The meniscus is a pair of C-shaped pieces of tough, rubbery cartilage that act as shock absorbers in the knee joint. A meniscus tear is a common injury, often caused by a forceful twist or rotation of the knee while bearing weight. Not all meniscus tears necessitate surgical intervention; many can be managed effectively with non-operative treatments, depending on the injury’s characteristics and the patient’s circumstances.
Key Variables Guiding Treatment Decisions
The decision to pursue surgery or conservative management hinges on the tear’s location and the patient’s condition, as the blood supply is the most significant factor in determining the potential for natural healing. The outer third, the “red zone,” has a rich blood supply, meaning tears here have a good chance of healing on their own or after surgical repair.
In contrast, the inner two-thirds, the “white zone,” is avascular and lacks a direct blood supply. Tears in this zone will not heal because healing factors cannot reach the damaged tissue. Complex tears, such as a “bucket handle” tear, are more likely to require surgery because they can displace and cause mechanical problems.
Patient factors heavily influence the treatment path, particularly mechanical symptoms like knee locking, catching, or instability. Locking occurs when a fragment of the torn meniscus gets caught in the joint, preventing full extension, and this is a strong indicator for surgical intervention. Age and activity level are also weighed, as a younger, highly active person is a better candidate for meniscal repair to preserve long-term joint function.
Managing Tears Without Surgery
When the tear is stable, small, or located in the well-vascularized zone, conservative management is the first course of action. This protocol begins with the RICE method: Rest, Ice, Compression, and Elevation. Resting the knee by avoiding weight-bearing activities helps prevent further damage, while applying ice manages pain and acute swelling.
Compression, usually with an elastic bandage, helps control swelling, and elevating the leg above heart level assists in draining excess fluid. Pain management often involves nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce discomfort and inflammation. In some instances, a corticosteroid injection may be used to deliver concentrated anti-inflammatory medication directly into the knee joint.
Physical therapy is the cornerstone of non-operative treatment, focusing on restoring full, pain-free range of motion. Specific exercises strengthen the muscles surrounding the knee, particularly the quadriceps and hamstrings, which act as dynamic stabilizers and shock absorbers. This strengthening reduces the load transmitted across the injured meniscus, restoring normal function and allowing the patient to return to prior activities.
Surgical Options Repair Versus Removal
If conservative treatment fails or the tear causes mechanical symptoms, surgery may be necessary, involving one of two primary procedures. The preferred option is a meniscal repair, which involves stitching the torn edges of the cartilage back together. This procedure is generally reserved for acute tears in younger patients and those located in the highly vascularized red zone, where the blood supply supports healing.
The goal of a meniscal repair is to save the entire structure, preserving the knee’s natural shock-absorbing and stabilizing functions. However, the recovery timeline is typically longer, often requiring restricted weight-bearing for four to six weeks to allow complete healing. The alternative is a partial meniscectomy, which involves surgically trimming and removing only the damaged or unstable portion of the meniscus.
A meniscectomy is more common, particularly for tears in the avascular white zone or degenerative tears seen in older individuals. This procedure removes the problematic tissue causing symptoms like locking or catching, allowing for a quicker return to full activity. While a meniscectomy offers faster short-term recovery, removing even a small portion of the meniscus increases contact pressure across the knee joint, carrying a higher long-term risk of developing knee osteoarthritis compared to a successful meniscal repair.