Knee iSAWE 15

Question

A 52 year old man has two months of medial knee pain without locking. His MRI report describes a degenerate posterior horn medial meniscal tear.

Knee iSAWE 15, sagittal MRI of the knee
Sagittal MRI of the knee. Image by Ciernik M, Wikimedia Commons, CC BY-SA 4.0.
  1. What does the MRI show?
  2. Summarise the evidence for arthroscopic partial meniscectomy in this setting.
  3. When is arthroscopy indicated?

Answer

MRI

  • High signal reaching the articular surface of the posterior horn of the medial meniscus
  • Degenerate horizontal or complex tear
  • Assess for bone marrow oedema, root tears and osteoarthritis

Evidence

  • FIDELITY (2013) showed no benefit of partial meniscectomy over sham surgery
  • METEOR showed similar outcomes with physiotherapy, with a third crossing over
  • ESCAPE showed physiotherapy was non inferior to surgery
  • Arthroscopy for degenerate knees is not recommended (BMJ Rapid Recommendations 2017)
  • Meniscectomy increases contact stress and speeds osteoarthritis

Indications for arthroscopy

  • True locking from a displaced bucket handle tear
  • Failure of 3 months of structured physiotherapy with mechanical symptoms
  • Repairable tears in younger patients
  • Medial meniscal root tears in knees without arthritis

Related pages

Author Contributions

Orthofracs team

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.