Meniscus Tears: Conservative VS Surgical Management
What is the meniscus?
The meniscus is a thick, rubbery, C-shaped cartilage between the thighbone and the shinbone. It acts as a cushion-like shock absorber, protecting the knee to reduce wear and tear to the knee cartilage. In simpler terms, think of it as the squishy discs that keep our knees happy!
What causes a meniscal tear?
Meniscus injuries can be sustained via two main causes; degenerative or acute trauma. We have both a lateral (outside edge) and medial (inside edge) meniscus; the medial side is most commonly involved, accounting for 78% of all meniscus injuries.
Degenerative: As we age, naturally our body displays signs of ‘wear and tear’. The older we get and the more repetitive stress we place on our knees over time, the meniscus may start to degenerate and become more susceptible to tears.
Acute Trauma: Sudden twisting or change of direction at speed combined with knee bending can commonly result in a meniscus tear. Less commonly, trauma tears can result from heavy compression loads (i.e landing from a height). Often in sporting injuries we see other important structures involved, like the Cruciate or Collateral Ligaments; which all play a role in the stability of your knee.
Signs and Symptoms of a Meniscal Tear:
Pain in the knee, often more focal to either side (outer or inner) and worse when walking/weight bearing
Stiffness
Swelling
Clicking, locking, or catching sensations in your knee
Instability - the feeling that your knee might ‘give way’
Difficulty bending or straightening your knee
Irritability with steps and stairs
Discomfort turning over in bed
When to consider surgery?
There are many different types of tears, and this will impact the management approach. Due to the varied blood supply across the meniscus, as well as the involvement with important ligaments in the knee, the location and type of tear will impact timeframe and treatment. Most importantly, the impact on your function will be the primary indicator. Significant locking of the knee is more often associated with complex tears (i.e. bucket-handle or parrot-beak) that can cause discomfort as well as loss of function.
Non-surgical treatment will involve soft tissue release work, addressing strength imbalances, and retraining poor motor patterns that may have contributed to the increased likelihood of injury. Your therapist will initially work to reduce your pain, whilst maintaining strength in your legs. As pain reduces, you will work with your practitioner to address strength deficits and retrain muscle patterns to minimise the risk of reinjury.
In some complex cases, conservative management has limitations. Examples of this may be the inability to reduce pain and swelling, or when instability and other important structures are affected. In these instances, meniscus repair or a meniscectomy may be recommended by an orthopaedic surgeon. Some
tears can be repaired, and essentially ‘stitched back together’. Other tears are treated by removing the torn cartilage from the meniscus; and this is known as a meniscectomy.
There is quite a high re-operation rate in meniscus repair cases comparatively to a meniscectomy; however recent studies suggest that long term follow up of meniscal repairs have been shown to demonstrate better clinical outcomes and less severe degenerative changes of osteoarthritis (Ozeki et al, 2018).
What are the benefits of conservative management?
As mentioned, depending on the severity of the injury, more often than not you can approach rehabilitation from a conservative approach. Surgery will require a period of rest and in some cases a bracing period, therefore lengthening your recovery time.
Conservative management is often used for smaller, non-complex tears where pain reduces within 4-6 weeks. Once pain reduces with acute rest and hands-on treatment, your practitioner will help you to regain the strength in your lower limbs, as well as teaching you how to reduce the risk of reinjury in the future.
It is important to consider that either way, you will need to do a rehabilitation program! Many individuals believe that choosing surgical options will require little-to-no effort from themselves. When it comes to knee injuries, there isn’t an ‘easy’ option that results in a positive outcome - so be sure to chat through your options with your practitioner.
Timeframes are a useful guide that we base on physiological principles (i.e. tissue healing time), but are influenced by individual factors such as rehabilitation compliance, occupation, and severity of injury.
Remember - returning to normal day-to-day function and sport should be criteria based, and not solely reliant on pain/symptoms.
Issy Ryles Reference List:
Ozeki, N, Seil, R, Krych, A, and Koga, H (2018), Surgical Treatment of Complex Meniscus Tear and
Disease: State of the Art, https://doi.org/10.1136/jisakos-2019-000380, 11/03/2025
