STUDY DESIGN: Case series. BACKGROUND: Exercise is a viable treatment alternative to arthroscopic partial meniscectomy in patients with degenerative meniscus tears. No study has reported in detail the type of exercises, progression, tolerance, and potential benefit from an exercise therapy program in these patients who have not had surgery. This case report describes a progressive exercise therapy program aimed at improving neuromuscular function and muscle strength in middle-aged patients with degenerative meniscus tears, the outcome over a 12-week period, and the ability to maintain improvements up to 1 year. CASE DESCRIPTION: The first 20 patients (age range, 38-58 years) included in an ongoing randomized controlled trial. OUTCOMES: Outcomes data included the Knee injury and Osteoarthritis Outcome Score, a 7-point global rating of change scale, isokinetic knee muscle strength tests, and 3 lower extremity performance tests. Postintervention, 16 of 20 patients showed clinically meaningful changes (greater than 10 points) on the Knee injury and Osteoarthritis Outcome Score knee-related quality of life subscale, 19 of 20 patients rated themselves as "a lot better" or "better" on the global rating of change scale, all patients had increased quadriceps muscle strength, and the majority of patients improved on the lower extremity performance tests. At 1 year postintervention, the majority of patients had maintained the improvements and none of the patients had undergone surgery. DISCUSSION: The described neuromuscular- and strength-training program should be considered for rehabilitation of middle-aged individuals with degenerative meniscus tears. However, head-to-head comparison of programs in a randomized design is needed to determine if this specific program is significantly better than other interventions.