I like to try to have a thoughtful personalized approach to treating meniscal pathology rather than a less sophisticated approach of “treat them all the same”. After 25 years of surgical experience to use to help interpret often contradictory published papers, I think the best approach is to separate out the acute from the degenerative tears, stable from the unstable tears, and finally to appreciate the vascular anatomy of the tear location. The picture presented is of a patient who had an acute onset of knee pain over the medial joint line and who failed to get better with a month of directed physical therapy. She then had a MRI (not at the beginning!) which shows this non displaced and likely stable tear of the medial meniscus. This is not a degenerative tear. This is not a bucket handle tear. I think she is a good candidate for an orthobiologic injection at this point…..the choice of which for me at this time happens to be PRP because I get good results with this autologous relatively cheap orthobiologic. I will inject intra articular her knee and can even target 0.5-1 cc into the meniscus itself under ultrasound guidance. This approach burns no bridges and if she were to not recover, I could still do arthroscopy and meniscal repair versus partial menisectomy based on the clinical situation. In my experience so far….well over 50% will recover without the need for surgery. Criticisms? Yea, I could continue to wait longer before trying an orthoibiologic….but a month of directed rehab and no improvement seems a reasonable trial of non-interventional care.
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