Dropping some links here that should outline the current "best medical advice."
TL;DR, it can be summarized as follows, as my delightfully conservative orthopedic surgeon said:
"The study comparing PT and surgery showed that after two years, the two groups ended up in about the same place. But about 25% in the PT group crossed over and had surgery after PT (because they were too impacted by symptoms). And they ended up in the same place after two years. So try 6-8 weeks of PT, and if you don't need surgery, that's great. But if your symptoms are still bothersome, you should get the surgery so you can get on with your life, and it should be an equally good outcome."
Most relevant research articles:
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October 2, 2018
Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears. The ESCAPE Randomized Clinical Trial
https://jamanetwork.com/journals/jam...rticle/2705186
Objective: To assess whether PT is noninferior to arthroscopic partial meniscectomy (APM) for improving patient-reported knee function in patients with meniscal tears.
Findings: In this noninferiority randomized clinical trial that included 321 patients, knee function that was measured by a self-administered questionnaire improved by 20.4 points in the physical therapy group vs 26.2 points in the early surgery group over a follow-up period of 24 months. The difference between the 2 treatment groups did not exceed the noninferiority margin of 8 points.
Conclusions and Relevance: Among patients with nonobstructive meniscal tears, PT was noninferior to APM for improving patient-reported knee function over a 24-month follow-up period. Based on these results, PT may be considered an alternative to surgery for patients with nonobstructive meniscal tears.
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20 July 2016
Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up
https://www.bmj.com/content/354/bmj.i3740
Objective: To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears.
Results: No clinically relevant difference was found between the two groups in change in KOOS4 at two years.
Conclusion: The observed difference in treatment effect was minute after two years of follow-up, and the trial’s inferential uncertainty was sufficiently small to exclude clinically relevant differences. Exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term. Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no definitive radiographic evidence of osteoarthritis to consider supervised exercise therapy as a treatment option.
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2014 Jul 18
Treatment of meniscal tears: An evidence based approach
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095015/
This study includes classification of meniscal tears with pictures of each.
Abstract: 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.
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2013 Jul;23(5):589-93. doi: 10.1007/s00590-012-1028-6. Epub 2012 Jun 30.
Traumatic and non-traumatic isolated horizontal meniscal tears of the knee in patients less than 40 years of age.
https://www.ncbi.nlm.nih.gov/pubmed/...?dopt=Abstract
Purpose: The aim of this study is to analyze the characteristics of isolated horizontal meniscal tears in young patients and compared traumatic and non-traumatic isolated horizontal meniscal tear without other type of meniscal tear.
Conclusions: Isolated horizontal meniscal tears in young patients predominantly involved non-dominant knees and medial meniscus. Anterior aspect of medial meniscus was more frequently involved in traumatic group. Meniscal cysts were more frequently showed in non-traumatic group.
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First published May 18, 2017. Online issue publication January 12, 2018
Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial
https://ard.bmj.com/content/77/2/188
Objective: To assess if arthroscopic partial meniscectomy (APM) is superior to placebo surgery in the treatment of patients with degenerative tear of the medial meniscus.
Results: In the intention-to-treat analysis, there were no significant between-group differences in the mean changes from baseline to 24 months in WOMET score.
Conclusions: In this 2-year follow-up of patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after APM were no better than those after placebo surgery. No evidence could be found to support the prevailing ideas that patients with presence of mechanical symptoms or certain meniscus tear characteristics or those who have failed initial conservative treatment are more likely to benefit from APM.
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