RESTORING KNEE MOBILITY AFTER MENISCUS INJURIES: THE ROLE OF SURGICAL AND REHABILITATION TECHNIQUES
Abstract
Meniscal injuries are common knee joint conditions affecting both young, active individuals and older adults. The meniscus plays a key role in load distribution, shock absorption, proprioception, and joint lubrication. Modern treatment trends prioritize preserving the meniscus rather than removing damaged tissue. Clinical decisions depend on tear type, location, vascularity, patient age, activity level, and comorbidities such as osteoarthritis.
This review, based on literature from PubMed, Web of Science, and Google Scholar, compares surgical and non-surgical strategies, focusing on outcomes, indications, and patient-specific factors. Arthroscopic meniscal repair (AMR) is favored for traumatic tears in younger, active patients, particularly those in vascular zones (red-red or red-white). Such injuries, often associated with anterior cruciate ligament (ACL) tears, yield better functional outcomes, reduced pain, and lower osteoarthritis risk with AMR compared to arthroscopic partial meniscectomy (APM). Results improve further when AMR is performed alongside ACL reconstruction due to enhanced healing conditions.
In contrast, degenerative meniscal lesions (DMLs) - prevalent in middle-aged and elderly populations-respond poorly to surgery. Major trials (FIDELITY, ESCAPE) have shown no significant benefit of APM over structured physiotherapy or even placebo surgery. Moreover, APM may accelerate osteoarthritis progression and carries surgical risks. Consequently, guidelines recommend conservative management, including physiotherapy, exercise, and potentially intra-articular injections, as first-line treatment for degenerative tears.
In summary, meniscal treatment should be individualized: surgical repair for young patients with repairable traumatic tears, and non-operative management for degenerative cases. Advances in biologics and imaging may further refine treatment approaches.
References
Sihvonen, R., Paavola, M., Malmivaara, A., Itälä, A., Joukainen, A., Nurmi, H & Järvinen, T. L. N. (2018). Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: A 2-year follow-up of the randomised controlled trial. Annals of the Rheumatic Diseases, 77(2), 188–195. https://doi.org/10.1136/annrheumdis-2017-211172
Rotini, M., Papalia, G., Setaro, N., Luciani, P., Marinelli, M., Specchia, N., & Gigante, A. (2023). Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: A systematic review of systematic reviews. Musculoskeletal Surgery, 107, 127–141. https://doi.org/10.1007/s12306-022-00760-z
Herrlin, S. V., Hållander, M., Wange, P. O., Weidenhielm, L., & Werner, S. (2007). Arthroscopic or conservative treatment of degenerative medial meniscal tears: A prospective randomized trial. *Knee Surgery, Sports Traumatology, Arthroscopy, 15*(4), 393–401. https://doi.org/10.1007/s00167-006-0243-2
Katz, J. N., Brophy, R. H., Chaisson, C. E., de Chaves, L., Cole, B. J., Dahm, D. L., Donnell-Fink, L. A., Guermazi, A., Haas, A. K., Jones, M. H., Levy, B. A., Mandl, L. A., Martin, S. D., Marx, R. G., Miniaci, A., Matava, M. J., Palmisano, J., Reinke, E. K., Richardson, B. E., ... Losina, E. (2013). Surgery versus physical therapy for a meniscal tear and osteoarthritis. *The New England Journal of Medicine, 368*(18), 1675–1684. https://doi.org/10.1056/NEJMoa1301408
Sihvonen, R., Paavola, M., Malmivaara, A., Itälä, A., Joukainen, A., Kalske, J., Nurmi, H., Kumm, J., Sillanpää, N., Kiekara, T., Turkiewicz, A., Toivonen, P., Englund, M., Taimela, S., & Järvinen, T. L. N. (2020). Arthroscopic partial meniscectomy for a degenerative meniscus tear: A 5-year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. *British Journal of Sports Medicine, 54*(22), 1332–1339. https://doi.org/10.1136/bjsports-2020-102813
Sonesson, S., Springer, I., Yakob, J., Hedevik, H., Gauffin, H., & Kvist, J. (2024). Knee arthroscopic surgery in middle-aged patients with meniscal symptoms: A 10-year follow-up of a prospective, randomized controlled trial. *The American Journal of Sports Medicine, 52*(9), 2250–2259. https://doi.org/10.1177/03635465241255653
Vaquero-Picado, A., & Rodríguez-Merchán, E. C. (2018). Arthroscopic repair of the meniscus: Surgical management and clinical outcomes. *EFORT Open Reviews, 3*(11), 584–594. https://doi.org/10.1302/2058-5241.3.170059
Kise, N. J., Risberg, M. A., Stensrud, S., Ranstam, J., Engebretsen, L., & Roos, E. M. (2016). Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle-aged patients: Randomised controlled trial with two year follow-up. *BMJ, 354*, i3740. https://doi.org/10.1136/bmj.i3740
Thorlund, J. B., Juhl, C. B., Roos, E. M., & Lohmander, L. S. (2015). Arthroscopic surgery for degenerative knee: Systematic review and meta-analysis of benefits and harms. *BMJ, 350*, h2747. https://doi.org/10.1136/bmj.h2747
Aneesullah, F., Kaleem, M., Umer, M., Hussain, A., Ahmed, K., & Javed, A. (2024). Functional outcomes of arthroscopic partial meniscectomy in patients with degenerative meniscal tears. *Pakistan Journal of Medical Sciences, 40*(2), 200–205. https://doi.org/10.12669/pjms.40.2.789
Rotini, M., Papalia, G., Setaro, N., Luciani, P., Marinelli, M., Specchia, N., & Gigante, A. (2023). Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: A systematic review of systematic reviews. *Musculoskeletal Surgery, 107*, 127–141. https://doi.org/10.1007/s12306-022-00760-z
Simonetta, R., Russo, A., Palco, M., Costa, G. G., & Mariani, P. P. (2023). Meniscus tears treatment: The good, the bad and the ugly-patterns classification and practical guide. *World Journal of Orthopedics, 14*(4), 171–185. https://doi.org/10.5312/wjo.v14.i4.171
Bottomley, J., & Al-Dadah, O. (2023). Arthroscopic meniscectomy vs meniscal repair: Comparison of clinical outcomes. *Cureus, 15*(8), e44122. https://doi.org/10.7759/cureus.44122
Akkawi, I., Draghetti, M., & Zmerly, H. (2021). Degenerative meniscal lesions: Conservative versus surgical management. *Acta Biomedica, 92*(6), e2021354. https://doi.org/10.23750/abm.v92i6.11195
Hare, K. B., Lohmander, L. S., Christensen, R., Roos, E. M., & Jørgensen, U. (2014). The challenge of recruiting patients into a placebo-controlled surgical trial. *Trials, 15*, 167. https://doi.org/10.1186/1745-6215-15-167
Willems, W. J., Jacobs, W. C., Wijn, S. R., Poolman, R. W., & Muradin, G. S. (2021). Arthroscopic partial meniscectomy vs non-surgical or sham treatment in patients with MRI-confirmed degenerative meniscus tears: A systematic review and meta-analysis. *British Journal of Sports Medicine, 55*(18), 1030–1038. https://doi.org/10.1136/bjsports-2020-103272
Kawamura, S., Lotz, M., & Rodeo, S. (2003). Biomechanics and healing response of the meniscus. *Instructional Course Lectures, 52*, 383–392.
Ozeki, N., Koga, H., & Sekiya, I. (2022). Degenerative meniscus in knee osteoarthritis: From pathology to treatment. *Life*, *12*(4), 603. https://doi.org/10.3390/life12040603
Jeong, H.-J., Lee, S.-H., & Ko, C.-S. (2012). Meniscectomy. *Knee Surgery & Related Research*, *24*(3), 129–136. https://doi.org/10.5792/ksrr.2012.24.3.129
Sari, A., Günaydin, B., & Dinçel, Y. M. (n.d.). Meniscus tears and review of the literature. In *The Athletic Knee - Function, Pathology and Management* (pp. 1–18). IntechOpen.
Luvsannyam, E., Jain, M. S., Leitao, A. R., Maikawa, N., & Leitao, A. E. (2022). Meniscus tear: Pathology, incidence, and management. *Cureus*, *14*(5), e25121. https://doi.org/10.7759/cureus.25121
Doral, M. N., Bilge, O., Huri, G., Turhan, E., & Verdonk, R. (2018). Modern treatment of meniscal tears. *EFORT Open Reviews*, *3*(5), 260–268. https://doi.org/10.1302/2058-5241.3.170067
Makris, E. A., Hadidi, P., & Athanasiou, K. A. (2011). The knee meniscus: Structure-function, pathophysiology, current repair techniques, and prospects for regeneration. *Biomaterials*, *32*(30), 7411–7431. https://doi.org/10.1016/j.biomaterials.2011.06.037
Makris, E. A., Hadidi, P., & Athanasiou, K. A. (2011). The human meniscus: A review of anatomy, function, and injuries. *Journal of Orthopaedic Research*, *29*(6), 956–962. https://doi.org/10.1002/jor.21345
Beaufils, P., Becker, R., Kopf, S., Englund, M., Verdonk, R., Ollivier, M., & Seil, R. (2017). Surgical management of degenerative meniscus lesions: The 2016 ESSKA meniscus consensus. *Knee Surgery, Sports Traumatology, Arthroscopy*, *25*(2), 335–346. https://doi.org/10.1007/s00167-016-4403-x
Views:
18
Downloads:
6
Copyright (c) 2025 Mateusz Myśliwiec, Tytus Tyralik, Maciej Karwat, Julia Kular, Oliwia Malec, Justyna Niebylecka, Izabella Michalska, Natalia Glanc, Dominik Sendecki, Grzegorz Zalewski
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
