Meniscus Tears: Do You Really Need Surgery or Can Physiotherapy Help?

If you've been told you have a meniscus tear, you're probably facing a difficult decision: should you have surgery, or can physiotherapy heal your knee? This question becomes even more pressing when your doctor recommends arthroscopic surgery, your friend swears by their meniscus operation, but you've also heard stories of people who recovered without going under the knife.

As a registered physiotherapist serving patients in Brampton, Mississauga, North Brampton, and Caledon, I've helped hundreds of people navigate this exact decision. The truth is more nuanced than "surgery vs. no surgery"—the right answer depends on your specific tear type, age, activity level, and goals.

What I can tell you with confidence, backed by extensive research and clinical experience: many meniscus tears heal successfully with physiotherapy alone, and even tears that eventually require surgery have better outcomes when you try conservative treatment first.

Let me help you understand your options so you can make the best decision for your knee.

Understanding Your Meniscus

What is the meniscus?

Your knee has two menisci (plural of meniscus)—crescent-shaped pieces of cartilage that sit between your thighbone (femur) and shinbone (tibia). Think of them as shock absorbers and stabilizers for your knee joint.

The two menisci:

• Medial meniscus: Inside (inner) part of knee—tears more frequently (accounts for about 70% of tears)

• Lateral meniscus: Outside (outer) part of knee—more mobile, tears less often

What the meniscus does:

• Absorbs shock during walking, running, jumping (distributes forces across knee joint)

• Provides stability by deepening the socket that holds the thighbone

• Reduces friction between bones

• Helps with proprioception (knee position awareness)

• Contributes to smooth knee motion

Important fact: The meniscus has limited blood supply, especially in the inner portions. This affects healing potential—outer third has good blood supply ("red zone"), middle third has some ("pink zone"), and inner third has virtually none ("white zone"). This blood supply geography significantly impacts treatment decisions.

Types of Meniscus Tears

Not all tears are created equal—type matters for treatment:

Traumatic Tears (Acute Injuries)

How they happen:

• Twisting injury with foot planted (common in soccer, basketball, skiing)

• Sudden pivoting or cutting movements

• Deep squatting with rotation

• Direct blow to knee

• Usually occurs in younger, active individuals (under 40)

Common traumatic tear patterns:

• Vertical tears: Run lengthwise, often in outer zone with good healing potential

• Bucket-handle tears: Large vertical tear where inner portion flips into joint, causing locking

• Radial tears: Perpendicular to meniscus edge, poor healing potential

• Flap tears: Piece of meniscus torn and displaced

Symptoms:

• Sudden onset of pain during specific incident

• Immediate swelling (within hours)

• Catching, clicking, or locking sensation

• Giving way or instability

• Difficulty bending or straightening knee fully

• Pain with twisting or pivoting

Degenerative Tears (Age-Related)

How they develop:

• Gradual wear and tear over years

• Weakening of meniscus tissue with age

• Often part of early osteoarthritis process

• May occur with minimal trauma or no specific injury

• Very common after age 40 (50%+ of people over 50 have meniscus tears on MRI, many without symptoms)

Common degenerative tear patterns:

• Horizontal cleavage tears: Split through middle of meniscus

• Complex tears: Multiple tear patterns combined

• Frayed edges: Degenerative breakdown along rim

Symptoms:

• Gradual onset of pain (may not remember specific injury)

• Mild to moderate swelling (develops over days)

• Stiffness, especially in morning

• Pain with squatting, kneeling, stairs

• Occasional clicking or catching

• May have minimal symptoms initially

Critical distinction: Degenerative tears are fundamentally different from traumatic tears. They represent normal aging of the meniscus, similar to grey hair or wrinkles. Research shows degenerative tears often respond better to physiotherapy than surgery.

The Research Revolution: What Science Actually Shows

The medical community's understanding of meniscus surgery has dramatically changed in the past 15 years:

Landmark Studies That Changed Practice

Finnish Study (2013) - The FIDELITY Trial: Published in the New England Journal of Medicine, this randomized controlled trial compared arthroscopic partial meniscectomy (surgery) to sham surgery (placebo) in middle-aged patients with degenerative tears.

Results: No difference in outcomes between real surgery and fake surgery at 1 year or 5 years.

Conclusion: For degenerative meniscus tears, surgery provides no benefit over placebo.

METEOR Trial (2016): Another high-quality study comparing surgery to physiotherapy for degenerative meniscal tears in patients without osteoarthritis.

Results: Both groups improved similarly over 2 years. 30% of physiotherapy patients eventually chose surgery, but even including those who "crossed over," the physiotherapy group did just as well.

Conclusion: Physiotherapy should be first-line treatment; surgery reserved for those who don't improve.

Systematic Reviews and Meta-Analyses: Multiple reviews analyzing dozens of studies consistently show:

• For degenerative tears: Surgery is NOT superior to conservative treatment (physiotherapy, exercise)

• For traumatic tears in younger patients: Evidence is mixed; some benefit from surgery, others do well conservatively

• Partial meniscectomy (removing torn piece): May provide short-term pain relief but increases osteoarthritis risk long-term

• Meniscus repair (stitching tear): Better long-term outcomes than removal, but requires longer recovery

What the Numbers Actually Tell Us

Surgery success rates:

• 50-70% of patients report good outcomes after meniscus surgery

• BUT: 50-70% of patients treated with physiotherapy ALSO report good outcomes

• 20-30% of surgical patients still have pain at 1-2 years

• Surgery accelerates knee arthritis by 5-10 years (removing meniscus = less shock absorption = more bone wear)

Physiotherapy success rates:

• 60-80% of degenerative tears improve with conservative treatment

• 40-50% of traumatic tears improve without surgery

• Those who don't improve with PT can still have successful surgery (outcomes are same or better than immediate surgery)

• No increased arthritis risk from trying PT first

The takeaway: For many people, especially those over 40 with degenerative tears, surgery doesn't work better than physiotherapy, but it carries more risks and costs.

Who Actually Needs Surgery?

Surgery may be necessary or beneficial if:

1. Mechanical Locking (True Locking)

What it is: Your knee gets stuck in a bent position and you cannot straighten it, no matter what you try.

Why it happens: Usually a bucket-handle tear where a large piece of meniscus flips into the joint, physically blocking motion.

Why surgery helps: The displaced meniscus piece must be removed or repaired to restore full motion.

Important distinction: True locking (cannot straighten) is different from catching or clicking (can still fully straighten). Catching/clicking often improves with physiotherapy.

2. Locked Bucket-Handle Tears in Young Athletes

Who this affects: Usually under 30, active in sports, acute traumatic injury with immediate locking

Why surgery may be better: Young patients with acute tears in vascular (red) zone are good candidates for meniscus repair (stitching tear back together rather than removing tissue).

Benefit: Preserves meniscus, reduces future arthritis risk, better than living with locked knee.

Timeline: Repair should happen within weeks of injury for best healing potential.

3. Failed Conservative Treatment

Criteria for "failed" physiotherapy:

• Completed 6-12 weeks of structured physiotherapy program

• Consistently performed home exercises as prescribed

• Pain and function have not improved adequately

• Functional limitations significantly impact quality of life

• Other conditions ruled out (arthritis, ligament injury, hip problems)

Why surgery becomes option: If you've genuinely tried comprehensive conservative treatment without improvement, surgery may provide benefit that PT cannot.

Important note: Many patients don't actually fail physiotherapy—they fail to complete proper physiotherapy. Two weeks of occasional stretching doesn't count as "trying PT."

4. Specific High-Demand Athletes

Young athletes with:

• Acute traumatic tears

• Need to return to high-level competition quickly

• Peripheral (outer zone) tears suitable for repair

• Otherwise healthy knee (no arthritis)

Consideration: Even athletes often do well with conservative treatment first, with surgery as backup plan if needed.

5. Associated Injuries Requiring Surgery

When meniscus tear comes with:

• ACL tear requiring reconstruction (meniscus repaired during same surgery)

• Multiple ligament injuries

• Unstable knee requiring surgical stabilization

Why combined surgery makes sense: Already having one knee surgery, addressing meniscus at same time is logical.

Who Should Try Physiotherapy First?

Conservative treatment is recommended as first-line for:

1. Degenerative Tears (Most Common)

If you:

• Are over 40 years old

• Don't remember specific injury or trauma was minimal

• Have gradual onset symptoms

• Can still fully straighten and bend knee (no true locking)

• MRI shows degenerative changes or early arthritis

Success rate: 60-80% improve with physiotherapy, avoid surgery

Why it works: Degenerative tears often aren't the pain source—weak muscles, poor biomechanics, and inflammation cause symptoms. PT addresses these root causes.

2. Minor Traumatic Tears

If you:

• Have small tear (less than 1 cm)

• Can fully straighten knee

• Minimal catching or locking (intermittent, not constant)

• Pain is manageable (less than 7/10)

• No other significant knee injuries

Success rate: 40-60% avoid surgery with proper rehabilitation

3. Middle-Aged Active Individuals

If you:

• Age 35-55

• Active lifestyle (recreational sports, exercise)

• Want to avoid surgery and willing to commit to rehabilitation

• Have time to complete 2-3 month PT program

• Symptoms tolerable enough to participate in therapy

Benefit: Even if you eventually need surgery, prehab (pre-surgery PT) improves surgical outcomes significantly.

4. Anyone Without True Mechanical Locking

If your knee:

• Fully straightens and bends

• Catches or clicks but doesn't get stuck

• Has pain but remains functional

• Symptoms came on gradually

Recommendation: Try physiotherapy first—research strongly supports this approach.

5. Patients with Medical Concerns About Surgery

If you have:

• Diabetes, heart disease, or other conditions increasing surgical risk

• Blood clotting disorders or on blood thinners

• Previous complications with anesthesia

• Concerns about surgery and preference to avoid if possible

Benefit: PT is low-risk, non-invasive, and often effective even in higher-risk patients.

What Physiotherapy Treatment Includes

Comprehensive approach to meniscus tear rehabilitation:

Phase 1: Pain and Inflammation Management (Weeks 1-2)

Goals:

• Reduce acute pain

• Decrease swelling

• Restore basic mobility

• Protect healing tissue

Treatment includes:

Manual therapy:

• Gentle joint mobilizations to improve range of motion

• Soft tissue massage to reduce muscle guarding

• Patella (kneecap) mobilization to improve mechanics

Modalities for symptom relief:

• Ice application protocols

• Compression and elevation guidance

• Acupuncture for pain management

• Electrical stimulation if appropriate

Early mobility exercises:

• Gentle range of motion (heel slides, wall slides)

• Quadriceps activation (quad sets)

• Ankle pumps to reduce swelling

• Non-weight bearing or partial weight bearing exercises

Activity modification:

• Avoid deep squatting, twisting, kneeling

• Use assistive device (crutches) if needed

• Identify and avoid aggravating movements

• Guidance on daily activities (stairs, sitting, sleeping)

Expected outcome: 30-50% reduction in pain, improved mobility for daily activities

Phase 2: Progressive Strengthening (Weeks 3-6)

Goals:

• Build quadriceps strength (critical for knee stability)

• Strengthen hip muscles (control knee alignment)

• Improve proprioception and balance

• Gradually increase functional activities

Key exercises:

Quadriceps strengthening:

• Straight leg raises (multiple directions)

• Short-arc quads (final 30 degrees of extension)

• Terminal knee extensions with resistance band

• Leg press (controlled depth to avoid pain)

Hip strengthening:

• Clamshells and side-lying leg lifts (hip abductors)

• Bridges and single-leg bridges (glutes)

• Hip extension exercises (strengthen posterior chain)

• Monster walks with resistance band

Functional exercises:

• Mini squats (quarter to half depth initially)

• Step-ups (forward and lateral)

• Balance exercises (single-leg stance progressions)

• Proprioception training (unstable surfaces)

Why hip strength matters: Weak hip muscles allow knee to collapse inward during activities (valgus collapse), increasing meniscus stress. Strengthening hips protects the meniscus.

Expected outcome: Significant strength gains, reduced pain with daily activities, able to walk without limp

Phase 3: Advanced Strengthening and Return to Activity (Weeks 7-12)

Goals:

• Build strength equal to or greater than uninjured side

• Return to recreational activities

• Progress to sport-specific training if applicable

• Prevent re-injury

Advanced exercises:

Strength progression:

• Full-depth squats (if pain-free)

• Lunges (forward, reverse, lateral)

• Bulgarian split squats

• Single-leg Romanian deadlifts

• Leg press with increased weight

Power and agility (if returning to sports):

• Box jumps (height progressed gradually)

• Lateral bounds and crossovers

• Agility ladder drills

• Sport-specific movements (cutting, pivoting)

Functional activities:

• Return to running protocol (if runner)

• Gradual return to hiking, cycling, recreational sports

• Work-related activities (climbing ladders, heavy lifting if applicable)

Return-to-activity criteria:

• Minimal or no pain (1-2/10 with activity)

• Strength at least 90% of uninjured side

• Full range of motion

• Able to perform functional tests without compensation

• Confidence in knee stability

Expected outcome: Return to pre-injury activity level, or determination that further intervention (possibly surgery) is needed

Ongoing Components Throughout Treatment

Education:

• Understanding meniscus healing and what to expect

• Pain science (pain doesn't always equal damage)

• Activity modification strategies

• Long-term knee health and arthritis prevention

Home exercise program:

• Customized to your specific tear and functional goals

• Progressive difficulty as you improve

• Daily exercises (15-30 minutes)

• Critical for success—clinic sessions alone aren't enough

Biomechanical assessment:

• Gait analysis (walking and running if applicable)

• Squat and lunge mechanics

• Movement pattern corrections

• Footwear recommendations if needed

Progress monitoring:

• Regular reassessment of pain, range of motion, strength

• Functional testing (step-down test, single-leg hop if appropriate)

• Objective measurements to track improvement

• Adjustment of program based on response

Timeline Expectations

Realistic recovery timelines with physiotherapy:

Degenerative Tears

• Weeks 1-3: Pain reduction, improved daily function

• Weeks 4-8: Significant strength gains, minimal pain with most activities

• Weeks 9-12: Return to normal activities, continued strengthening for maintenance

• Total timeline: 8-12 weeks for most functional goals, 3-6 months for full strength restoration

Minor Traumatic Tears

• Weeks 1-2: Acute phase management, protected mobility

• Weeks 3-6: Progressive strengthening, reducing limitations

• Weeks 7-12: Advanced exercises, return to activity

• Total timeline: 10-16 weeks typical, competitive athletes may need 4-6 months

Larger Traumatic Tears (Conservative Management)

• Weeks 1-4: Pain management, basic strengthening

• Weeks 5-12: Progressive rehabilitation

• Months 3-6: Continued strengthening, gradual return to higher activities

• Total timeline: 4-6 months for full return to demanding activities

Important notes:

• Everyone heals at different rates

• Age, fitness level, and tear severity affect timeline

• Consistency with home exercises significantly impacts speed of recovery

• Some improvement should be seen within 4-6 weeks; if not, reassessment needed

The "Prehab" Advantage

Even if you eventually need surgery, physiotherapy first improves outcomes:

Benefits of Pre-Surgery Physiotherapy

Stronger going into surgery = better results coming out:

Research shows:

• Patients who do prehab have less post-surgical pain

• Return to function faster after surgery

• Better range of motion outcomes

• Reduced complication rates

• Higher satisfaction with surgical results

What prehab achieves:

• Builds quadriceps strength (atrophy happens quickly after surgery)

• Improves range of motion (especially full extension critical)

• Reduces pre-operative swelling and inflammation

• Teaches exercises you'll need post-operatively

• Builds confidence and understanding of rehabilitation process

Time investment: 4-8 weeks of prehab before surgery

Outcome: Better surgical results + you might discover you don't need surgery after all

You Don't Lose Anything by Trying PT First

Common concern: "If I wait and try physiotherapy, will my tear get worse and make surgery harder?"

Reality: For most meniscus tears (especially degenerative), delaying surgery to try physiotherapy does NOT worsen outcomes. Multiple studies confirm:

• Waiting 3-6 months for conservative treatment doesn't make subsequent surgery more difficult

• Surgical outcomes are the same whether you operate immediately or after failed PT

• You give yourself chance to avoid surgery altogether

• No harm in trying, significant potential benefit

Exception: True mechanical locking with displaced tear—don't delay surgery for this situation.

What If Physiotherapy Doesn't Work?

After 8-12 weeks of proper physiotherapy:

Signs PT Isn't Sufficient

You may need surgery if:

• Pain remains significant (6+/10 with daily activities)

• Function hasn't improved adequately (can't perform necessary work/life activities)

• Consistent compliance with home exercises but minimal progress

• Quality of life significantly impacted

• Recurrent episodes of catching, locking, or giving way

• Other treatments ruled out or tried (injections if applicable)

Having surgery after failed PT:

• You'll have better surgical outcomes due to prehab

• You'll know surgery was truly necessary (no regrets about not trying conservative)

• Insurance often requires documented PT attempt before approving surgery

• Your surgeon will respect that you tried conservative approach first

The Shared Decision-Making Process

Surgery decisions should involve:

• Your symptoms and functional limitations

• Your activity goals and lifestyle needs

• Your age and overall health

• Tear type and associated injuries

• Your preferences and values

• Discussion with surgeon AND physiotherapist

Questions to ask your surgeon:

• What type of tear do I have?

• Am I a candidate for repair or would tissue be removed?

• What are risks and benefits of surgery vs. waiting?

• What does research show for my specific tear type?

• What if I try physiotherapy first—does that change surgical outcomes?

• What's recovery timeline and expected result with surgery?

Red flags in surgical consultation:

• Surgeon dismisses conservative treatment without discussion

• Immediate surgery recommended for degenerative tear in person over 45

• No mention of research showing PT effectiveness

• Pressure to schedule surgery without time to consider

• Unwillingness to answer your questions thoroughly

Good surgical consultations include:

• Balanced discussion of surgical and non-surgical options

• Acknowledgment of research supporting conservative treatment

• Realistic outcome expectations

• Respect for your preference and timeline

• Willingness to collaborate with physiotherapist

Real Patient Success Stories

Case 1: Degenerative Tear Avoided Surgery

Robert, 52, office worker in Mississauga, knee pain for 6 months

Initial presentation:

• MRI showed horizontal cleavage tear, medial meniscus

• Orthopedic surgeon recommended arthroscopic surgery

• Pain 6/10 with stairs, squatting, prolonged walking

• Wanted to avoid surgery if possible

Treatment approach:

• Manual therapy to restore full extension (was lacking 5 degrees)

• Quadriceps strengthening (very weak initially)

• Hip strengthening program

• Gradual return to walking for exercise

Results:

• Week 4: Pain reduced to 3/10, climbing stairs easier

• Week 8: Pain 1-2/10, back to weekend hiking

• Week 12: Essentially pain-free, full function restored

• 2 years later: Continues maintenance exercises, no surgery needed

Key factor: Degenerative tear with weak muscles—strengthening addressed root cause of symptoms.

Case 2: Traumatic Tear in Young Athlete

Aisha, 28, recreational soccer player in Brampton, twisted knee during game

Initial presentation:

• Acute injury with immediate swelling

• MRI showed vertical tear, medial meniscus

• Catching sensation but no true locking

• Orthopedic surgeon said surgery "probably needed eventually"

Treatment approach:

• Initial focus on reducing swelling and restoring motion

• Progressive strengthening with emphasis on eccentric control

• Gradual return to running protocol

• Sport-specific agility training

Results:

• Week 6: Returned to jogging

• Week 10: Back to soccer-specific training

• Week 14: Full return to recreational soccer

• 18 months later: Still playing without surgery, occasional mild discomfort managed with exercise

Key factor: Even traumatic tear can heal with proper rehabilitation. Aisha avoided surgery and associated recovery time.

Case 3: Surgery After Failed PT—But Better Outcome

James, 45, construction worker in North Brampton, bucket-handle tear

Initial presentation:

• Traumatic injury lifting heavy material

• MRI showed large bucket-handle tear

• Intermittent locking episodes

• Surgeon recommended immediate surgery

Treatment approach:

• Requested 6 weeks of physiotherapy first

• Built significant quadriceps and hip strength

• Improved range of motion

• Symptoms improved but not enough for heavy labor demands

Results:

• Decided to proceed with surgery after PT trial

• Post-surgical recovery much faster than typical

• Returned to modified duties at 6 weeks (vs. typical 8-12 weeks)

• Full duties at 10 weeks with excellent strength

• Attributed faster recovery to pre-surgical conditioning

Key factor: Prehab made surgery more successful. James tried conservative route, needed surgery, but got better outcome because of physiotherapy first.

Case 4: Avoided Unnecessary Surgery

Linda, 58, teacher in Caledon, knee pain and clicking

Initial presentation:

• Gradual onset knee pain over 6 months

• MRI showed complex degenerative tear + mild arthritis

• Surgeon recommended "cleaning out" torn meniscus

• Worried about being unable to stand for teaching

Treatment approach:

• Education about research (surgery doesn't help degenerative tears better than PT)

• Comprehensive strengthening program

• Weight loss support (lost 15 lbs)

• Activity modification strategies for classroom

Results:

• Week 8: Pain reduced from 7/10 to 3/10

• Week 12: Teaching full days without significant pain

• Clicking still present but no longer bothered by it

• Avoided surgery that research shows wouldn't have helped anyway

Key factor: Understanding that MRI findings (tear, arthritis) don't always correlate with symptoms. Strengthening and weight loss addressed actual pain sources.

My Treatment Approach

At PinPoint Health in Mississauga and serving patients throughout Brampton, Mississauga, North Brampton, and Caledon:

Comprehensive Assessment

Initial evaluation includes:

• Detailed history of how injury occurred

• MRI review if available (or recommendation to get one if needed)

• Physical examination:

  • Range of motion testing

  • Strength assessment (quadriceps, hamstrings, hip muscles)

  • Special meniscus tests (McMurray's, Apley's, Thessaly test)

  • Joint line palpation

  • Gait analysis

  • Functional movement screening

Differential diagnosis:

• Rule out other causes of knee pain (arthritis alone, ligament injury, patellofemoral syndrome)

• Identify all contributing factors (hip weakness, ankle stiffness, poor biomechanics)

• Determine if symptoms match MRI findings (often they don't correlate perfectly)

Evidence-Based Treatment Plan

Individualized program based on:

• Your specific tear type and location

• Your age and activity level

• Your goals (return to sports vs. pain-free daily activities)

• Your timeline (work requirements, life demands)

Treatment combines:

• Hands-on manual therapy to restore joint mobility

• Progressive exercise prescription tailored to your abilities

• Education about meniscus tears, healing, and realistic expectations

• Activity modification guidance specific to your work/life

• Home exercise program you can perform independently

Honest Communication

What I provide:

• Realistic timeline expectations based on research and experience

• Clear criteria for when surgery might be necessary

• Regular progress updates with objective measurements

• Honest feedback if physiotherapy isn't producing expected results

• Collaboration with orthopedic surgeons when needed

My philosophy:

• Surgery is sometimes necessary and beneficial—I don't oppose it

• But research clearly shows many meniscus tears heal without surgery

• You deserve to know research supports trying PT first for most tears

• My goal is getting you better, whether that's with PT alone or PT plus surgery

• Your body, your choice—I provide information to make informed decision

Direct Insurance Billing

Financial access:

• Direct billing to most major insurance providers (Sun Life, Manulife, Green Shield, Canada Life)

• Extended health benefits cover physiotherapy

• No out-of-pocket costs for most patients (depending on plan coverage)

• WSIB claims if work-related injury

• Focus on recovery, not paperwork

Frequently Asked Questions

Q: How long does a meniscus tear take to heal with physiotherapy? A: Degenerative tears: 8-12 weeks typical. Traumatic tears: 10-16 weeks for most people, up to 4-6 months for return to demanding sports. Everyone heals at different rates based on age, tear severity, and consistency with rehabilitation.

Q: Can a torn meniscus heal on its own without surgery or physiotherapy? A: Some tears, especially small degenerative ones, can improve over time with basic activity modification. However, targeted physiotherapy significantly improves outcomes compared to just waiting and hoping. Proper rehabilitation addresses muscle weakness and poor biomechanics that contributed to symptoms.

Q: Will my meniscus tear get worse if I don't have surgery? A: For most tears, especially degenerative, the tear itself won't significantly worsen with conservative treatment. Symptoms may persist without proper rehabilitation, but you're not causing additional structural damage by trying physiotherapy first. Exception: unstable tears with true locking should be addressed surgically sooner.

Q: Should I stop exercising with a meniscus tear? A: Not necessarily. Avoid activities that cause sharp pain or locking (deep squatting, twisting, kneeling), but continue modified activities like swimming, cycling, or walking that don't aggravate symptoms. Complete rest weakens muscles and slows recovery. Your physiotherapist will guide safe exercise progression.

Q: What activities should I avoid with a meniscus tear? A: Initially avoid: deep squatting, kneeling, pivoting/twisting on affected leg, running or jumping until cleared by physiotherapist. Gradually reintroduce these activities as symptoms improve and strength increases. Permanent activity restrictions usually aren't necessary after successful rehabilitation.

Q: Can I make my meniscus tear worse by exercising? A: Proper therapeutic exercise, even if it causes mild discomfort, doesn't worsen meniscus tears. Sharp pain, locking, or significant swelling indicate exercise modification needed. Your physiotherapist monitors response and adjusts program accordingly. Pain isn't always harmful—often it's part of rehabilitation process.

Q: Is surgery better for younger people with meniscus tears? A: Not automatically. Young age alone doesn't mean surgery is better. Factors that matter more: tear type (traumatic vs. degenerative), tear location (vascular vs. non-vascular zone), symptoms (true locking vs. pain only), and activity goals. Many young patients recover fully with physiotherapy.

Q: What if I've already had surgery on the other knee—should I just have surgery on this one too? A: Not necessarily. Each tear is different. Even if surgery helped your other knee, this tear might respond to physiotherapy. Also, if your previous surgery was years ago, research and recommendations have evolved significantly. Consider trying conservative treatment first.

Q: Will physiotherapy get rid of the clicking in my knee? A: Possibly, but clicking alone isn't necessarily a problem. Many people have clicking knees without pain or dysfunction. Physiotherapy focuses on reducing pain and improving function. Clicking may improve, stay the same, or even develop during healing—what matters is whether you're pain-free and functional.

Q: How much does physiotherapy cost compared to surgery? A: Physiotherapy is significantly less expensive. Average cost: $700-1,200 for complete conservative treatment program (8-12 sessions over 3 months), usually covered by insurance. Surgery costs healthcare system $3,000-5,000+, plus time off work, potential complications, and post-surgical rehab. Trying PT first saves money and potentially avoids surgery altogether.

Q: My MRI shows a tear but I have no pain—what should I do? A: Nothing if you're pain-free. Research shows 50%+ of people over 50 have meniscus tears on MRI without symptoms. Tears found incidentally don't require treatment. Only treat symptomatic tears (pain, locking, significant functional limitation).

Q: Can I run with a meniscus tear? A: Eventually, yes, for most people. Initially you'll need to stop running and focus on rehabilitation. As symptoms improve and strength increases, gradual return-to-running protocol (walk-run progressions) is introduced, typically weeks 8-12 for degenerative tears, 10-16 weeks for traumatic tears. Many runners return to full training.

Making Your Decision

Questions to help you decide:

Consider physiotherapy first if:

• You're over 40 with degenerative tear

• You can fully straighten your knee (no true locking)

• You're willing to commit to 8-12 weeks of rehabilitation

• Your symptoms are tolerable enough to participate in therapy

• You prefer to avoid surgery if possible

• You have time to complete conservative treatment

Consider surgery if:

• Your knee truly locks and cannot be straightened

• You're young with traumatic tear in vascular zone (good repair candidate)

• You've completed proper 8-12 week physiotherapy program without adequate improvement

• Your functional limitations significantly impact quality of life despite PT

• You have associated injuries requiring surgery anyway (ACL tear)

When in doubt:

• Try physiotherapy first—you can always have surgery later

• Research strongly supports conservative treatment as first-line for most tears

• Physiotherapy doesn't burn bridges—surgery remains option if PT fails

• Even if you eventually need surgery, prehab improves surgical outcomes

The Bottom Line

What research and experience teach us:

✓ Many meniscus tears heal with physiotherapy alone (60-80% of degenerative tears, 40-50% of traumatic tears)

✓ Surgery doesn't work better than PT for degenerative tears (landmark research shows no benefit over placebo surgery)

✓ Trying PT first doesn't worsen surgical outcomes (you don't lose anything by trying conservative treatment)

✓ Pre-surgery physiotherapy improves surgical results (even if you eventually need surgery, you'll get better outcome)

✓ Age matters less than tear type (degenerative vs. traumatic is more important than how old you are)

✓ Consistent rehabilitation is key (home exercises are critical—clinic sessions alone aren't enough)

✓ Some tears truly require surgery (mechanical locking, young athletes with peripheral tears suitable for repair)

The smartest approach for most meniscus tears: Try comprehensive physiotherapy first, with surgery as backup plan if conservative treatment fails after 8-12 weeks.

Ready to explore conservative treatment for your meniscus tear? Book an appointment at PinPoint Health in Mississauga, serving patients throughout Brampton, Mississauga, North Brampton, and Caledon. I'll provide comprehensive assessment, honest discussion of surgical vs. non-surgical options, and evidence-based treatment designed to get you back to the activities you love—with or without surgery. Direct billing available to most major insurance providers.

Have a meniscus tear and unsure about surgery? Contact me today for a thorough evaluation and clear guidance on whether physiotherapy can help you avoid the operating room.