Meniscal tears in the middle-aged and older population



Knee injury is a common ailment, and meniscal tears often cause confusion into what is the best treatment approach for both the short and long-term.


Approaches to meniscal tear include arthroscopic partial meniscectomy, where the surgeon removes the damaged part of the meniscus; and physical therapy. Physical therapy is often focused on strengthening the quadriceps, hamstring, and other lower extremity muscles, along with neuromuscular exercise.


Historically, the outcomes were predominately in favour of a surgical intervention but over the last 15 years treatment has swayed towards physical therapy as first line intervention. Currently, evidence suggests that initial treatment with either surgery or physical therapy is associated with substantial pain relief. Up to 30% of those who initially undergo physical therapy will later have surgery.


Those who have physically demanding jobs and need to return to work promptly may be more likely to under-go arthroscopic surgery as many have no knee-related activity restrictions after just four weeks, whereas physical therapy is inherently a longer journey.


There is conflicting evidence to suggest those who undergo arthroscopic partial meniscectomy are more likely to suffer advance osteoarthritic changes, and also to latterly opt for a total knee replacement in the long-term. This indicates the need for more long-term studies to be conducted. If patients can accept the longer rehabilitation period with physical therapy, then the long-term results are more favourable with enhanced patient adherence to maintaining strength, stability and cardiovascular fitness.