Treatment
Meniscus Repair
Meniscus repair is an alternative to “trimming” (partial meniscectomy) for some patients with meniscus tears. The procedure helps to restore the cushion between the femur (thighbone) and tibia (shinbone), protecting the cartilage of the knee joint and restoring stability.
Meniscus repair is often performed in patients who are young and involved in sports or other physically demanding recreational activities.
Anatomy
Two bones meet to form your knee joint: the femur and the tibia. The kneecap (patella) sits in front of the joint to provide some protection.
Between the tibia and femur are two wedge-shaped cushions: the medial (inside) meniscus and the lateral (outside) meniscus. The menisci act as shock-absorbers and also provide stability to the knee joint.
The structure of each meniscus includes:
- The meniscal roots (the attachments to the tibia in the front and back of the knee)
- The posterior horn (the back 1/3 of the meniscus)
- The body (the inner 1/3 of the meniscus)
- The anterior horn (the front 1/3 of the meniscus)
There are three zones of the meniscus with different amounts of blood flow that affects healing:
- The red-red zone
- The red-white zone
- The white-white zone
The red-red zone has the greatest blood supply and ability to heal, while the white-white zone has limited blood supply and poor healing potential.
When Is Meniscus Repair Recommended?
A meniscus repair is typically performed for tears in zones that have good blood supply.
Repairing the meniscus mends together the torn fibers to aid healing and restore the cushion between the femur (thighbone) and tibia (shinbone). This, in turn, helps protect the cartilage of the knee joint and restoring stability, especially when meniscal tears occur along with an ACL injury.
If a meniscus tear is in a zone with poor healing ability and loose or partly detached meniscal tissue is causing knee catching and pain, simple trimming of the meniscus may be recommended instead of repair.
However, trimming, also known as partial meniscectomy, is not recommended for tears in zones that typically have a high rate of healing after repair. In these cases, trimming can increase pressure on the cartilage and may lead to early development of osteoarthritis. Even though repair has a longer healing time than trimming, it is a better option.
Optimal candidates for meniscal repair include active patients with minimal cartilage wear or arthritis. These procedures are often performed in patients who are young and involved with sports or other physically demanding recreational activities.
In patients with moderate to severe osteoarthritis, meniscal repairs have low success rates, as they do not address the underlying cartilage wear and tear.
A decision to move forward with meniscal repair or trimming may also depend on the patient’s goals and age.
- In athletes, meniscal repair requires a longer recovery time before being cleared to return to play.
- However, meniscus repair provides greater long-term benefits by reducing the risk of early onset of osteoarthritis.
Other treatment options for meniscus tears include physical therapy and corticosteroid injections. These therapies do not address the structural injury to the knee — in other words, they do not repair the tear — but they may help to relieve symptoms.
Preparing for the Procedure
Meniscus repair is often performed on an outpatient basis, which means you will be able to go home on the same day as your surgery. You will need to make sure that you have adequate support at home to help you move around and perform activities of daily living, like cooking, doing laundry, and bathing.
If you do not have support at home, consider arranging for some friends or family members to assist you for the first week as you gain experience with postoperative restrictions and start physical therapy.
If you are a smoker, it is recommended that you stop smoking at least 6 weeks before your surgery to improve the chances of meniscus healing and reduce the risk of infection and postoperative blood clots. Learn more about how smoking can affect recovery from orthopaedic surgery.
Procedure
Before surgery, an anesthesiologist will assess your health and determine the best anesthesia option for you.
For meniscus repair, the surgery can be done with regional anesthesia (a nerve block) and sedation or general anesthesia. An injection that consists of numbing medication, called a regional block, may be administered at the thigh to numb your leg during the procedure and also help with pain control after surgery.
The procedure typically takes about 1 hour.
The surgical approach and recovery depend on the type and location of the meniscus tear:
- Tears that occur in line with the parallel fibers within the posterior horn or body can be treated with an "all-inside repair"' or “inside-out repair” technique.
- Tears that are at a right (90 degree) angle to these fibers (i.e., radial tears) can also be treated with either of these techniques. However, if the “root” of the meniscus is torn, the surgeon may need to drill small bone tunnels through your shinbone to help anchor the “root” of the meniscus into place
All-inside repairs are performed entirely within the knee joint. A device is used to pass sutures through the meniscus and knee capsule to repair the tear.
The inside-out technique requires a separate incision on either the inside (for medial meniscus tears) or outside (for lateral meniscus tears) of your knee. Sutures are passed from the inside of your knee and out of the separate incision, and knots are tied to the capsule of the knee joint to allow for repair.
Recovery
Depending on your tear and repair type, you may be able to fully bear weight on a straight leg early on, or you might have to use crutches at first to keep weight off of your leg. Root repairs often require more time on crutches and protected weightbearing than other tear types. Your surgeon will provide instructions to your physical therapist to appropriately guide your recovery.
Knee range of motion is often gradually progressed during the first 6 weeks. Patients are expected to return to their normal level of activity at around 6 months, when the meniscus is fully healed.
The majority of patients do well after surgery and are able to return without functional limitation.
Complications
Potential complications of this procedure are rare, but may include:
- Damage to nerves and blood vessels around the knee
- Wound or knee joint infection
- Blood clots
- Knee stiffness
- Muscle weakness
- Need for additional surgery after failed repair or reinjury of the meniscus
Long-Term Outcomes
Long-term outcomes often depend on the following:
- The patient's age
- The patient's overall health
- The patient's activity level
- Commitment to physical therapy — patients who complete their prescribed physical therapy do better than patients who don’t
- Which surgical technique was used
- The type and location of the meniscus tear
- Overall patient health
- Alignment of the knee
- Cartilage health prior to surgery
A recent review of meniscus repair outcomes showed favorable outcomes for both all-inside and inside-out techniques for both athletes and the general population.
- Return-to-sport rates after meniscus repair are reported to be approximately 91% and 95% after all-inside or inside-out repairs, respectively.
- Average time to return to play is 8 months post-surgery.
To assist doctors in the management of meniscus injuries, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Clinical Practice Guideline - Acute Isolated Meniscal Pathology - AAOS
Last Reviewed
March 2025
Contributed and/or Updated by
Peer-Reviewed by
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website.