Treatment Options for Root Tear of Posterior Horn Medial Meniscus with Advanced Medial Compartment Osteoarthritic Changes

Initial Conservative Management

The American Academy of Orthopaedic Surgeons recommends implementing a structured exercise program focusing on both cardiovascular and resistance land-based exercises to improve function and reduce pain in patients with root tear of the posterior horn of the medial meniscus with advanced medial compartment osteoarthritic changes 3
The American Academy of Orthopaedic Surgeons suggests considering aquatic exercises, particularly for patients who are aerobically deconditioned or have difficulty with weight-bearing exercises 3
Weight loss is strongly recommended for overweight patients to reduce joint loading, according to the American Academy of Orthopaedic Surgeons 3
Self-management educational programs should be encouraged to improve patient understanding and compliance, as recommended by the American Academy of Orthopaedic Surgeons 4
The American Academy of Orthopaedic Surgeons recommends using acetaminophen, oral NSAIDs, topical NSAIDs, tramadol, or intra-articular corticosteroid injections for pain management in patients with root tear of the posterior horn of the medial meniscus with advanced medial compartment osteoarthritic changes 3
Patellar taping may provide short-term pain relief and functional improvement, according to the American Academy of Orthopaedic Surgeons 5

The American Academy of Orthopaedic Surgeons recommends total knee arthroplasty as the preferred option for advanced medial compartment osteoarthritis with root tear 1, 2
For isolated medial compartment OA with root tear in younger patients, unicompartmental knee arthroplasty may be considered, though total knee arthroplasty has lower revision rates, according to the American Academy of Orthopaedic Surgeons 1, 2
Valgus-producing proximal tibial osteotomy shows similar outcomes to unicompartmental knee arthroplasty in appropriate candidates, as recommended by the American Academy of Orthopaedic Surgeons 1
Total knee arthroplasty with cemented components is recommended for advanced OA with root tear, according to the American Academy of Orthopaedic Surgeons 1, 2

The American Academy of Orthopaedic Surgeons recommends beginning rehabilitation on the day of total knee arthroplasty to reduce hospital length of stay 1, 2
Implementing a supervised exercise program during the first 2 months after total knee arthroplasty can improve physical function, according to the American Academy of Orthopaedic Surgeons 1, 2
Early mobilization helps reduce pain and improve function, as recommended by the American Academy of Orthopaedic Surgeons 1, 2
Continuous passive motion devices after knee arthroplasty do not improve outcomes and are not recommended, according to the American Academy of Orthopaedic Surgeons 1, 2

Attempting meniscus repair in the setting of advanced osteoarthritis is unlikely to be successful and may delay appropriate definitive treatment, as noted by the American Academy of Orthopaedic Surgeons 7
Lateral heel wedges should not be prescribed for patients with symptomatic medial compartmental OA of the knee, according to the American Academy of Orthopaedic Surgeons 5
Rushing to arthroscopic procedures without adequate trial of conservative management in patients with degenerative meniscal tears and osteoarthritis should be avoided, as recommended by the American Academy of Orthopaedic Surgeons 7