Why do we try to preserve the meniscus?

The meniscus helps distribute loads between the thigh bone and the shin bone. When part of it is lost, the remaining structures have to take on more load. That is why we try to preserve as much functional tissue as possible. However, this does not mean that every tear can be successfully repaired.

Imagine a tear in a strong piece of fabric. If the edges can be brought together and the material can hold the stitches, a repair makes sense. If the tissue is badly damaged and falls apart when we try to grasp it, stitches alone will not be enough. This simplified comparison shows why tissue quality matters.

What determines whether a tear can be repaired?

The outer part of the meniscus, closer to the joint capsule, has a better blood supply. The inner part has a much poorer blood supply. Healing requires a stable repair and suitable biological conditions. However, the location of the tear alone does not determine everything.

The shape and extent of the tear are also important. Some longitudinal tears are well suited to repair. Selected radial tears, horizontal tears, and meniscal root tears can also be repaired. The root is where the meniscus attaches to the bone. Damage to this attachment can seriously impair meniscal function, even if most of the tissue remains in the joint.

Does age determine the choice of surgery?

Age alone does not determine the choice of surgery. Tissue quality, the type of tear, the condition of the cartilage, and knee stability are more important. We also consider the patient’s activity level and what they want to return to after treatment. Together, these factors help us assess whether a repair has a reasonable chance of healing and providing a benefit.

When is earlier assessment needed?

A recent tear that may be suitable for repair should be assessed early, particularly when a displaced fragment blocks movement. If you cannot straighten your knee after an injury, do not try to force it past the blockage or put off a consultation for weeks.

How is a meniscus repaired?

We usually perform the repair during arthroscopy, using a camera and instruments inserted through small incisions. We bring the edges of the tear together using surgical sutures or specialised meniscal repair implants. You can think of them as tiny staples, although many consist of small fixation devices connected by a suture. They remain in the knee and hold the repaired tissue together while it heals.

Bringing the edges together does not guarantee healing. Suitable biological conditions and protection of the repair after surgery are also needed.

Why is the final decision sometimes made during surgery?

An MRI helps us plan treatment, but arthroscopy allows us to directly assess tissue quality, tear stability, and whether a repair is possible. An MRI cannot always tell us whether the meniscus can be repaired, or how much will need to be removed if repair proves impossible. That is why the treatment plan and possible surgical options should be discussed before surgery.

When is part of the meniscus removed?

When it is causing symptoms, but the condition of the tissue does not allow a lasting repair. The tissue may be so frayed and degenerated that the sutures cut through it and cannot hold the edges together. Sometimes, despite attempting a repair, we cannot achieve a stable result. We then consider removing the part that cannot be repaired, while preserving as much functional meniscus as possible.

A fragment being displaced or moving around does not, by itself, mean it needs to be removed. That fragment may still be repairable.

Rehabilitation after partial removal and after repair

After part of the meniscus is removed, returning to everyday activities can be quicker than after a repair. There is no healing repair site that needs protection. However, swelling still needs to settle, and movement and muscle strength need to be restored. Getting back to walking sooner does not mean the knee is immediately ready for running or football.

After a repair, rehabilitation usually requires more patience. Depending on the type of tear and the stability of the repair, crutches and restrictions on weight bearing and knee bending may be needed. There is no single timetable for everyone. We protect a longitudinal tear differently from a root repair or a radial tear repair.

Returning to sport after a repair usually takes months. The decision depends on time since surgery, range of motion, muscle strength, and control of the leg. We also check whether increasing activity causes knee pain or swelling. The pain going away does not, on its own, mean that the repaired meniscus is ready for sport.

Is repair always better?

If a repair has a realistic chance of success, preserving the meniscus is an important goal. But repairing tissue that does not have the conditions needed to heal may lead to another operation. We need a careful assessment of what is appropriate, rather than a promise to repair every tear.

Meniscal transplantation and reconstruction

It is important to distinguish between removing a small, damaged portion and losing most of the meniscus. Not every loss of tissue requires reconstruction. But when a substantial amount is missing, we also need to think about how the knee will function in the future.

In certain situations, a meniscal transplant using donor tissue may be considered. For partial defects, specialised scaffolds made from biological or synthetic materials can sometimes be used. Techniques using the patient’s own tissue, such as a tendon, are also being developed, but the evidence supporting their outcomes is less established.

These methods are not used automatically every time part of the meniscus is removed. They are mainly considered when substantial meniscal loss is causing symptoms, and the condition of the knee offers a reasonable chance of benefiting from reconstruction. Cartilage, leg alignment, and joint stability all matter. Sometimes, other problems need to be corrected at the same time. This treatment requires separate planning and does not guarantee that all the properties of the natural meniscus will be restored.

A plan tailored to the procedure actually performed

The aim is to preserve as much functional meniscus as possible, and to tailor rehabilitation to the procedure actually performed. In the next episode, we will discuss walking without crutches and returning to work and sport. Surgery is one stage of treatment. The next is safely regaining function.

Author: Tomasz Poboży - orthopaedic surgeon, MD, PhD. 4 October 2026.

This educational resource does not replace an individual medical assessment.

Part IV — rehabilitation and recovery

Crutches, exercises, work, driving and sport after three types of meniscus surgery.