Topic Highlight
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2014; 5(3): 233-241
Published online Jul 18, 2014. doi: 10.5312/wjo.v5.i3.233
Treatment of meniscal tears: An evidence based approach
Simon C Mordecai, Nawfal Al-Hadithy, Howard E Ware, Chinmay M Gupte
Simon C Mordecai, Nawfal Al-Hadithy, Chinmay M Gupte, Imperial College NHS Trust, St Mary’s and Charing Cross Hospitals, London W21NY, United Kingdom
Howard E Ware, Chinmay M Gupte, The Wellington Hospital, The Knee Surgery Unit, London NW8 9LE, United Kingdom
Author contributions: Mordecai SC and Al-Hadithy N wrote the manuscript; Ware HE and Gupte CM provided specialist input and edited the manuscript.
Correspondence to: Dr. Simon C Mordecai, Imperial College NHS Trust, St Mary’s and Charing Cross Hospitals, Praed St, London W21NY, United Kingdom.
Telephone: +44-020-33130970 Fax: +44-020-33130971
Received: December 31, 2013
Revised: April 5, 2014
Accepted: May 16, 2014
Published online: July 18, 2014

Treatment options for meniscal tears fall into three broad categories; non-operative, meniscectomy or meniscal repair. Selecting the most appropriate treatment for a given patient involves both patient factors (e.g., age, co-morbidities and compliance) and tear characteristics (e.g., location of tear/age/reducibility of tear). There is evidence suggesting that degenerative tears in older patients without mechanical symptoms can be effectively treated non-operatively with a structured physical therapy programme as a first line. Even if these patients later require meniscectomy they will still achieve similar functional outcomes than if they had initially been treated surgically. Partial meniscectomy is suitable for symptomatic tears not amenable to repair, and can still preserve meniscal function especially when the peripheral meniscal rim is intact. Meniscal repair shows 80% success at 2 years and is more suitable in younger patients with reducible tears that are peripheral (e.g., nearer the capsular attachment) and horizontal or longitudinal in nature. However, careful patient selection and repair technique is required with good compliance to post-operative rehabilitation, which often consists of bracing and non-weight bearing for 4-6 wk.

Keywords: Meniscus, Meniscectomy, Meniscal tear, Meniscal repair, Arthroscopic surgery

Core tip: Meniscal tears are a common orthopaedic pathology. Selecting the correct treatment can be challenging and involves multiple factors. This review explores the evidence for managing meniscal tears and when to consider each treatment option based on current available evidence.