Exercise Beats Surgery for Common Knee Tears—What New Research Reveals

For people with degenerative meniscus tears and minimal arthritis, exercise therapy produces comparable outcomes to arthroscopic surgery—and may even slow osteoarthritis progression better. A randomized controlled trial of 140 participants published in the British Journal of Sports Medicine found that those who underwent arthroscopic partial meniscectomy experienced more knee osteoarthritis progression than those who completed 12 weeks of exercise therapy, challenging decades of surgical convention.

Should You Have Surgery for a Degenerative Meniscus Tear?

The research comparing surgery to exercise therapy offers surprising clarity. Participants assigned to arthroscopic partial meniscectomy showed an adjusted mean difference in osteoarthritis progression of 0.39 points on the Osteoarthritis Research Society International (OARSI) atlas sum score—meaning the surgery group experienced more progression. The surgery group also had a higher incidence of radiographic knee osteoarthritis at 23% compared to 20% in the exercise group. Importantly, isokinetic knee muscle strength and patient-reported pain and function showed no clinically relevant differences between the two groups.

"Historically, we grouped these all as 'atraumatic' meniscus tears and now we're getting a little bit more nuanced into subclassifying these," explains Dr. Aaron J. Krych, department chair and John and Posy Krehbiel Professor of Orthopedic Surgery at the Mayo Clinic. "If you don't have displacement of fragments, it's clear that physical therapy is very much supportive of nonoperative management, but you have to look for those outliers."

The key takeaway: if your meniscus tear isn't causing fragments to shift or lock in your knee, conservative treatment with structured exercise should be your first choice. Surgery appears to accelerate osteoarthritis development rather than prevent it in these cases.

What About Meniscus Repair During ACL Surgery?

The picture changes dramatically when meniscus tears occur alongside anterior cruciate ligament (ACL) injuries. A 10-year follow-up study of 2,387 patients who underwent ACL reconstruction found that successful meniscus repair—when it heals without requiring additional surgery—significantly improves long-term pain outcomes.

Researchers from the Multicenter Orthopaedic Outcomes Network (MOON) Knee Group tracked patients from 2002 to 2008 and measured their pain levels using the Knee Injury and Osteoarthritis Outcome Score (KOOS), which ranges from 0 to 100. At the 10-year mark, 252 patients reported KOOS pain scores below 80 (indicating persistent pain), while 1,573 reported scores of 80 or higher (better pain control). The critical finding: when patients had a successful medial meniscal repair without needing subsequent surgery, the likelihood of having KOOS pain below 80 decreased by 7.1%. However, when patients required additional surgery after their initial meniscus repair and ACL reconstruction, the likelihood of persistent pain increased by 2.9%.

This means repairing your meniscus during ACL surgery—and keeping that repair intact—matters significantly for your long-term comfort and function.

How to Identify and Manage Overlooked Knee Meniscus Tears

One critical finding from 2025 research involves a specific type of meniscus tear called a ramp lesion that surgeons sometimes miss during initial ACL reconstruction. A retrospective review of patients who developed bucket handle tears (where a piece of meniscus flips into the joint) after ACL surgery revealed that unrepaired ramp lesions at the time of the original surgery significantly increased the risk of these secondary tears.

The research found that nearly three in four patients with subsequent bucket handle tears had shown signs of a posterior medial bone bruise pattern and possible ramp tear on their preoperative MRI before the index ACL surgery. This suggests these lesions were present but missed during the initial procedure.

The clinical implications are substantial. Surgeons and patients should focus on:

• Careful MRI Review: Thoroughly scrutinizing magnetic resonance imaging before ACL reconstruction to identify all meniscus tears, including ramp lesions that might be easy to overlook.
• Posterior Horn Assessment: Paying special attention to the posterior horn of the medial meniscus, which requires careful diagnosis and proper posterior drawer testing during arthroscopy.
• Conservative Bracing: Using more conservative bracing and partial weight-bearing protocols after surgery to protect repairs while they heal.

"You have to look at your MRI and study it carefully, but don't miss it at the time of arthroscopy," Dr. Krych emphasized. Missing these lesions during the initial surgery creates a domino effect—unrepaired ramp tears become risk factors for bucket handle tears, which then require additional procedures and worsen long-term outcomes.

What This Means for Your Knee Health

The 2025 research paints a clear picture for managing meniscus tears. For degenerative tears without displacement, physical therapy should be your first line of treatment—not surgery. The evidence strongly supports this approach, showing that exercise produces comparable pain relief and better long-term osteoarthritis outcomes than arthroscopic procedures.

However, if you're undergoing ACL reconstruction and have a meniscus tear, repair should be prioritized when possible. The long-term data demonstrates that successful repair without subsequent surgery significantly improves pain outcomes at 10 years. The challenge lies in identifying all tears—especially subtle ramp lesions—during the initial surgery so they can be properly addressed and given the best chance to heal.

If you're facing a meniscus tear diagnosis, ask your healthcare provider whether your tear shows displacement or locking symptoms. If not, discuss a structured physical therapy program before considering surgery. And if you need ACL reconstruction, ensure your surgeon carefully reviews your MRI for all possible meniscus pathology and performs thorough arthroscopic inspection to catch lesions that might otherwise be missed.