Okay, so I finally got a diagnosis for my knee pain: avulsion of the posterior horn of the medical meniscus. I saw the MRIs and the surgeon showed me how the meniscus is oozing out from inside the joint. I understand I can go the surgical route or take a more conservative approach with activity modification and physical therapy. Which do you recommend?

Treatment often depends on the patient’s age, intensity of symptoms (mild versus severe), and activity level. The goal is to protect the knee joint and prevent degenerative changes that end up as painful knee arthritis. For the older, less active adult, it may be possible to get by with some activity modifications, antiinflammatory drugs (or just pain relievers), and weight loss for those who are overweight.

When it looks like surgery might be needed, the patient has several options to choose from. If at all possible, the surgeon tries to save the meniscus. The goal is to restore the menisci’s ability to absorb stress and still support normal knee biomechanics.

Repair is preferred over removal. The meniscus is no longer routinely removed but rather reattached whenever possible. Rehab after surgery is important so if a patient isn’t willing (or able) to follow the surgeon’s guidelines, then surgery may not be successful.

If it’s not possible to repair the meniscus, then partial removal is considered. With complete removal of menisci that cannot be repaired, meniscal transplantation may be possible in a small, limited number of cases. Meniscal transplantation is referred to as a salvage procedure.

Many surgeons advise patients to complete a three- to six-month course of conservative care first before considering surgery. Those who can control their symptoms with a change in activity, pain relievers or antiinflammatories, and weight loss/management should do so for as long as possible.