Background Arthroscopic partial meniscectomy has become the default treatment for symptomatic traumatic meniscal tears, despite the lack of scientific evidence for it. Therefore, our aim was to compare arthroscopic partial meniscectomy with physical therapy for effectiveness in young patients with traumatic meniscal tears. Methods We conducted a multicenter, open-labelled, randomized controlled trial in patients aged 18-45 years, with a recent onset, traumatic, MRI-verified, isolated meniscal tear. Main exclusion criteria were knee osteoarthritis on radiographs, a locked knee, a repairable meniscal tear based on MRI findings or a rupture of the anterior cruciate ligament. Patients were randomized to either arthroscopic partial meniscectomy or standardized physical therapy. The primary outcome was the International Knee Documentation Committee (IKDC; 0-100) score at 24 months, that measures patients’ perception of symptoms, knee function and ability to participate in sports activities. Results Between 2014 and 2018, 100 patients were included. Forty-nine patients were randomized to arthroscopic partial meniscectomy and 51 patients to physical therapy. In the physical therapy group, 21 patients (41%) received delayed arthroscopic partial meniscectomy during the follow-up period. In both groups the IKDC scores improved clinically relevant during follow-up compared to baseline scores. The between group difference in IKDC score at 24 months of follow-up was 0.2 (95% CI -7.1 to 7.5). Conclusions In patients with a traumatic meniscal tear, treated with either arthroscopic partial meniscectomy or physical therapy, we found no difference in IKDC score between treatment groups after 24 months of follow-up. Clinically relevant differences were excluded by the 95% confidence interval. The majority of the physical therapy group did not need surgery during the 24 months follow-up.