Does a Torn Meniscus Always Need Surgery?

Does a Torn Meniscus Always Need Surgery?
Hearing “torn meniscus” can make you think you need surgery or have to step away from your sport. A torn meniscus does not automatically need surgery. For many tears that develop gradually with age, exercise-based physical therapy is a good starting point.

The right approach depends on how the tear happened, whether your knee can move freely, and what you want to get back to doing. Understanding those differences can help you make a more informed decision.

Not all meniscus tears are the same
Your knee has two menisci, wedges of tough cartilage that help cushion the joint and distribute load between your thighbone and shinbone. Some tears happen during a sudden twist or pivot. Others develop gradually as the tissue changes with age. These are called degenerative tears.

There is also an important difference between two types of surgery. A partial meniscectomy trims away damaged meniscus tissue. A meniscus repair stitches a tear together to preserve tissue when the tear has healing potential. Research about trimming degenerative tears should not be applied to every injury or used to assume that a repair would not help.

Does a torn meniscus need surgery? What the research found:
The ESCAPE randomized clinical trial included 321 adults ages 45 to 70 with degenerative meniscal tears. Participants were assigned to surgery to trim the meniscus or a program of 16 exercise-based physical therapy sessions. Five years later, physical therapy remained as effective as surgery within the study’s predefined threshold for a meaningful difference in knee function. Both groups improved substantially.

That supports starting with exercise-based care for many degenerative tears. It also means that feeling better does not necessarily require removing the torn tissue. Improving strength and movement can help the knee function better even when a tear is present.

What physical therapy can help you work toward
Rehabilitation focuses on what your knee needs to handle daily life and your sport. That may include improving knee motion, rebuilding thigh and hip strength, and gradually increasing your tolerance for stairs, squatting, running, or changing direction.

A program should progress with you. Early exercises may look different from the movements you eventually need on the court, in the gym, or on a hike. Physical therapy at Superior PT uses individualized exercise programming to connect rehabilitation with your activity goals.

But what if squats and lunges hurt?
Squats, lunges, and other strengthening exercises can be painful with a meniscal tear. That can make it difficult to build the muscles that support your knee. Pain with one exercise does not mean every strengthening option is off the table. Changing the depth, resistance, support, or exercise may make training more manageable.

Blood flow restriction training, or BFR, can be another option when heavier weights are difficult to tolerate. A specialized cuff around the upper thigh limits blood flow during light resistance exercise, allowing the muscles to work hard with less weight.

In a 12-week randomized study of 48 women with knee osteoarthritis, researchers compared light resistance with BFR, light resistance alone, and heavy resistance. The BFR and heavy-resistance groups had similar improvements in strength and muscle size. Quadriceps muscle size increased about 7% with BFR and 8% with heavy lifting. This study involved knee arthritis, rather than meniscal tears. It supports BFR as a way to build muscle with lighter resistance, but does not establish that BFR heals a torn meniscus.

When might surgery help?
Sometimes a displaced piece of meniscus physically blocks knee movement. The knee gets stuck, and the person cannot fully straighten it. Surgery may help relieve that blockage. The American Academy of Orthopaedic Surgeons’ 2024 guideline supports considering early surgery for acute displaced tears that restrict movement and for symptomatic tears that may benefit from repair.

A knee that remains physically stuck deserves timely assessment. It is different from occasional clicking or catching.

In a trial comparing meniscus trimming with sham surgery, trimming did not provide greater relief from catching or occasional locking in people with degenerative tears. For a degenerative tear, pain alone is generally a less compelling reason to trim the meniscus.

Why preserving the meniscus matters
Removing meniscus tissue leaves less tissue to distribute load across the knee. That is one reason to preserve as much functional meniscus as possible when surgery is needed.

In the five-year FIDELITY trial follow-up, meniscus trimming was associated with a slightly greater risk of arthritis changes on X-rays than sham surgery, without a meaningful advantage in pain or function.

Arthritis is not inevitable after surgery, and surgery may still be appropriate. The goal is to choose a procedure for a clear reason and preserve tissue whenever possible.
What can you do when your knee is painful?
You can start by adjusting how you move, rather than repeatedly pushing through the same painful activity.
- Reduce the depth. Try a shallower squat or a higher chair if deeper bending hurts.
- Adjust the amount. Shorter walks or activity sessions may be easier to tolerate than one long session.
- Keep comfortable movement in your day. Walking on level ground or easy cycling may be options if they feel manageable.
- Watch the response afterward. More swelling, limping, or a clear increase in next-day pain suggests the activity needs adjusting.
These are starting points, not a fixed exercise prescription. Avoid forcing a knee that feels physically blocked.

Explore your options at Superior Physical Therapy
A tear does not automatically decide your next step. Your symptoms, movement, tear type, and goals should guide the plan.

Superior Physical Therapy is located inside The Heights Racquet & Social Club in Mendota Heights and serves active adults and athletes throughout the Twin Cities.

Learn more about BFR training, or contact Superior PT to discuss physical therapy for a meniscal tear and getting back to your sport.

About the author: Keely Behning, PT, SCS, ATC, is a Board-Certified Sports Clinical Specialist and the founder of Superior Physical Therapy. She brings more than two decades of experience in outpatient orthopedics and sports medicine.