, in some cases, the need for partial knee replacement.

Many patients prefer to try nonoperative treatment first to avoid surgery. Options such as injections, physical therapy, over-the-counter anti-inflammatory medications, and bracing may help reduce pain, stiffness, and instability. While these treatments can improve symptoms and may help prevent the tear from worsening, they typically do not eliminate symptoms completely.

Because meniscus tears rarely heal fully on their own, surgery is often needed to achieve the best long-term outcome. For tears located in the white-white zone, where blood supply is minimal, the surgeon will usually trim and remove the torn tissue. Although this can relieve symptoms, having less meniscus reduces cushioning in the knee and increases the risk of future arthritis.

When possible, repairing the meniscus is generally the preferred option. Tears in the red-white or red-red zones have better healing potential, allowing the surgeon to stitch the meniscus back together so it can continue protecting the joint cartilage.

The method used to repair the meniscus depends on several factors, including the size, location, and direction of the tear, as well as how long it has been since the injury occurred. These considerations help determine which repair technique offers the highest chance of healing.

Two commonly used repair techniques include the all-inside repair, which is well suited for tears in the posterior horn of the meniscus, and the inside-out repair, which is often used for tears in the middle or anterior portions of the meniscus.

In general, earlier treatment of a meniscus tear improves the likelihood of delaying the onset of arthritis. Older patients may develop chronic degenerative tears that occur gradually rather than from a specific injury. These tears are typically not repairable, and while trimming the torn tissue can improve symptoms, it may also accelerate existing arthritis.

In rare and severe cases, a meniscus transplant may be considered. This procedure uses a donor meniscus to replace a patient’s damaged or absent meniscus, usually after significant injury or multiple prior meniscus surgeries.

Recovery after surgery depends on the procedure performed. Patients who undergo trimming of the torn tissue often walk without crutches within a few days and return to most activities in about a month. Meniscus repairs require greater protection, with crutches typically used for four to six weeks to avoid damaging the repair.

Following repair, patients gradually progress through range-of-motion and strengthening exercises, avoiding running until around three months after surgery. Return to sports may take up to six months. Whether treated nonoperatively, with trimming, or with repair, patients and surgeons should work together to choose the best treatment plan to support a safe return to desired activities.