Degenerative Meniscal Tears

Evidence-based treatment focused on improving symptoms while avoiding unnecessary surgery.

Degenerative Meniscal Tears – Key Points

• Degenerative meniscal tears are common, particularly in middle age and beyond
• They are often associated with early wear in the knee rather than a single major injury
• Current BASK-based guidance recommends non-operative treatment first, usually with physiotherapy
• High-quality trials show physiotherapy provides similar outcomes to surgery for many patients
• Some patients may benefit more from surgery, particularly in selected groups
• Around 35–40% of patients may go on to require surgery if symptoms persist
• Meniscal root tears are a separate injury and should be identified early, as they often require surgical repair
• At UHCW, we are investigating which patients may benefit from earlier surgical intervention

What is a degenerative meniscal tear?

The meniscus is a cushion in the knee that helps transmit load evenly through the joint. A degenerative meniscal tear develops gradually as part of the ageing process, rather than from a single injury.

These tears are common and often seen on MRI, but they are not always the primary cause of symptoms. Many patients also have early cartilage wear, which can contribute to pain and stiffness.

First-line treatment

Current UK guidance based on BASK recommends that the vast majority of patients with a degenerative meniscal tear should be treated non-operatively first.

This typically includes:

• Physiotherapy focused on strength and control
• Activity modification
• Simple pain relief where required
• Weight management where appropriate

This approach is important because many degenerative tears improve without surgery, and imaging findings alone do not necessarily mean an operation is required.

What does the evidence show?

Several high-quality studies have compared physiotherapy with arthroscopic meniscal surgery for degenerative meniscal tears.

The METRO study (Bone & Joint Journal) demonstrated that, in selected patients, arthroscopic meniscal surgery resulted in greater improvement in symptoms compared to physiotherapy alone. This highlights that there is a subgroup of patients who may benefit more from early surgical intervention.

In contrast, other large randomised trials, including ESCAPE, have shown that physiotherapy provides outcomes comparable to surgery for many patients, even at longer-term follow-up.

Taken together, this evidence supports a selective and individualised approach, rather than a one-size-fits-all treatment strategy.

Will physiotherapy always avoid surgery?

Not always. While many patients improve with rehabilitation alone, some continue to have symptoms and later choose surgery.

Across multiple randomised trials, approximately 30–40% of patients initially treated with physiotherapy go on to have arthroscopic surgery. This reflects the fact that:

• Physiotherapy is the appropriate starting point for most patients
• Surgery remains an important option for those who do not improve

Important distinction: meniscal root tears

It is important to distinguish degenerative meniscal tears from meniscal root tears, which are a different and more serious injury.

A root tear involves detachment of the meniscus from the bone. This causes the meniscus to stop functioning properly, leading to:

• Loss of normal load transmission
• Increased contact pressures in the knee
• A high risk of rapid progression to osteoarthritis if not treated

Unlike typical degenerative tears, root tears often require early surgical repair and should not be managed with physiotherapy alone.

Careful assessment, including MRI and clinical evaluation, is essential to ensure these injuries are not missed.

When might surgery still be considered?

Surgery may be appropriate in selected patients, particularly where:

• Symptoms persist despite a structured course of physiotherapy
• There are mechanical symptoms such as catching or locking
• Clinical assessment suggests the meniscal tear is the main driver of symptoms

At UHCW, we are actively researching which patients may benefit from earlier surgical intervention, with the aim of improving patient selection and delivering more personalised care.

Why choose Mr Smith?

Mr Smith uses an evidence-based and individualised approach to degenerative meniscal tears, combining current BASK guidance with the latest clinical research. Each patient is carefully assessed to determine whether physiotherapy or surgical treatment is most appropriate.

His practice is supported by ongoing research at UHCW focused on identifying which patients benefit most from early surgery, ensuring treatment is tailored to optimise outcomes.