I wrote part one nine days after tearing my lateral meniscus in a Saturday league soccer game, which in retrospect is a strange moment to write about an injury. Nine days in you know almost nothing. You know it hurts, you know what the imaging said, and you have started doing something about it. Everything else is a guess dressed up as a plan.
Two years on I owe the other half of that piece, because the interesting part of a meniscus tear shows up around month eight, when the sharp pain is long gone and you are deciding what you are willing to ask of it.
The short version is that the knee is fine and I am back doing everything I was doing before, including Muay Thai, which is the activity I was most worried about. The longer version has a couple of things I got wrong.
What the ten-year data shows
When I tore it, the standard mental model most people carry is that a meniscus tear is a mechanical problem requiring a mechanical fix. Something is torn, so something should be trimmed. That model has been under sustained pressure for a decade and the evidence is now about as clear as musculoskeletal evidence gets.
A Norwegian trial randomized 140 middle-aged adults with MRI-verified degenerative medial meniscal tears to either arthroscopic partial meniscectomy or twelve weeks of exercise therapy (1). At two years, exercise therapy was not inferior to surgery for knee function, and the exercise group had greater gains in muscle strength. That result got a lot of attention in 2016 and generated the usual objection, which was that two years is not long enough to see what happens to a knee.
So they followed the same cohort out to ten years and published it in 2025 (2). The primary outcome was radiographic osteoarthritis progression measured on the OARSI atlas. The adjusted mean difference between groups was 0.39 on the sum score, with the confidence interval crossing zero, and the direction of that non-significant difference favored the exercise group. Rates of developing knee osteoarthritis were comparable. A decade later, the surgical group had no structural advantage to show for the surgery.
That is a strong result and I want to fence it properly. It applies to degenerative tears in middle-aged people with no or minimal existing arthritic change. It does not apply to a locked knee that will not extend, to displaced bucket-handle tears, to large traumatic tears in young athletes, or to the meniscus root repairs that have their own separate literature. Those are different problems with different answers, and anyone telling you surgery is never indicated for a meniscus is overselling the finding.
Mine was a lateral tear from a planting mechanism, so it sat somewhere between the two categories. What made the decision easy was that I could load it. That is the practical filter I have used since with clients who arrive holding an MRI report: what can this knee currently do under supervision, and does that improve week over week.
The part I got wrong
In part one I listed my protocol at day nine, and it was reasonable work. Knee flexion PAILs and RAILs, knee CARs, hip flexion passive range holds, hip flexion lift-offs. What I underweighted was rotation.
The tibia rotates on the femur. Not much, around 20 to 30 degrees of internal and external rotation available at the knee depending on flexion angle, but that motion is real and the menisci move with it. My early work was almost entirely in the sagittal plane, flexion and extension, because that is the plane where the pain and the obvious range loss showed up. It took me longer than it should have to bring tibial rotation back in deliberately, and when I did, the knee stopped feeling vague at the end of flexion in a way it had for months.
I do not want to turn one person’s experience into a rule. What I would say is that a knee is not a hinge, it gets trained like a hinge, and rotation is the motion most likely to be missing from a rehab plan because it is the motion nobody assesses.
The second thing I underweighted was how long I would need to keep working on it after it felt fine. Around month four the knee felt normal in daily life and I quietly dropped the frequency. Around month six it started feeling uncertain again during faster changes of direction. Not painful, uncertain, which is a different signal and a reminder that tracking progress needs better markers than how something feels. Going back to consistent work resolved it. That gap between symptom resolution and capacity restoration is exactly the territory where people finish physical therapy and stall out, and knowing about it did not stop me from walking into it.
The knee I have now is stronger than the knee I had before the tear, mostly because the tear made me train it deliberately in ways I never bothered to when it was quiet. That is a real outcome and also a slightly annoying one to admit.
If there is a takeaway beyond my own case, it is that the meniscus question is usually asked as surgery or no surgery, and that framing skips the variable that predicts how things go. The knees that do well are the ones that get loaded progressively and comprehensively, in every plane the joint has, for longer than feels necessary. That is true on both sides of a surgical decision, which is also what the ACL rehab literature keeps showing.
References
- Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ. 2016
- Berg B, Roos EM, Englund M, Kise NJ, Engebretsen L, Eftang CN, Risberg MA. Arthroscopic partial meniscectomy versus exercise therapy for degenerative meniscal tears: 10-year follow-up of the OMEX randomised controlled trial. Br J Sports Med. 2025
Written by
Brian Murray, FRA, FRSC
Founder of Motive Training
Motive Training is a coaching studio in South Austin built around assessment, joint health, and strength you can use. Train with us in the studio, come to a KINSTRETCH class, or work through the progressions in KINSTRETCH Online.