By Austin V. Stone MD, PhD
Treatment options for meniscus tears depend on the person, the tear type, and the symptoms that may be related to the tear. Meniscus tears and healthy knees without arthritis may be accompanied by ligament injuries or may be isolated. For knees that do not have arthritis, meniscus tears are often surgical problems. These tears are most frequently the result of a known traumatic injury, such as a sport injury or a fall. An MRI is typically ordered after x-rays. X-rays in the setting are most commonly normal. Based on the tear pattern, the meniscus may be repaired or partially removed.
Acute meniscus tears are usually managed with arthroscopy, which is the use of a camera in small incisions to address problems inside the knee joint. While it is important to repair meniscus tears, not all tears are amenable to repair. Some tears will not heal because of the lack of blood flow to the meniscus. These tear types are trimmed out in what is called a partial meniscectomy. After a partial meniscectomy, the patient may bear weight and return to activity within a few days or a few weeks. It is generally recommended to avoid high-impact activity after partial meniscectomy for at least a month to allow the need to adapt to its new biomechanical state. For those tears that can be repaired, sutures are used to sew the meniscus back together. Oftentimes, the meniscus may be repaired without accessory incisions, but in some cases additional incisions are necessary. Meniscus repairs take much longer to heal and return to full activity typically takes 4 to 6 months.
Meniscus tears in osteoarthritis for a different problem. The meniscus can develop osteoarthritis much like the cartilage of the joint. This leads to small degenerative tears. These tears often do not bother patients but may be found on MRIs obtained for a different reason. The mainstay of treatment is to begin physical therapy and strengthening exercises. In several large studies published in the New England Journal of Medicine, the authors found that patients did well with physical therapy rather than surgical management.
If the tear progresses in patients with osteoarthritis in the meniscus tear, then the arthroscopy may be beneficial. Another study in the New England Journal of Medicine found that patients who performed physical therapy first but then had mechanical symptoms requiring arthroscopy with partial meniscectomy did just as well is patients who had early surgery. Early arthroscopy in the setting of osteoarthritis may be detrimental to the knee and increases the risk of requiring total knee arthroplasty in the short term. Patients with osteoarthritis and degenerative tears of the meniscus who are unable to improve with physical therapy or have mechanical symptoms may benefit from arthroscopic partial meniscectomy. A discussion with your surgeon and establishing realistic expectations is the best strategy.