In a degenerative tear of the knee meniscus without osteoarthritis, what is the recommended initial management?

• A. Immediate arthroscopic meniscectomy
• B. Corticosteroid injection
• C. Weight-bearing protocol
• D. Physical therapy and exercise regimen

Answer: (D)

Degenerative tears of the knee meniscus without osteoarthritis are typically managed nonoperatively first. The aim is to reduce pain and improve function through restoring strength and proper knee mechanics, not to remove tissue right away. A structured physical therapy program targets quadriceps and hip abductor/rotator strength, knee range of motion, gait and proprioception, and gradual return to activities. This approach often relieves symptoms and improves function without the risks of surgery, and studies show no long-term advantage of arthroscopic meniscectomy over well-delivered rehabilitation for these tears. Corticosteroid injections may help temporarily, but they don’t address the tear itself and aren’t considered first-line. Surgery is reserved for those with persistent mechanical symptoms (like true locking) or failure of an adequate course of rehabilitation.