Medial meniscus and knee joint damage- is surgery the best option for this case?

Hi everyone,

A client of mine has had a recent CT Arthrogram of a left knee injury which is about a month old which occurred after a low impact squatting injury. Findings were:

1. Medial mensicus tear in outer region of posterior horn 3-4 mm
2. Fraying of the outer portion of the lateral meniscus
3. High grade chrondal lesions on the MCP and patella
4. Synovial cyst or ganglion on the PCL.

The ACL and PCL ligaments are intact.

Clinically, he is going ok- has close to full knee ROM (about 140 deg passive flexion before pain) and can walk ok. He is restricted in his work though, as he is required to squat and be quite mobile on his feet as a cleaner. He is 38 years of age, relatively fit (goes to the gym) and is not overweight.

His GP has cleared him to go back to work, and he does not want to have surgery due to fears of being out of action for a while. He thinks that there may have been some damage done to his knees years ago as he used to squat with weights with poor technique. Because he doesn't want to do surgery, I am thinking about focusing on strengthening the quads and hip muscles. I suggested a surgical review, just so he knows the options and he seemed receptive to this.

Is this case best to be managed surgically, or could there be ok outcomes with conservative treatment?