Meniscal Injuries

Usually not. The FIDELITY trial (Sihvonen et al., NEJM 2013) randomised 146 patients with degenerative medial meniscus tears and no osteoarthritis to arthroscopic partial meniscectomy or sham surgery, and found no difference in any primary outcome at 12 months. The ESCAPE trial (van de Graaf et al., JAMA 2018) compared physical therapy to arthroscopic partial meniscectomy in 321 patients with degenerative tears, and 5 year follow-up confirmed physical therapy remained noninferior for patient-reported knee function. For degenerative tears, a structured rehabilitation program is a reasonable first step for the large majority.

Traumatic tears usually happen in a specific moment, often a loaded twist or cutting movement in a younger athletic knee, with immediate pain, swelling, and sometimes a true locking episode. Degenerative tears develop over years in middle-aged and older knees, often without a clear injury event, and commonly sit alongside early osteoarthritis. The rehabilitation pathway is quite different, which is why the history matters as much as the MRI.

The outer third has blood supply and some capacity to heal, particularly in younger patients with peripheral tears. The inner two thirds are essentially avascular and do not heal in a true biological sense. That does not mean symptoms cannot settle. Plenty of degenerative tears become asymptomatic with strengthening, load management, and time, even if the tear itself stays visible on imaging.

Possibly, but true locking and a vague sense of catching are different. True locking is a mechanical block to full extension that the patient cannot unlock on their own, often from a bucket-handle tear, and this is an orthopaedic issue that needs prompt assessment. A feeling of clicking, catching, or the knee 'hesitating' is common in degenerative tears and osteoarthritis, and is usually managed conservatively.

The METEOR trial (Katz et al., NEJM 2013) randomised 351 patients with a meniscal tear plus osteoarthritis to arthroscopic partial meniscectomy plus physical therapy or physical therapy alone, and found no meaningful difference in function at 6 months. Thorlund and colleagues' 2015 BMJ systematic review and meta-analysis of arthroscopic surgery for the degenerative knee concluded that any benefit of arthroscopy over conservative care was small, short-lived, and gone by one to two years. Physiotherapy is a reasonable first choice for most degenerative tears, and plenty of traumatic tears without mechanical blocks also respond well to loading.

True mechanical locking that cannot be released, large bucket-handle tears, and displaced flap tears in younger patients with genuine function-limiting symptoms are the clearer surgical indications. Younger patients with peripheral longitudinal tears in well-vascularised tissue may also be candidates for meniscus repair, which is a different operation from a partial meniscectomy and has very different implications for long-term knee health. These are case-by-case decisions made with an orthopaedic surgeon.

Often yes, with modification. The tear itself is not made worse by most training activities, and loading the quadriceps and hip musculature is part of the treatment. Sharp twisting, deep loaded squatting early on, and sudden large jumps in volume tend to flare symptoms. The usual approach is reducing aggravating activities for a few weeks while rebuilding strength, then layering load back in.

Meniscus loss is a known risk factor for later knee osteoarthritis, and partial meniscectomy removes tissue that will not grow back. This is one of the reasons the evidence has pushed back against routine surgery for degenerative tears: operating on a tear that would have settled with rehab can be counterproductive over decades. Keeping as much functional meniscus as possible is generally the priority.