Conflicting opinions

I am a 47F who has been running for 30+ years, have always cross trained quite a bit due to frequent injuries. I was training for the 2026 Boston Marathon in February when I developed pain and swelling in my right knee after (an overly aggressive in retrospect) hilly long run. Got a cortisone shot and pain improved, was able to cautiously resume training but pain came back in March. Finally got an MRI that showed “Slightly oblique thin radial tear nearly completely transects the mid posterior horn medial meniscus, well-appreciated on the axial imaging. Mild inner rim truncation midline of this radial tear. Very small medial contiguous longitudinal tear within the mid to medial aspect posterior horn medial meniscus violating the tibial articular surface of the juncture of the middle and peripheral one-thirds. Very subtle ill-defined horizontal band of increased T2 signal within the posterior juncture medial meniscus likely violating the tibial articular surface. Body is mildly extruded from the joint space. Very mild fraying of the inner rim anterior horn medial meniscus.”

I haven’t run in a month but have continued strength/cross training/PT and my pain has improved significantly. I can squat, lunge, cycle, elliptical and walk without pain. No clicking or catching. I have minor pain with impact/jumping near the medial joint line.

I have since seen three orthopedic surgeons. #1 said the tear doesn’t look degenerative and he can repair it. #2 said tear is degenerative and in the white-white zone so repair would almost certainly fail and a trim is my only option. #3 agrees with #2 (he used the word “macerated” to describe my meniscus) but thinks we should try a gel shot and if that doesn’t help, do a trim/debridement. My PT agrees with #3’s approach and says my pain is likely caused by something else going on in my knee bc it’s incongruent with where the tear is.

I have no idea what to do and don’t understand how the most respected orthopedic surgeons in my city have such vastly different interpretations of the same imaging. I want to give myself the best chance of being able to run for years to come, but I also just spent the last year rebuilding from proximal hamstring repair on the other leg and the prospect of being sidelined for another year (and on crutches for 6-8 weeks!) with meniscus repair surgery is devastating. How do I decide?