Management of Middle-Aged and Older Patients with a Meniscal Tear

Management of degenerative meniscal tears in adults over 40 is the main focus, with emphasis on how treatment decisions should be guided by evidence rather than assumptions. Degenerative tears are described as injuries that often develop gradually or after minor incidents in an already worn meniscus. The key finding is that arthroscopic partial meniscectomy does not provide meaningful added benefit over exercise therapy or even sham surgery in middle-aged and older patients. Evidence from randomized trials, systematic reviews, and a 2022 Cochrane review shows very small or no significant differences in outcomes. The lecture also examines common beliefs about who might benefit most from surgery, including patients with mechanical symptoms such as catching or locking, and finds little support for these ideas in degenerative cases. Exercise therapy is presented as first-line treatment, although the ideal program remains unclear because studies use widely different exercise approaches. The discussion also highlights the overlap between degenerative meniscal tears and early osteoarthritis, the limited likelihood of fully regaining a “normal” knee, and the importance of realistic expectations, activity modification, and patient acceptance.