What's Happening

The meniscus is a C-shaped cushion of cartilage that absorbs shock and stabilizes the knee. Tears generally fall into two categories with very different implications for treatment.

Degenerative

  • Age-related wear, often in middle age or older

  • Frequently found alongside early knee arthritis

  • Usually no single injury moment

Traumatic

  • A specific twisting or pivoting injury

  • More common in younger, active people

  • Sometimes paired with an ACL injury

What the Evidence Shows

For degenerative tears: multiple large trials — including one following 879 patients — found that arthroscopic surgery provided no meaningful benefit over sham surgery or structured exercise. Surgery also carries real risks, including infection and blood clots, that exercise doesn't.

Traumatic tears are more individual — larger tear patterns, locking of the knee, or tears alongside an ACL injury are more likely to need surgery, especially in younger, highly active patients. For most other tears, a real trial of rehab (typically 3–6 months) makes sense before considering surgery.

How We Treat It

  1. Calm the joint — manage swelling, protect painful motion, and restore a normal walking pattern.

  2. Rebuild quad and hip strength — the muscles that offload and stabilize the knee, shown to meaningfully reduce pain.

  3. Restore motor control — balance and movement-pattern retraining, not just strength alone.

  4. Return to activity by milestone, not by calendar — full motion, no swelling, and strength/hop tests within about 90% of the other leg before clearing higher-level activity.

Bottom line: For most meniscus tears — especially degenerative ones — a structured course of rehab is a safe, evidence-backed first step, with surgery kept in reserve for the cases that truly need it.