Treatment for meniscus tears ranges from non-operative to surgical options. Based on the MRI report and the physical exam findings, as long as a patient does not have significant mechanical symptoms with a displaced flap that is irritating the joint further, most meniscus tears can be managed successfully without surgery. Non-operative measures aim to reduce inflammation in the joint; thus, the classic RICE treatment of rest, ice, compression, and elevation is very effective at reducing the initial swelling. To further assist with reducing inflammation in the knee, the judicious use of over-the-counter anti-inflammatory medications like Ibuprofen or Meloxicam can also be helpful. After the swelling has been minimized and pain is well controlled, targeted physical therapy is essential to restore strength, stability, and motion within the knee. Non-operative management works best when there are small tears of the meniscus that do not have a displaced flap. Non-operative treatment is also indicated for chronic complex degenerative tears in the context of degenerative arthritis. Injections can also be considered to help reduce inflammation in the joint if the previous measures outlined don’t provide the significant pain relief that the patient needs. Injections do not heal the tear but they can be very useful to help calm the joint down so the patient is able to regain knee function with therapy.
If there is failure of thoughtful non-operative treatment that has been appropriately done for an extended period of time or if the patient has a meniscus tear that meets an indication for surgery, then surgery can be considered. The decision to proceed with surgery is made upon consideration of the patient’s age, their goals of treatment, activity level, the type and location of the tear noted on the MRI, as well as the overall health of the knee. Certain meniscus tears actually may not benefit from non-operative treatment and surgery would be considered as the ideal option. Examples of such meniscus tears include radial tears that extend throughout the medial to lateral extent of the meniscus thereby rendering it non-functional to disperse hoop stresses. Meniscal root tears occur when the root of the meniscus that attaches into the tibia is torn off again rendering the meniscus not functional. In the context of complete radial tears or root tears, patients have a non-functional meniscus and without appropriate treatment, they will develop rapidly degenerative arthritis in that affected compartment. Other examples of meniscus tears that require earlier surgical intervention include meniscus tears in younger people that have a higher propensity to heal, tears that involve the outer third of the meniscus close to the joint capsule as this portion of the meniscus has more vascular blood supply and a higher likelihood of healing with surgery, and meniscus-capsular separations that render the meniscus unstable.
A meniscus repair involves placing stitches to help reconsolidate the torn meniscus tissue but the success of a repair relies heavily on the patient’s own blood supply and healing capability to help heal that tissue. Trying to repair every meniscus tear is not the best approach because if the tear does not heal appropriately, the patient will be no better off than they were before the surgery and would have undergone a more extensive rehabilitation process with little gain. Thus, it is very crucial to identify if the meniscus tear is actually amenable to being repaired both preoperatively on our MRI evaluation as well as intraoperatively with the arthroscopic camera looking at the meniscus. Tears that are repaired require a period of immobilization and limited weight-bearing to allow the meniscus to properly heal during the rehabilitation process.
If the tear is not amenable to repair, then a partial meniscectomy can be undertaken. A partial meniscectomy involves trimming out the torn portion such that the rest of the meniscus is not violated. Only the torn portion of the meniscus that is not functional is carefully removed and the rest of the healthy meniscus is preserved. Partial meniscectomies have a much faster rehabilitation process than meniscus repairs as there is not a waiting period to allow the body to heal the repaired tissue. However, patients are counseled to take it easy for the first couple of weeks as their body adjusts to the new state of their knee as overdoing it early after a partial meniscectomy can overload the tibia with walking.
