Ninety-nine patients with recent traumatic, MRI-verified isolated meniscal tears and no radiographic osteoarthritis were randomized to either arthroscopic partial meniscectomy (n=48) or standardized physical therapy with optional delayed arthroscopic partial meniscectomy (n=51). The primary outcome was progression of bone marrow lesions (BMLs), cartilage defects, and osteophytes on MRI at 24 months. Secondary outcomes included the development of new BMLs or cartilage defects and comparison of baseline abnormalities to healthy controls (n=50). Outcomes were assessed at baseline and 24 months using the MRI Osteoarthritis Knee Score (MOAKS). Overall, the results of the study revealed slightly more worsening of BMLs and cartilage defects in the arthroscopic partial meniscectomy group compared to the physical therapy group, although differences did not reach statistical significance. These findings suggest that initial physical therapy may better preserve knee joint integrity over two years in young patients with traumatic meniscal tears.