The knee meniscus: management of traumatic tears and degenerative lesions

Overview

This review covers the management of meniscal pathology of the knee. It draws a clear line between traumatic tears, which are usually seen in younger and active patients, and degenerative lesions, which are common in middle-aged and older adults. The guiding principle throughout is preserving the meniscus, because it plays a central part in load distribution, joint stability and cartilage protection.

Traumatic tears

For traumatic tears, the review favours repair whenever the tear pattern, location and tissue quality allow. This is especially true when an ACL injury is also present and addressed at the same time. It highlights tear types that deserve particular attention, such as root tears and ramp lesions, because missing them can badly impair meniscal function.

Degenerative lesions

For degenerative meniscal lesions, the review emphasises that the tear often forms part of early osteoarthritis. Conservative management with exercise therapy, education and symptom control should come first. Routine arthroscopic partial meniscectomy is not supported for most of these patients. Surgery is kept for selected cases, such as persistent mechanical symptoms that do not respond to non-operative care.

Consequences and reconstruction options

Removing meniscal tissue raises the long-term risk of osteoarthritis. For carefully selected patients who have lost meniscal tissue and have symptoms, the review discusses meniscal allograft transplantation and scaffold techniques.

Implications for practice

Clinicians should separate traumatic from degenerative presentations, save and repair the meniscus where possible, and avoid unnecessary arthroscopy in degenerative knees.