Meniscal tear

• Programmes designed to improve knee joint range of motion, core and leg strength, and knee stability, and to normalise gait are recommended.

• Physiotherapy is not necessary for small meniscal tears to heal but is beneficial for addressing gait abnormalities and strengthening the leg muscles that surround and stabilise the knee joint.

• Paracetamol is the preferred drug for reducing pain because it acts centrally and does not interfere with the healing process. [22]

• NSAIDs should be used only for short periods because of the negative effects on musculoskeletal healing. [21]

Primary Options

Secondary Options

• Large (≥1 cm) meniscal tears, root tears, and cases where symptoms persist despite non-operative care should receive arthroscopic surgery to prevent further damage and save healthy meniscus tissue.

• Suturing of the tissue is possible if a stable repair can be achieved (usually reserved for clear, clean pattern tears). View imageView image Meniscal repair should only be used to heal peripheral meniscal lesions affecting healthy meniscal tissue in vascularised areas. [23]

• Degenerative tears where the meniscus tissue is unhealthy, yellowed, stiff, or filled with chondrocalcinosis deposits are usually resected by partial meniscectomy, the goal of which is to preserve meniscal volume and shape, permitting some shock absorption. In general, tears in patients >40 years old are infrequently healthy enough to be repaired, and therefore partial meniscectomy is the preferred option.

• A complete meniscectomy, involving removal of the entire meniscus, is rarely performed and usually reserved for cases where the tear is too large or cuts through the entire meniscus.

• At short- and long-term follow-up, meniscal repair had a higher reoperation rate than partial meniscectomy. However, meniscal repair has a better long-term outcome score and less radiologic degeneration than partial meniscectomy. [24]

• Associated ligamentous injury of the knee leads to knee instability. Therefore, in meniscal tears associated with such injuries, concomitant repair of the affected ligament should be considered, as meniscal repairs should be carried out on a stable knee.

• Post-operative care of the repaired or resected meniscus focuses on limiting axial load and rotational movement for the first month, followed by range-of-motion and strengthening exercises.

• Partial meniscectomy: icing and elevation of knee above the level of the heart, use of crutches for first week, and progression to weight bearing as tolerated. Intra-articular hyaluronan injection may decrease post-operative pain and swelling. [26]

• Meniscal repair: similar to above; however, full weight bearing should be delayed for at least 4-6 weeks and range of movement of the knee, especially full flexion, should be limited to reduce strain on the repair site. Should not return to knee-twisting sports (e.g., football, basketball) for 2 months after meniscal repair.

• A knee brace is not usually indicated following meniscectomy. After meniscal repair the need for a brace depends on patient activity and condition of repair.

Primary Options