Management of Young Patients with Meniscal Tears

Management of traumatic meniscal tears in young adults is the main focus, especially in patients aged 40 or younger. The summary explains how treatment has traditionally favored surgery, either partial meniscectomy or meniscal repair, but newer evidence challenges early surgery as the default approach. Two recent randomized trials, DREAM and STARR, compared surgery with structured exercise therapy, with the option of later surgery if needed. Despite differences in patient selection and rehabilitation programs, both studies found similar improvements in knee symptoms and function between the two strategies. A notable proportion of patients who started with exercise later chose surgery, but their outcomes were not worse, suggesting that beginning with exercise does not reduce later benefit. Special attention is given to mechanical symptoms such as catching and locking. Surgery appeared better at relieving these specific symptoms, although broader patient-reported outcomes were similar. The episode also reviews short-term MRI findings, which showed no clear difference in structural joint changes between treatment groups, and discusses realistic expectations for return to sport and recovery. Overall, treatment decisions should be individualized and based on symptoms, goals, and patient preferences.