Can a Meniscus Tear Heal Without Surgery?

Two kinds of meniscus tears

Traumatic tears happen with a specific twisting injury, usually in younger, active people. Degenerative tears develop gradually as the cartilage ages, often without any injury, and they're very common: MRI studies of middle-aged and older adults find meniscus tears in many people who have no knee symptoms at all.

Location matters for healing. The outer third of the meniscus has a blood supply and can heal. The inner portion has little or none, so tears there usually don't heal, though symptoms often settle anyway.

What the research shows

Three large randomized trials changed how degenerative tears are treated. Because of them, exercise therapy is now the usual first step for degenerative meniscus tears that don't truly lock.

• FIDELITY (2013): in adults aged 35 to 65 with degenerative tears, arthroscopic partial meniscectomy did no better than a sham (placebo) surgery.
• METEOR (2013): in adults with a meniscus tear and mild to moderate arthritis, physical therapy and surgery produced similar improvement at 6 months. About 30% of the physical therapy group went on to have surgery.
• ESCAPE (2018): in adults aged 45 to 70 with tears that didn't block the knee, physical therapy was as good as early surgery for knee function over 2 years, and the results held at 5 years.

Signs surgery may be the better choice

• The knee truly locks and won't straighten, which suggests a displaced tear.
• A younger person has a large traumatic tear that a surgeon can repair. Repair preserves the meniscus, which helps protect the cartilage long term.
• Pain and catching persist after a good trial of physical therapy.
• The tear is part of a larger injury, such as a torn ACL.

What non-surgical treatment includes

• Physical therapy focused on thigh and hip strength, balance, and a gradual return to activity.
• Short-term changes, like avoiding deep squats and twisting under load while symptoms settle.
• Managing swelling with ice, compression, and elevation.
• Pain relievers, and for knees that also have arthritis, injections to calm flares. These ease pain but don't heal the tear.
• A knee brace to support the knee during activity.

Where a knee brace fits in

A meniscus tear often comes with a knee that feels unreliable, and in older adults it often comes with arthritis. A brace can support the knee and reduce giving way while you do the strengthening that settles symptoms. For knee osteoarthritis, the 2019 American College of Rheumatology and Arthritis Foundation guideline strongly recommends a knee brace for people whose arthritis significantly affects walking, stability, or pain. A brace doesn't heal the meniscus.

Common questions

How long does a meniscus tear take to feel better without surgery?

Many people notice improvement over 6 to 12 weeks of consistent exercise therapy, though it varies with the type of tear and the health of the rest of the knee.

Is walking OK with a torn meniscus?

Usually, within comfort. Early on, avoid deep squatting, kneeling, and twisting while bearing weight, and let pain and swelling guide how much you do.

My MRI shows a meniscus tear. Do I need surgery?

Not necessarily. Meniscus tears show up on MRI in many middle-aged and older adults who have no knee symptoms, so the tear may not explain your pain. Your symptoms and exam matter as much as the image.

Sources

• AAOS OrthoInfo: Meniscus Tears
• Sihvonen R, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear (FIDELITY). N Engl J Med. 2013
• Katz JN, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis (METEOR). N Engl J Med. 2013
• van de Graaf VA, et al. Early surgery vs physical therapy for nonobstructive meniscal tears (ESCAPE). JAMA. 2018
• Englund M, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008
• Kolasinski SL, et al. 2019 ACR/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee