Meniscal Injuries: Surgery or Physical Therapy?

Patients with meniscal injuries (such as a meniscal tear) face an interesting choice: surgery or physical therapy. The goal, of course, is to restore functional movement of the knee joint and to reduce pain after an injury to the meniscus. Before getting to what the research says, let’s first take a closer look at the injury.

Common Symptoms of a Meniscus Tear

A meniscus tear can present in different ways depending on its severity and location. Many people notice symptoms shortly after a twisting injury, while others may experience gradual knee pain over time.

Common symptoms include:

• Knee pain along the joint line.
• Pain and swelling that develop within the first 24 to 48 hours.
• Stiffness or difficulty bending and straightening the knee.
• Catching, locking, or clicking sensations.
• Difficulty moving the knee through a full range of motion.

If you are experiencing these symptoms, it may be a sign of a torn meniscus and should be evaluated by a provider.

The menisci are two crescent-shaped cartilages that lie between the femur (thigh bone) and the tibia (shin bone). It is often torn by twisting or by applying pressure to the knee joint. Many types of tears can occur with a meniscus injury, including horizontal, longitudinal, radial, oblique, degenerative, or discoid tears. Tears in the outer 1/3 of the menisci are more likely to heal because the blood supply is greater in that area. Tears closer to the center of the knee (deeper) are less likely to receive the blood supply and nutrients they need to heal effectively.

What Causes a Meniscus Tear?

A meniscus tear often occurs during activities that involve twisting, pivoting, or sudden changes in direction. This is common in sports, but it can also happen during everyday movements.

In older adults, a torn meniscus may develop gradually due to the wear-and-tear associated with osteoarthritis. Over time, the cartilage becomes weaker and more prone to injury, even with minimal stress.

Research About Meniscal Injuries

Scientific studies have looked at the difference in function and pain between patients who underwent surgery and those who opted for physical therapy. Studies use both “Lysholm” and visual analog scores to measure the different treatment methods. 

Lysholm is a patient-reported outcome measure consisting of 8 questions covering categories of limping, support, locking, instability, pain, swelling, stair climbing, squatting, and knee locking. A visual analog scale allows a patient to rate their pain on a 0-10 scale, usually using faces ranging from “happy” to “sad”. 

In a study by Yim et al. (2013), the authors found no difference in Lysholm and visual analog scores between the two groups. In another study by Herrlin et al. (2013), it was also reported that conservative therapy (physical therapy without surgery) was as effective as arthroscopic partial meniscectomy (the surgery to repair or “clean out” the knee joint) for symptomatic and functional improvement. From a cost-effectiveness perspective, receiving physical treatment is the better option for the patient, with cost savings of $1,000–$6,000. After analyzing the literature and reviewing the data, these studies concluded that there were no significant differences in outcomes between surgery and conservative physical therapy.

As physical therapists, we notice that patients can often be discouraged by a lack of perceived progress during their sessions. Even though the more conservative approach of slow, steady results can take longer, it’s important to remember all the benefits of conservative treatment versus surgery. This includes, but is not limited to: cost-effectiveness, the benefits of strengthening (especially pre-operatively in circumstances of definite surgical intervention), and the literature, which found no differences between conservative treatment and surgery in choosing one treatment over the other.

How Physical Therapy Treats a Meniscus Tear

Physical therapy focuses on restoring movement, reducing symptoms, and helping you return to activity safely. A PT will create a personalized treatment plan based on your needs and goals.

Treatment may include:

• Targeted exercise to improve range of motion and reduce stiffness.
• Strengthening exercises for the quadriceps, hamstrings, and hips.
• Balance and stability training to support the knee joint.
• Strategies to help reduce pain and swelling.

These approaches allow many patients to recover and return to activity without pain and without surgery.

When Does a Meniscus Tear Require Surgery?

Not all meniscus tears require surgery. Many people improve with physical therapy alone. However, some cases may require surgery, especially if:

• The knee locks or cannot fully straighten.
• There is persistent pain despite conservative care.
• A large tear interferes with joint movement.

In these situations, a procedure such as surgery to remove or repair the damaged portion of the meniscus may be considered.

What to Do if You Have a Meniscal Injury

If you’ve recently experienced an injury to your meniscus, be sure that you’re fully educated before making a decision about whether to go under the knife or to get treated by a physical therapist.

To learn more about knee injuries, click here.

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