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Meniscal repair

165 citationsUpdated Oct 2026

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Overview

Meniscal repair aims to achieve healing and avoid the adverse effects of meniscectomy, which is associated with increased peak stresses and a higher risk of osteoarthritis [1, 2, 3]. Meniscal tears are the most common knee injury necessitating surgery, with the medial meniscus torn approximately three times more often than the lateral meniscus [2, 3]. Traumatic tears are common in young patients with sports-related injuries, while degenerative tears usually occur in older patients with an insidious onset [2, 3]. The vascular supply of the meniscus is a primary determinant of healing potential, with tears in the peripheral third having the highest potential for healing [2, 3]. General indications for repair include a tear between 1 and 4 cm, a vertical tear, a red-red tear, a meniscal root tear, and a patient younger than 40 years [2, 3]. Concomitant ACL reconstruction may extend the indications for meniscal repair because results are typically better [2, 3].

In appropriately selected patients, meniscal repair can deliver improved subjective outcomes with comparable reoperation rates and the potential for reduced risk of osteoarthritis over time versus meniscectomy [8]. Success rates for meniscal repair exceed 80% when performed with anterior cruciate ligament reconstruction [19]. The success rate of meniscal repair is 90% when performed in conjunction with an ACL reconstruction, 60% when performed in a knee with an intact ACL, and 30% when performed in a knee with a deficient ACL [2, 3]. Patients treated with primary meniscectomy have over three times higher odds to undergo subsequent knee arthroplasty compared to those treated with meniscal repair [26]. In patients aged 40 years and older, patient-reported outcomes at an average of 5 years postoperatively were satisfactory and similar in patients undergoing meniscal repair and meniscectomy [179]. Age alone should not be a contraindication to meniscal repair [179].

Both meniscectomy and meniscal repair are safe surgical procedures with low adverse event rates (0.95% and 1.4%, respectively) [21]. Complications after meniscal surgery are associated with medical comorbidities, older age, and longer operative times [21]. Meniscal repair is effective over the medium and long term in 70 to 80% of cases [24]. The menisci should be repaired if at all possible, especially in the setting of anterior cruciate ligament reconstruction, for optimal functional outcome and patient satisfaction [203].

Anatomy & Pathophysiology

Gross Anatomy

The menisci are wedge-shaped, crescentic fibrocartilaginous structures with a triangular cross section situated between the femoral condyles and tibial plateaus [131, 158]. The medial meniscus is semicircular or C-shaped, wider in diameter than the lateral meniscus, and covers 50% to 60% of the medial tibial plateau surface [131]. It measures 10 mm wide and 3 to 5 mm thick, covering 64% of the condyle surface [158]. The lateral meniscus is more circular with equally sized anterior and posterior horns, covering 84% of the condylar surface [131]. It measures 12 to 13 mm wide and 3 to 5 mm thick [158]. The medial meniscus attaches to the deep medial collateral ligament fibers and joint capsule, limiting mobility, whereas the lateral meniscus has less continuous capsular attachment, conferring greater mobility [131]. The transverse intermeniscal ligament connects the medial and lateral menisci in 60% to 94% of knees [131]. At the posterior lateral attachment, popliteomeniscal fascicles extend from the meniscus to the posterior capsule, creating the popliteal hiatus as the popliteus tendon becomes intra-articular [131]. The meniscofemoral ligaments connect the posterior horn of the lateral meniscus to the medial femoral condyle [131]. The anterior meniscofemoral ligament of Humphrey courses anterior to the posterior cruciate ligament, while the posterior meniscofemoral ligament of Wrisberg courses posterior to it [131].

Histology and Biochemistry

The meniscal substance consists of a solid extracellular matrix and water [131]. Fibrochondrocytes are the predominant cell type, producing an extracellular matrix primarily composed of type I collagen, with smaller amounts of types II, III, V, and VI collagen [131]. Proteoglycans, such as aggrecan, comprise 1% of the dry weight and attract water, which constitutes 65% to 75% of meniscal volume [131, 158]. Type I collagen is most abundant in the superficial zones to provide tensile strength [131]. Deeper zones contain larger concentrations of proteoglycans and water, providing compressive strength [131].

Vascular Supply

The menisci receive vascular supply from the superior, middle, and inferior geniculate arteries [131]. The peripheral 10% to 30% is well vascularized by synovial and capsular branches, as are the anterior and posterior root attachments [131]. The outer third is the red/red zone, well vascularized; the middle third is the red/white zone, marking the border between vascularized and avascular tissue; and the inner third is the white/white zone, devoid of vascular supply [131]. Poorly vascularized portions receive nutrition through diffusion [131]. At birth, 50% of the meniscus is vascularized, decreasing to 10% to 25% in adults, with vascularity further decreasing with advancing age [158, 9]. The peripheral blood supply supports a reparative response via a perimeniscal capillary plexus supplying the peripheral 10% to 25% [212].

Biomechanics and Function

The menisci provide proprioceptive feedback, load distribution, joint lubrication, and maintenance of tibiofemoral stability and congruity [131]. They distribute load, deliver congruency, enhance stability, and contribute to lubrication and nutrition [7]. In deeper zones, collagen fibers are oriented circumferentially and stabilized by intermittent radial tie fibers [131]. This orientation provides superficial tensile strength and absorbs hoop stresses from axial loading during weight bearing [131]. The menisci transmit 50% of joint loads in extension and up to 85% in flexion [131]. In extension, 50% of load is absorbed by the meniscus, increasing to 90% at 90° of knee flexion [9]. Beyond 90° of flexion, most force transmits to the posterior horns [158]. The lateral meniscus provides more biomechanical protection than the medial meniscus [158]. Complete meniscectomy increases articular cartilage contact stress by two to three times compared to an intact meniscus [158]. Removal of the inner third reduces contact area by 10% and increases contact stress by 65% [158]. Total meniscectomy carries a relative risk of 14.0 for osteoarthritis, with 4% cartilage loss per year [12]. Impaired meniscal function disrupts chondroprotection, increasing the risk of degenerative change and morbidity [7].

Pathophysiology of Tears

Meniscal tears are classified by location relative to vascular supply, position, and appearance or orientation [2]. Longitudinal tears most commonly result from trauma to a reasonably normal meniscus [6]. A bucket-handle tear occurs when the inner fragment of a complete longitudinal tear displaces into the intercondylar notch [6]. Horizontal tears are more common in older patients, resulting from shear that divides the superior and inferior surfaces [6]. Radial tears are vertically oriented, extending from the inner edge toward the periphery, and may be complete or incomplete [6]. Complex tears contain elements of all types and are common in chronic lesions or older degenerative menisci [6]. Degenerative tears often refer to complex tears with marked irregularity [6]. Medial meniscus root tears result in peak articular cartilage contact pressure similar to complete meniscectomy [158]. Disruption of circumferential fibers leads to loss of hoop stress transmission, with biomechanical effects approaching total meniscectomy [243]. Posterior medial meniscal root tears increase contact pressure, external rotation, and lateral tibial translation [243]. Lateral root tears substantially decrease contact area and increase contact pressure in the lateral compartment [243]. Meniscal root tears are frequently unrecognized, significantly altering knee biomechanics and kinematics and leading to accelerated degenerative changes [13]. The radial tear configuration is almost unique to the lateral meniscus, occurring rarely in the medial meniscus [134]. Meniscal cysts are frequently associated with tears and are nine times more common on the lateral than medial side [75]. Discoid menisci are abnormal and vulnerable to compression and rotary stresses due to hypermobility and tissue bulk [75]. Histopathology shows disorganization of the circumferential collagen network at a molecular level [56]. These structural abnormalities compromise stress tolerance and predispose to tears [56]. The mechanical dysfunction is further demonstrated by the association with the relatively rare lateral femoral condyle osteochondritis dissecans lesion [56].

Classification

Tear Morphology and Patterns

O’Connor: This classification system categorizes meniscal tears into longitudinal, horizontal, oblique, radial, and variations including flap, complex, and degenerative types [6]. Longitudinal tears are vertically oriented and parallel to the meniscus edge; they may be complete or incomplete [6]. A complete longitudinal tear with a displacable inner fragment that moves into the intercondylar notch is defined as a bucket-handle tear [6]. Longitudinal tears near the meniscocapsular attachment are termed peripheral tears [6]. Horizontal tears involve a cleavage plane dividing the superior and inferior surfaces of the meniscus [6]. These horizontal tears are more common in older patients and frequently occur in the posterior half of the medial meniscus or the midsegment of the lateral meniscus [6]. Oblique tears are full-thickness tears running obliquely from the inner edge into the body of the meniscus [6]. Radial tears are vertically oriented, extending from the inner edge toward the periphery, and can be complete or incomplete [6]. Flap tears resemble oblique tears but include a horizontal cleavage element [6]. Complex tears contain elements of multiple tear types and are more common in chronic lesions or older degenerative menisci [6]. Degenerative tears often refer to complex tears presenting with marked irregularity and complex tearing, most often seen in older patients [6].

Campbell: This classification includes longitudinal, radial and oblique, horizontal cleavage, complex, cystic meniscus-associated, and discoid meniscus-associated tears [75]. The posterior root tear is a type of radial tear at the posterior root attachment of the meniscus [75]. The ramp lesion is a form of longitudinal tear at the menisco-capsular junction or the menisco-tibial attachment of the meniscus [75]. Longitudinal tears are the most common type of meniscal tear, usually involving the posterior segment of either the medial or lateral meniscus [75]. Transverse, radial, or oblique tears more commonly involve the lateral meniscus and are usually located at the junction of the anterior and middle thirds [75]. Discoid menisci are abnormal and vulnerable to compression and rotary stresses due to hypermobility and tissue bulk [75].

Vascular Zones and Location

A peripheral vertical tear in zone I is referred to as a red-red tear [6]. A tear between zone I and zone II is referred to as a red-white tear [6]. Red-red and red-white tears are located in the vascularized portion of the meniscus [6]. Tears posterior to the popliteal tendon may heal on their own or with local stimulation techniques [6].

Diagnostic Assessment and Reliability

Classification of meniscal tear types during diagnostic arthroscopy is essential for planning subsequent resection or repair [6]. Arthroscopy permits precise classification of the type, extent, and location of meniscal tears [30]. Surgeons can reliably classify meniscal pathology and agree on treatment, which is important for multicenter trials [216]. A convolutional neural network model has the potential to diagnose the presence of meniscal tears and differentiate their types using magnetic resonance images [208]. MRI sensitivity and specificity for diagnosing primary meniscal tears are high, but these values are lower for assessing the healing status of repaired menisci [90]. The frequency of intrameniscal signal anomalies adjacent to the tear (grades 2–4) was significantly lower in ACL-deficient knees than in stable knees [244]. Histological anomalies were observed in 20 of 21 resected meniscal segments that displayed hyperintense signal zones adjacent to the tear on MRI [244].

Reparability Criteria and Prediction

Accepted criteria for meniscal repair include a complete vertical longitudinal tear >10 mm long, a tear within the peripheral 10% to 30% of the meniscus or within 3 or 4 mm of the meniscocapsular junction, a tear that can be displaced by probing, a tear without secondary degeneration or deformity, a tear in an active patient, and a tear associated with concurrent ligament stabilization or in a ligamentously stable knee [16]. Certain meniscal tears do not require treatment because they heal spontaneously or remain asymptomatic [16]. Meniscal tear location in addition to type likely plays a crucial role in dictating the success of non-operative treatment of the menisci [70]. The incidence of medial meniscal lesions and the complexity of tear types increased significantly with increasing time intervals between the index injury and ACL reconstruction [74]. Traumatic meniscal tear tissue showed a higher degree of degeneration than intact menisci [55]. BMI is an independent risk factor for meniscal degeneration in traumatic meniscal tears [55]. No clear association was observed between histological degree of degeneration and age, sex, or time interval between trauma and surgery in traumatic meniscal tears [55]. A scoring system to predict the reparability of the meniscus based on MRI has limitations regarding MRI sensitivity, statistical details, and demographic data [66].

Clinical Presentation

History and Symptoms

Meniscal tears are unusual in patients younger than 10 years [18]. In adolescents and young adults, most tears occur with a twisting injury or a change in direction [18], whereas middle-aged and older adults often sustain tears from squatting or falling [18]. Patients with a traumatic tear may report pain onset during a twisting mechanism or deep knee flexion [160], and occasionally an audible or palpable popping is reported [160]. Approximately one-half to two-thirds of patients report knee swelling [160]. With an acute meniscal tear, an effusion often develops several hours after injury [18]. Patients localize pain to the joint line or posterior knee [18] and may describe mechanical symptoms of locking or catching [18]. Mechanical symptoms such as catching or frank locking have been reported in 12% to 69% of patients [160] and may suggest an unstable tear [160]. Chronic meniscal tears demonstrate intermittent effusions, often with mechanical symptoms [18]. Not all meniscal tears cause symptoms, and many symptomatic tears become asymptomatic [9]. Meniscal injury is identified on MRI in 31% of asymptomatic athletes [12] and in 91% of patients with knee osteoarthritis [12].

Physical Examination

Small joint effusions and joint line tenderness with palpation are common findings with meniscal tears [18]. Palpation of the joint line may elicit tenderness at the location of a meniscal tear [160]. Posterior horn tears are most prevalent, making the posterior joint line a common location for tenderness [160]. In a patient with an isolated meniscal tear, joint line tenderness was found to be an accurate test in 81% to 90% of patients [160]. Range of motion is typically normal in patients with meniscal tears [18], although patients may report tightness in flexion if an effusion is present [18]. Longitudinal bucket-handle tears may block full extension of the knee joint [18].

Manipulative maneuvers, including the McMurray and Apley tests, may produce a palpable or audible click with localized tenderness [18]. However, these tests are not specific for meniscal pathology [18]. In a patient with an isolated meniscal tear, the McMurray test was accurate in 57% to 77% of patients [160]. The Thessaly test involves the patient flexing the knee to 20° while standing on the affected extremity and twisting in internal and external rotation [18]. This test often reproduces pain in patients with a meniscal tear [18] and was accurate in 61% to 80% of patients with an isolated meniscal tear [160]. In patients with associated ligamentous or chondral injury, the physical examination can be particularly challenging because the aforementioned tests lose specificity for meniscal pathology [160]. Clinical examination by an experienced examiner using multiple meniscus tests is sufficient for a diagnosis of a meniscal tear [114]. Several large studies have demonstrated the accuracy of the clinical diagnosis of meniscal tears to be 70% to 75% [18]. Pre-operative tests and clinical findings are not conclusive for identifying a meniscal tear [36].

Imaging

Standard knee radiographs should be obtained to evaluate for bone injuries or abnormalities [18]. A weight-bearing radiograph is necessary to evaluate for osteoarthritis [18]. A right-to-left difference of at least 2 mm on weight-bearing radiographs represents a significant difference that will be verified by articular cartilage chondrosis at the time of arthroscopy [18]. MRI remains the noninvasive diagnostic procedure of choice for confirming meniscal pathology [18]. In grade III MRI classification of meniscal tears, increased signal intensity reaches the articular surface of the meniscus [18]. MRI has demonstrated a high negative predictive value for meniscal tears [18], and a well-performed MRI of a knee with no meniscal pathology will rarely demonstrate a tear [18]. The diagnostic validity of magnetic resonance imaging is similar for meniscal tears in acute knee trauma and in knee symptoms lasting over 6 months in young adults [58].

The sensitivity and specificity of 1.5-Tesla (T) and 3.0-T MRI diagnosis of medial meniscal tears, as confirmed with arthroscopy, were found to be 93% to 96% and 88% to 90%, respectively [160]. MRI was less sensitive (77% to 82%) but more specific (98% to 99%) for lateral meniscal tears [160]. A study of 3.0-T MRI for detecting posterior meniscal root tears found sensitivity of 77% and specificity of 73% [160]. The decreased accuracy of MRI for diagnosing root tears may be attributable in part to the radial orientation of many posterior root tears, making them more difficult to visualize on MRI [160]. To be considered a relevant finding, a tear seen on MRI should correspond to the patient’s history and clinical examination findings [160]. MRI contributes to enhancing the diagnostic accuracy of an unhealed meniscal repair when there are limited clinical signs of meniscal pathology [39]. A lack of joint line tenderness is consistent with a healed meniscus [111]. Positive clinical examination findings and MRI scans are inconsistent in identifying failure after meniscal repair [111].

Investigations

History and Physical Examination

Patients with meniscal injuries localize pain to the joint line or posterior knee and may describe mechanical symptoms of locking or catching [18]. Manipulative maneuvers, including the McMurray and Apley tests, may produce a palpable or audible click with localized tenderness, but they are not specific for meniscal pathology [18]. Range of motion is typically normal in patients with meniscal tears [18]. The accuracy of the clinical diagnosis of meniscal tears has been demonstrated to be 70% to 75% in several large studies [18]. In nonarthritic knees, focal joint line tenderness, effusion, and positive meniscal signs on physical examination may indicate meniscal pathology as a symptomatic source worthy of surgical intervention [12]. In the presence of osteoarthritis, mechanical symptoms such as locking or catching in combination with unstable meniscal tears on MRI warrant intervention [12]. Débridement of stable meniscal tears in the presence of osteoarthritis is unlikely to provide lasting relief [12].

Imaging

MRI: Pre-operative tests and clinical findings are not conclusive for identifying a meniscal tear, and surgeons should be vigilant in identifying and repairing tears at the time of surgery [36]. Confusion between meniscal fraying and small tears is a major source of discrepancy between MRI and surgical findings [267]. Meniscal deformation or displacement observed on preoperative MR images suggests a higher risk of meniscal tears, even in menisci with signal changes other than grade 3 changes [246]. MRI is successful in determining the presence or absence of tears in discoid menisci; however, its ability to determine the tear type is questionable [257].

CT: Advanced imaging by 3-dimensional computed tomography may better allow preoperative planning for a safe approach to the posterior horn of the lateral meniscus using all-inside repair techniques [252].

Ultrasound: Sonographic evaluation should be considered in patients presenting with ongoing knee pain after all-inside meniscus repair [94].

Predicting Reparability

MRI is not always useful in predicting reparability of symptomatic isolated lateral semilunar meniscus tears, and most of the symptomatic cases with normal MRI were reparable [233]. Magnetic resonance imaging is not an effective or efficient predictor of reparability of meniscal tears with the current arthroscopic criteria [236]. MRI continues to be a poor predictor of meniscus tear reparability as assessed by arthroscopic criteria, even when using higher resolution 3-T scanners [265]. Precise description of meniscal tears on MRI should continue to improve its ability to assist with surgical planning [238].

Post-Repair Assessment

The sensitivity and specificity of magnetic resonance imaging for the diagnosis of primary meniscal tears are high, but these values are lower for the assessment of healing status of repaired menisci [90]. The meniscus fulfills its function as normal or nearly normal even though the MRI findings fail to prove healing [211]. Several abnormal vertical and/or horizontal hypersignals are present on MRI ten years after arthroscopic all-inside meniscal repair, without any subjective or objective clinical significance [224]. Magnetic resonance imaging is unsuitable for diagnosis of the healing process of a repaired meniscus [254]. Magnetic Resonance Imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair [224]. Preservation of the integrity of the articular cartilage on quantitative MRI has been associated with healed meniscal repairs [11].

Treatment

Non-Operative

Nonoperative management serves as a comparator in the evaluation of meniscal repair outcomes, particularly for medial meniscus root tears where it results in significantly greater arthritis progression and subsequent knee arthroplasty compared with anatomical repair [234]. Arthroscopic repair of acute meniscus root tears may result in slower progression of radiological deterioration compared with nonoperative management [25].

Operative

Indications: Meniscal repair aims to achieve healing and avoid the adverse effects of meniscectomy, with indications largely dependent on tear type and precise assessment [1]. General indications include tears between 1 and 4 cm, vertical tears, red-red tears, meniscal root tears, and patients younger than 40 years [2]. Traumatic longitudinal tears in the red/red zone in patients younger than 30 years are most amenable to successful repair, though good results are also demonstrated in red/white zone repairs in young patients [11]. White/white zone tears are avascular and have limited healing potential [11]. In pediatric patients, long (>10 mm) peripheral tears without irreparable body damage are indications for repair, and surgeons may push limits regarding avascular zone location, time from injury, or tear size [10]. Older age is not a contraindication in appropriately selected patients [8]. According to current standard indications, 34.9% of all meniscal injuries offer repair potential, rising to 55.6% with anterior cruciate ligament (ACL) damage [38]. Augmentation techniques such as fibrin clot, platelet-rich plasma, vascular access channels, and synovial rasping may extend indications [2]. Meniscal surgery is appropriate even in the presence of early osteoarthritis due to the regenerative potential of the meniscus and surrounding cartilage [43].

Surgical Approach / Technique: The choice of technique depends on tear location, morphology, patient size, and surgeon preference [84]. Inside-to-out vertical mattress suture techniques remain the gold standard, offering versatility in suture placement and lower implant cost, though they carry risks of neurovascular injury and require additional incisions [10, 151]. Arthroscopic inside-out repairs use absorbable or nonabsorbable sutures placed with zone-appropriate cannulas and tied through a small capsular incision [9]. The arthroscopic outside-in technique is usually reserved for anterior horn tears, involving a suture placed through a needle across the tear and tied outside the knee to reduce the tear over the capsule [9, 84]. All-inside repairs involve absorbable stents or sutures tied to stents placed through arthroscopic portals, potentially offering reduced neurovascular risk [9]. Newer generation all-inside devices demonstrate similar strength and excellent early outcomes, with anatomic and radiographic studies establishing safe zones and trajectories [10]. However, all-inside repair is generally avoided in younger children due to the risk of injury to the popliteus neurovascular bundle from smaller distances between anchors and the bundle [84]. Open repair is usually reserved for peripheral tears in the posterior horn approached through a capsular incision [9]. Hybrid repairs combining techniques may also be performed [84]. Preparation of the meniscus and capsule by mechanically abrading tissue on either side of the planned repair with a rasp or shaver is an important step in all procedures [84]. Regardless of technique, saphenous nerve branches must be protected during medial repairs, and the peroneal nerve during lateral repairs [2].

Implant Selection: Mechanical studies indicate that no device improves on the load to failure of vertically placed inside-out sutures [9]. Robust fixation of segmental meniscal repairs may improve outcomes for meniscal deficiency and offer an alternative to full meniscal transplantation [271]. The circumferential-surrounding (“sandwich”) technique may be a good option for irreparable tears in young, active individuals [253]. Non-anatomic reinsertion of the anterior horn of the lateral meniscus is a simple salvage procedure for anterior root amputation that provides satisfactory clinical outcomes [242].

Adjuncts: Biologic enhancement increases the likelihood of healing [10]. Young patients with isolated chronic meniscal tears may benefit from techniques intended to optimize vascularity, such as trephination or injection of autologous blood clots [84]. Concomitant ACL reconstruction positively correlates with healing [11]. A greater number of fixation sites may achieve successful repairs and lower failure rates [93].

Other Considerations: Success rates for meniscal repair in stable knees range from 70% to 95%, with second-look arthroscopy showing lower success rates of 45% to 91% [9]. Ligamentously unstable knees decrease success rates to 30% to 70% [9]. In general, success is 90% with concurrent ACL reconstruction, 60% with an intact ACL, and 30% with a deficient ACL [2]. Meniscal repair is not contraindicated in a knee with a deficient ACL, even though failure rates may be higher in unstable knees [44, 163]. Age younger than 30 years trends toward positive correlation with healing, while tears longer than 2 cm and smoking are negatively associated with healing rates [11]. The failure and revision surgery rate is higher for medial than lateral meniscal repairs at short-term and medium-term follow-up [11]. In a systematic review of traumatic meniscal tears, short-term and long-term revision surgery rates were higher after repair than after meniscectomy (16.5% versus 1.4% and 20.7% versus 3.9%, respectively) [11]. However, no plain radiographic degenerative changes were present in 78% of knees after repair compared with 64% after meniscectomy [11]. Nearly 80% of patients with arthroscopic meniscal repair had no osteoarthritis progression compared with only 40% of patients with meniscectomy at 8- to 10-year follow-up [11]. Approximately 96% of patients who underwent arthroscopic meniscal repair returned to their preinjury level of sports activity compared with only half of those who underwent partial meniscectomy [11]. The risk for symptomatic osteoarthritis progression following meniscal repair is 25% to 50% lower than that following arthroscopic partial meniscectomy but remains approximately twice as high as the general population [11]. Meniscal repair yields the lowest incidence of progressive osteoarthrosis compared with total menisectomy, partial menisectomy, and nonoperative treatment in stable knees [27]. Successful medial meniscal repair reduces knee pain 10 years after ACL reconstruction [292]. Meniscal repair is a viable alternative to resection in many clinical situations, with success rates exceeding 80% when performed with ACL reconstruction [19]. Meniscal repair is effective over the medium and long term in 70 to 80% of cases, with indications extending to radial lesions and specific unstable knee scenarios [24]. In several studies, 80% to 90% success rates have been reported, though success depends on location, tear type, and chronicity [2]. It is generally accepted that results are best with acute peripheral tears in young patients undergoing concurrent ACL reconstruction [2]. Eighty-three percent of menisci were symptom-free regardless of integrity, but newly formed injuries may occur even in asymptomatic cases [46]. Complete healing of both menisci was confirmed arthroscopically 3 years postoperatively in one case, testifying to the efficacy of the treatment strategy [20]. The history of meniscal surgery started 130 years ago with the same conceptual principles applied nowadays, as the first documented operation was a reattachment rather than a resection [45]. Advancements in surgical techniques have demonstrated meniscus repair is possible in tears previously deemed unsalvageable, and the use of biologics is an active area of investigation [156]. Additional research is needed to ensure these tools are used with appropriate clinical indications and to acknowledge that not all meniscal repairs can always heal [183]. Meniscal removal should always be the last option, but is sometimes unavoidable; the author advocates for meniscal preservation with the plea to 'Repair Regularly, Resect Rarely' [170]. An integrated approach to meniscal surgery is required as part of an overall strategy to preserve and restore knee function, preserving meniscal tissue whenever possible [119]. Meniscal repair is critical to prevent degenerative changes, with success dependent on tear location, vascularity, and appropriate fixation techniques [297]. If the meniscal tear complies with the criteria mentioned, with careful preparation of the suture site, correct surgical techniques and rehabilitation, the meniscus should be preserved, which could result in long-term benefits [22]. Meniscal repair is a successful procedure in conjunction with anterior cruciate ligament reconstruction [145].

Complications

General Adverse Events and Safety: Arthroscopic meniscal repair and meniscectomy are safe procedures with low overall adverse event rates of 1.4% and 0.95%, respectively [21]. Thirty-day complication rates remain below 1% overall and below 1.3% in patients aged over 40 years [324]. Potential complications include infection, arthrofibrosis, deep venous thrombosis, and neurovascular injuries such as peroneal nerve palsy, saphenous neuritis, and complex regional pain syndrome [261]. Chondral injury from protruding implants has also been reported [261]. In a series of revision meniscal repairs, no short-term or long-term postoperative complications were observed, including no cases of infection, joint stiffness requiring intervention, neurovascular injury, or reoperation [210].

Nerve Palsy: Peripheral nerve damage accounted for 0.6% of serious complications during arthroscopic meniscus repairs [249]. Common peroneal nerve injury caused by suture entrapment is a specific complication of arthroscopic inside-out lateral meniscus repair [249]. A partial peroneal nerve palsy following open lateral meniscal repair by posterolateral arthrotomy spontaneously recovered four months after surgery [173]. Surgeons must protect saphenous nerve branches during medial repairs and the peroneal nerve during lateral repairs [2, 3].

Infection: Septic arthritis is a recognized complication that can be successfully managed with sequential arthroscopic incision and drainage [342]. In one series, two patients required repeat arthroscopic washouts for septic arthritis, which cleared with four weeks of intravenous antibiotics [108]. Another patient developed postoperative septic arthritis and underwent incision and drainage with antibiotic treatment [173].

Repair Failure and Reoperation: The overall meniscal repair failure rate ranges from 14.8% at a minimum follow-up of 2 to 5 years [217] to 21.8% at a minimum of 5 years [340]. Long-term studies with a minimum follow-up of 5 years report failure rates of 19% [310] and 19.5% [333]. In large population-based cohorts, the 5-year reoperation risk is 32.7% [258], with a reoperation rate of 31.9% at 5 years following meniscus suture [343]. The risk of any knee reoperation after meniscal repair is four times higher than after partial meniscectomy, and the risk for same-meniscus reoperations is approximately 17 times higher [97]. One-fifth of patients underwent subsequent ipsilateral surgery, with 4.3% receiving a repeat meniscal repair and 12.1% experiencing a meniscectomy [29].

Other Considerations: Failure rates vary by patient population and procedure type. In pediatric populations, the failure rate was 17.3% at a mean of 16.6 months [173]. In selected patients aged 60 years and older, the clinical failure rate was 22% [321]. No significant difference in failure rates exists based on age thresholds, with no difference between patients younger than 40 years and those 40 years or older [323, 281]. Female sex and the absence of ACL reconstruction increase the risk of high failure rates after all-inside revision meniscal repair [317]. All-inside revision meniscal repair demonstrated a high failure rate of 50% at mid-term follow-up [317], while the failure rate for isolated revision meniscal repair is slightly higher than for primary repair but remains acceptable [85]. The failure rate after staged procedures was 36.7% at 3 years [335]. In revision ACLR cohorts, the meniscus repair failure rate was 16% at 6 years [339], with an overall meniscal failure rate of 13% defined by reoperation [311, 312]. More than 80% of failures for repairs using the Meniscus Arrow occurred during the first 3 postoperative years [337], and failures frequently occur after the second postoperative year [310].

The principal cause for re-intervention is meniscal suture failure [109]. In a series of 43 patients, suture failed in 7 cases (16.28%), and in a series of 49 cases, it failed in 5 cases (10.20%) [109]. All cases of suture failure required partial meniscectomy and were reevaluated 2 years later [109]. The use of absorbable sutures leads to a lower incidence of additional tears than nonabsorbable sutures in patients undergoing meniscal repair with ACL reconstruction [346]. Patients undergoing repair of horizontal cleavage tears had higher complication rates than those undergoing partial meniscectomy [325], although survivorship for horizontal cleavage tear repair is comparable to other tear types with high rates of return to sport and low complication rates [80].

Meniscal repair is associated with lower progression to knee osteoarthritis at approximately six years compared to partial meniscectomy [4]. While meniscal repair leads to significantly lower rates of reoperation and higher rates of early complications with a higher total cost compared with meniscectomy [307], it is associated with a lower rate of future total knee arthroplasty [344]. In a 13-year follow-up study, the incidence and severity of arthrosis did not differ significantly between meniscus repair and meniscectomy groups [345]. Long-term evaluation of ACL-reconstructed knees with concurrent successful meniscal repairs demonstrated a low rate of radiographic arthritis [334]. Meniscal repair in selected patients aged 40 years or older resulted in good success rates and patient-reported outcome measures similar to those for patients aged less than 40 years [35]. Ten-year post-traumatic osteoarthritis incidence is lower after meniscal repair than meniscectomy in pediatric populations [32]. Relative to the well-documented 10-year incidence in the adult population, ranging from 16.4% to 23% after meniscectomy and 10% after meniscal repair, PTOA development in the decade after surgery in pediatric patients was notably lower [32]. Meniscus root repairs are cost beneficial and prevent the early need for total knee arthroplasty, with most patients showing significantly improved patient-reported outcomes [316]. While a high proportion of patients required additional procedures on their operative knee at 8-year follow-up for transtibial medial meniscal root repair, few of these additional procedures were related to failure of their primary surgery [318].

Recovery

Light activity (weeks): Basic science evidence indicates that meniscal healing is largely complete by 6 weeks, during which weight bearing and range of motion are beneficial in a stable knee [65].

Full activity (months): A majority of isolated meniscal repair patients perform well on functional testing by 4 months post-operatively [296]. Patients undergoing isolated ACL reconstruction achieve similar functional testing results at 6 months post-operatively [296]. Generally, meniscal repair in conjunction with ACL reconstruction does not significantly alter the recovery of limb symmetry in strength at 6 months postoperatively [327]. Patients with concomitant meniscal resection are able to reach the same subjective knee function as isolated ACL reconstructions as early as 6 months postoperatively [303].

Rehabilitation protocol: An international formal consensus established clear, updated, and structured recommendations for surgeons and physiotherapists treating patients after meniscus surgery [72]. Rehabilitation after meniscal repair and reconstruction should progress according to both time- and criterion-based milestones [155]. Of publicly available meniscal repair rehabilitation protocols, 10.2% changed their protocol in relation to tear type, with a wide range of timeframes for each rehabilitation component [164]. Standard exercise therapy under the supervision of a physiotherapist improved the functional recovery of the knee after partial arthroscopic meniscectomy [181]. Accelerated rehabilitation protocols after meniscal repair are safe and at least as effective as more conservative approaches, supported by limited short-term data [192]. The FasT-Fix meniscal repair associated with an accelerated rehabilitation program resulted in clinically effective meniscal repair in 83% at the time of follow-up [199].

Functional milestones: Functional testing following isolated meniscus repair may help to identify patients who need additional physical therapy prior to a return to activity [296]. Isolated repair of meniscal tears results in good to excellent sport-specific outcomes and a high return to sports rate in both recreational and professional athletes [69]. Meniscal repair and healing are possible, and most elite athletes can return to their preinjury level of activity [186]. Meniscal repair should be attempted in the young active-duty population because the chance of healing outweighs the potential risks and long-term sequelae of meniscectomy [201]. Despite increased risk of failure in a young patient, meniscal repair is recommended when possible to return patients to previously high levels of function [221].

Other Considerations: The repaired meniscus, regardless of its healing status, maintains its biomechanical function [81]. In the long-term after meniscal repair, osteoarthritis is limited and meniscal function seems preserved [299]. Meniscal repair is associated with a lower progression to knee osteoarthritis at approximately six years of follow-up compared to partial meniscectomy [4]. Arthroscopic meniscal repair offers significantly improved results for isolated traumatic meniscal tears regarding long-term follow-up in osteoarthritis prophylaxis and sports activity recovery compared with partial meniscectomy [237]. Meniscal root repairs in patients with no to mild osteoarthritis yield significantly improved patient outcomes and stall the progression of osteoarthritis [62]. Better outcomes were seen after meniscal repair compared with partial meniscectomy for medial meniscus root tears, with greater improvements in Lysholm scores, lower rates of progression to knee osteoarthritis, and lower reoperation rates [309]. One-fifth of patients underwent subsequent ipsilateral surgery during follow-up after bucket-handle meniscal repairs, with 4.3% receiving a repeat meniscal repair and 12.1% experiencing a meniscectomy [29]. The failure rate for isolated revision meniscal repair is slightly higher compared to isolated primary meniscal repair, but still acceptable [85]. In patients with re-tears or failed healing after previous isolated meniscal repair, revision meniscal repair results in good to excellent knee function, high level of sports participation, and high patient satisfaction [218]. Repeat repair of retorn menisci had a 72% survival rate with relief of symptoms and return to high levels of function [328]. While 15% of meniscal repairs failed in professional soccer players, rates of subsequent surgery and 5- and 10-year professional sport participation did not differ significantly from those after partial meniscectomy [283]. Meniscal repairs performed concomitantly with an ACL reconstruction result in fewer reoperations [23]. Meniscal repair location (medial vs lateral) and baseline activity level were the main drivers of meniscal repair outcomes in patients undergoing ACL reconstruction [162]. Second-look arthroscopy confirmed complete healing in 92% of meniscal tears when performed in association with tibial plateau fractures [95]. Concurrent medial meniscal posterior root repair during proximal tibial osteotomy appears to improve the arthroscopic appearance regarding healing of tears and cartilage regeneration during second-look arthroscopy [326]. Complete healing of both menisci was confirmed arthroscopically 3 years postoperatively in a case of radial tears in the roots of the posterior horns combined with an ACL tear [20].

Key Evidence

• [L5] Meniscal repair aims to achieve healing and avoid the adverse effects of meniscectomy, with techniques largely depending on the type of tear and requiring precise assessment. [1] (10.1016/j.otsr.2017.04.016)
• [L1] Meniscal repair is associated with a lower progression to knee osteoarthritis at approximately six years of followup compared to partial meniscectomy. [4] (10.1007/s00167-023-07600-y)
• [L5] Meniscal repair should be considered whenever possible, with strategies specific to tear type and patient features. [5] (10.5435/jaaos-d-21-01153)
• [L5] [7] (10.1177/0363546513498503)
• [L5] In appropriately selected patients, meniscal repair can deliver improved subjective outcomes with comparable reoperation rates and the potential for reduced risk of osteoarthritis over time versus meniscectomy. [8] (10.1016/j.arthro.2024.11.058)
• [L5] Meniscal root tears are frequently unrecognized injuries that significantly alter knee biomechanics and kinematics, leading to accelerated degenerative changes. [13] (10.1177/0363546514524162)
• [L3] A meniscectomy after meniscal repair is performed infrequently, supporting the notion that repairing a meniscus is a safe and effective procedure in the long term. [14] (10.1177/0363546513503444)
• [L5] [16] (10.5435/00124635-200205000-00003)
• [L4] Meniscal repair is a viable alternative to resection in many clinical situations, with success rates exceeding 80% when performed with anterior cruciate ligament reconstruction. [19] (10.5435/00124635-200205000-00004)
• [Case_report] Complete healing of both menisci was confirmed arthroscopically 3 years postoperatively, and the restoration of a stable and functional knee joint testifies to the efficacy of the treatment strategy. [20] (10.1007/s00167-009-0839-4)
• [L5] Both meniscectomy and meniscal repair are safe surgical procedures with low adverse event rates (0.95% and 1.4%, respectively), but complications are associated with medical comorbidities, older age, and longer operative times. [21] (10.1016/j.arthro.2023.12.017)
• [L4] If the meniscal tear complies with the criteria mentioned, with careful preparation of the suture site, correct surgical techniques and rehabilitation, we suggest the meniscus should be preserved, which could result in long-term benefits. [22] (10.1007/s00167-009-0926-6)
• [L3] Meniscal repairs performed concomitantly with an ACLR result in fewer reoperations. [23] (10.1177/2325967120905529)
• [L5] Meniscal repair is effective over the medium and long term in 70 to 80% of cases, with indications extending to radial lesions and specific unstable knee scenarios, while surgical techniques continue to simplify and focus on biological environments. [24] (10.1016/j.otsr.2009.09.004)
• [L4] The current level 3 and 4 evidence suggests that arthroscopic repair may result in slower progression of radiological deterioration compared with meniscectomy and nonoperative management. [25] (10.1177/03635465211031250)
• [L3] Patients treated with primary meniscectomy have over three times higher odds to undergo subsequent knee arthroplasty compared to those treated with meniscal repair. [26] (10.1002/ksa.12216)
• [L5] Meniscal repair has been shown to yield the lowest incidence of progressive osteoarthrosis when compared with total menisectomy, partial menisectomy, and nonoperative treatment of meniscal tears in stable knees. [27] (10.1016/s0278-5919(05)70131-9)
• [L4] One-fifth of patients underwent subsequent ipsilateral surgery during follow-up, with 4.3% receiving a repeat meniscal repair and 12.1% experiencing a meniscectomy. [29] (10.1177/03635465221101136)
• [L5] Arthroscopy permits precise classification of the type, extent, and location of meniscal tears. [30] (10.1016/s0278-5919(05)70008-9)
• [L3] [32] (10.1002/ars2.70067)
• [L4] Meniscal repair in selected patients aged 40 years or older resulted in good success rates and patient-reported outcome measures, which appear similar to those reported for patients aged less than 40 years. [35] (10.1177/23259671241258974)
• [L3] Pre-operative tests and clinical findings are not conclusive for identifying a meniscal tear, and surgeons should be vigilant in identifying and repairing tears at the time of surgery. [36] (10.1007/s00167-020-06375-w)
• [L4] According to current standard indications, 34.9% of all meniscal injuries offer the potential for repair, rising to 55.6% when accompanied by anterior cruciate ligament damage. [38] (10.1016/j.arthro.2018.08.051)
• [L3] The clinical relevance of this finding is that MRI contributes to enhancing the diagnostic accuracy of an unhealed meniscal repair when there are limited clinical signs of meniscal pathology. [39] (10.1007/s00167-019-05523-1)
• [L4] Meniscal surgery can be performed with the correct timing and the proper indication even in the presence of early osteoarthritis, as there is a relevant regenerative potential of the meniscus and the surrounding cartilage that should be taken into account. [43] (10.1007/s00167-016-4069-2)
• [L4] Medial meniscus repair in the ACL-deficient knee is not contraindicated. [44] (10.1007/s00167-006-0162-2)
• [L4] The history of meniscal surgery started 130 years ago with the same conceptual principles that we try to apply nowadays, as the first documented operation was a reattachment rather than a resection. [45] (10.1007/s00167-013-2490-3)
• [L4] Eighty-three percent of menisci were symptom-free regardless of meniscal integrity, but newly formed injuries may occur even in asymptomatic cases. [46] (10.1177/0363546509356977)
• [L4] [55] (10.1177/0363546520934766)
• [L2] The diagnostic validity of magnetic resonance imaging is similar for meniscal tears in acute knee trauma and in knee symptoms lasting over 6 months in young adults. [58] (10.1177/0363546508329543)
• [L5] The described technique is simple and reproducible and can be used for all types of tears and with all meniscal repair systems. [61] (10.1016/j.eats.2025.103638)
• [L5] Meniscal root repairs in patients with no to mild osteoarthritis yield significantly improved patient outcomes and stall the progression of osteoarthritis. [62] (10.1016/j.csm.2019.08.009)
• [L5] Basic science studies suggest meniscal healing is largely complete by 6 weeks, with weight bearing and range of motion being beneficial in a stable knee. [65] (10.1016/j.csm.2004.03.001)
• [L5] The authors appreciate the attempt to formulate a scoring system to predict the reparability of meniscus, limited to tears identifiable by MRI after testing the classification of zones and patterns of meniscal tear based on MRI, but highlight limitations regarding MRI sensitivity, statistical details, and demographic data. [66] (10.1007/s00167-019-05825-4)
• [L3] Although the failure rate of meniscus repair may be greater in an unstable knee, meniscal repair is not contraindicated in a knee with a deficient ACL. [67] (10.1007/s00264-004-0616-4)
• [L4] Meniscal repair in ACL reconstructed knees with expanded indications achieved a healing rate (including incomplete healing) of 75%. [68] (10.1016/j.arthro.2019.04.009)
• [L4] This systematic review suggests that isolated repair of meniscal tears results in good to excellent sport-specific outcomes and a high return to sports rate in both recreational and professional athletes. [69] (10.1007/s00167-017-4463-4)
• [L5] Meniscal tear location in addition to type likely plays a crucial role in dictating the success of non-operative treatment of the menisci. [70] (10.1007/s00167-018-5090-4)
• [L1] This international formal consensus established clear, updated and structured recommendations for both surgeons and physiotherapists treating patients after meniscus surgery. [72] (10.1002/ksa.12674)
• [L5] Positive outcomes for meniscal allograft transplantation are most likely to be achieved when performed in appropriately selected patients, with studies reporting long-term graft survivorship as high as 89% at 10 years and significant improvements in multiple patient reported outcome measures. [73] (10.1007/s00167-020-06058-6)
• [L4] The incidence of medial meniscal lesions and the complexity of tear types increased significantly with increasing time intervals between the index injury and ACL reconstruction. [74] (10.1177/03635465231216364)
• [L5] The authors argue that evaluating the usefulness of meniscectomy is flawed due to insufficient stratification of meniscal tear characteristics, and that clinical practice guidelines may be flawed if they recommend against treatments that benefit specific patient subgroups despite Level I evidence showing safety and efficacy. [79] (10.1016/j.arthro.2014.03.016)
• [L1] Survivorship is comparable to repairs of other types of meniscal tears with high rates of return to sport and low complication rates. [80] (10.1016/j.arthro.2020.04.027)
• [L2] The repaired meniscus, whatever its healing may maintain its biomechanical function. [81] (10.1016/j.arthro.2013.07.142)
• [L5] The authors of the original systematic review maintain that meniscus repair should be adopted as the preferred initial intervention for medial meniscus root tears to prevent knee osteoarthritis, despite the additional evidence presented regarding nonoperative management. [82] (10.1177/0363546518783958)
• [L4] The failure rate is slightly higher compared to isolated primary meniscal repair, but still acceptable. [85] (10.1186/s12891-018-2368-0)
• [L2] [90] (10.1177/0363546520904680)
• [L4] [92] (10.1016/j.jisako.2022.04.004)
• [L4] Successful meniscal repairs and a lower failure rate may be achieved with a greater number of fixation sites with promising results at a minimum 2-year follow-up. [93] (10.1177/2325967119881963)
• [L4] Sonographic evaluation should be considered in patients presenting with ongoing knee pain after all-inside meniscus repair. [94] (10.1177/2325967116664882)
• [L4] Second-look arthroscopy confirmed complete healing in 92% of meniscal tears when performed. [95] (10.1177/0363546512457552)
• [L3] The risk of any knee reoperation after meniscal repair had a four-fold increase compared with partial meniscectomy, and for same meniscus reoperations about 17-fold. [97] (10.1002/ksa.12791)
• [L3] [108] (10.1007/s00167-010-1286-y)
• [L3] [109] (10.1186/s13018-020-01878-1)
• [L4] [111] (10.1177/03635465241295709)
• [L2] Clinical examination by an experienced examiner using multiple meniscus tests is sufficient for a diagnosis of a meniscal tear. [114] (10.1007/s00167-011-1636-4)
• [L4] An integrated approach to meniscal surgery is required as part of an overall strategy to preserve and restore knee function, preserving meniscal tissue whenever possible. [119] (10.1016/j.csm.2019.08.012)
• [L5] This technique can be performed in conjunction with standard arthroscopic meniscal repair methods and delivers the graft directly to the repair site, where its proposed impact is desired. [120] (10.1016/j.eats.2024.103072)
• [L5] The primary advantage of the surgical technique described is the preservation and retention of the meniscus. [138] (10.1016/j.eats.2024.102974)
• [Paper] The described surgical technique allows for a reliable, reproducible repair and better equips the surgeon for a difficult repair with a decrease in associated iatrogenic injuries or meniscal malreductions. [139] (10.1016/j.eats.2017.07.005)
• [Paper] The proposed technique maintains the advantages provided by the standard inside-out meniscus repair while reducing operative time as well as technical difficulty. [142] (10.1016/j.eats.2019.09.007)
• [Paper] The technique is a technically straightforward, quick, and cheap method of outside-in meniscal repair that uses easily obtainable devices found in the operating theater. [144] (10.1016/j.eats.2013.11.001)
• [L4] Meniscal repair is a successful procedure in conjunction with anterior cruciate ligament reconstruction. [145] (10.1177/0363546509337010)
• [L4] This procedure should be considered to treat degenerative menisci for which repair options have been limited until now. [146] (10.1007/s00167-011-1404-5)
• [Paper] With proper technique, the majority of lateral meniscus tears may be managed by this method. [147] (10.1016/j.eats.2020.03.016)
• [Paper] The inside-out meniscal repair technique remains the standard of care for meniscal repair, offering advantages such as versatility in suture placement and lower implant cost, though it carries risks of neurovascular injury and requires additional incisions. [151] (10.1016/j.eats.2015.10.017)
• [Paper] Rehabilitation after meniscal repair and reconstruction should progress according to both time- and criterion-based milestones. [155] (10.1002/arj.70589)
• [L4] Advancements in surgical techniques have demonstrated meniscus repair is possible in tears previously deemed unsalvageable, and the use of biologics is an active area of investigation. [156] (10.1136/jisakos-2019-000426)
• [L2] Anatomical repair techniques, particularly pull-out and all-inside methods, appear to provide better functional outcomes for meniscal root tears than partial meniscectomy or conservative care. [157] (10.1186/s12891-026-09704-1)
• [L2] Arthroscopic meniscal repair with the inside-out technique seems to be superior in comparison with the other methods because it offers a high rate of meniscus healing without prolonged operation time. [159] (10.1007/s00167-006-0094-x)
• [L3] Meniscal repair location (medial vs lateral) and baseline activity level were the main drivers of meniscal repair outcomes. [162] (10.1177/23259671211033584)
• [L4] Even though the failure rate of meniscus repair may be greater in an unstable knee, we conclude that meniscus repair is not contraindicated in an anterior cruciate deficient knee. [163] (10.1177/036354659001800609)
• [L4] Of publicly available meniscal repair rehabilitation protocols, a small percentage (10.2%) changed their protocol in relation to tear type and there was a wide range of timeframes for each rehabilitation component. [164] (10.1016/j.asmr.2020.10.004)
• [L5] Meniscal removal should always be the last option, but is sometimes unavoidable; the author advocates for meniscal preservation with the plea to 'Repair Regularly, Resect Rarely.' [170] (10.1016/j.csm.2019.10.002)
• [L4] [173] (10.1177/2325967119843355)
• [L3] In patients aged 40 years and older, patient-reported outcomes at an average of 5 years postoperatively were satisfactory and similar in patients undergoing meniscal repair and meniscectomy, indicating that age alone should not be a contraindication to meniscal repair. [179] (10.1007/s00167-020-06299-5)
• [L1] This prospective, randomised, partially blinded study showed that standard exercise therapy under the supervision of a physiotherapist improved the functional recovery of the knee after partial arthroscopic meniscectomy. [181] (10.1007/s001670050181)
• [L5] Additional research is needed to shed more light in this fascinating microworld, and we need to ensure that all these amazing tools are used with appropriate clinical indications and that we acknowledge that not all menisci repairs can always heal. [183] (10.1016/j.arthro.2021.08.017)
• [L4] The authors consider meniscal repair a successful option and recommend increasing the rate of meniscal suture. [184] (10.1177/2325967117s00010)
• [L4] Meniscal repair and healing are possible, and most elite athletes can return to their preinjury level of activity. [186] (10.1177/0363546508330138)
• [L5] Knee meniscal repair has a success rate of approximately 80% in both men and women, and meniscal repair is a critical procedure for maintaining long-term knee health. [188] (10.1016/j.arthro.2019.12.017)
• [Paper] Accelerated rehabilitation protocols after meniscal repair are safe and at least as effective as more conservative approaches, supported by limited short-term data. [192] (10.1016/j.csm.2011.08.010)
• [L3] Although meniscal preservation is generally accepted in the treatment of meniscal tears, most tears in this cohort were not repairable, despite contemporary methods. [197] (10.1055/s-0030-1247746)
• [L3] Meniscus repair in the revision setting is a successful treatment choice when appropriate. [198] (10.1177/2325967117s00239)
• [L4] The FasT-Fix meniscal repair associated with an accelerated rehabilitation program resulted in clinically effective meniscal repair in 83% at the time of follow-up. [199] (10.1016/j.arthro.2008.08.001)
• [L4] Meniscal repair should be attempted in the young active-duty population because the chance of healing outweighs the potential risks and long-term sequelae of meniscectomy. [201] (10.1016/j.csm.2014.06.007)
• [L3] The menisci should be repaired if at all possible, especially in the setting of anterior cruciate ligament reconstruction, for optimal functional outcome and patient satisfaction. [203] (10.1177/03635465020300061501)
• [L4] Our study showed that the CNN model has the potential to be used in diagnosing the presence of meniscal tears and differentiating the types of meniscal tears. [208] (10.1186/s12891-022-05468-6)
• [L4] [210] (10.1177/23259671261451781)
• [L3] The meniscus fulfills its function as normal or nearly normal even though the MRI findings fail to prove healing. [211] (10.1177/2325967114s00132)
• [L4] Surgeons can reliably classify meniscal pathology and agree on treatment, which is important for multicenter trials. [216] (10.1177/0363546504264586)
• [L4] This meta-analysis on close to 4000 patients demonstrates an overall meniscal repair failure rate of 14.8% at a minimum follow-up from 2 years up to 5 years. [217] (10.1177/03635465231158385)
• [L4] In patients with re-tears or failed healing after previous isolated meniscal repair, revision meniscal repair results in good to excellent knee function, high level of sports participation, and high patient satisfaction. [218] (10.1177/2325967119s00223)
• [L3] Despite increased risk of failure in a young patient, we recommend meniscal repair be performed when possible to return patients to previously high levels of function. [221] (10.1016/j.arthro.2016.03.095)
• [L3] Several abnormal vertical and/or horizontal hypersignals are present on MRI ten years after arthroscopic all-inside meniscal repair, without any subjective or objective clinical significance. [224] (10.1007/s00264-013-2039-6)
• [L3] MRI is not always useful in predicting reparability of symptomatic isolated lateral semilunar meniscus tears, and most of the symptomatic cases with normal MRI were reparable. [233] (10.1007/s00167-002-0280-4)
• [L3] Meniscus root repair leads to significantly less arthritis progression and subsequent knee arthroplasty compared with nonoperative management and partial meniscectomy in a matched cohort based on patient characteristics. [234] (10.1177/0363546519888212)
• [L3] Magnetic resonance imaging is not an effective or efficient predictor of reparability of meniscal tears with the current arthroscopic criteria. [236] (10.1177/0363546510387507)
• [L3] Arthroscopic meniscal repair offers significantly improved results for isolated traumatic meniscal tears regarding the long-term follow-up in osteoarthritis prophylaxis and sports activity recovery compared with partial meniscectomy. [237] (10.1177/0363546510364052)
• [L4] Precise description of meniscal tears on MRI should continue to improve its ability to assist with surgical planning. [238] (10.1016/j.csm.2013.03.005)
• [L5] The purpose of this technical report is to describe the technique for performing in-office needle arthroscopy for meniscal injuries of the knee including the technique for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room. [239] (10.1016/j.eats.2023.06.013)
• [L4] The non-anatomic reinsertion of the anterior horn of the lateral meniscus is a simple salvage procedure for cases of anterior root of the lateral meniscus amputation that provides satisfactory clinical outcomes after 2-year follow-up preserving the meniscal remnant. [242] (10.1016/j.otsr.2019.04.007)
• [L3] [244] (10.1007/s001670050163)
• [L4] Meniscal deformation or displacement observed on preoperative MR images suggests a higher risk of meniscal tears, even in menisci with signal changes other than grade 3 changes. [246] (10.1016/j.arthro.2011.08.300)
• [L4] [249] (10.1055/s-0030-1247723)
• [L5] Advanced imaging by 3-dimensional computed tomography may better allow preoperative planning for a safe approach to the posterior horn of the lateral meniscus using all-inside repair techniques, solving limitations of cadaveric and MRI studies. [252] (10.1016/j.arthro.2019.02.038)
• [L5] [253] (10.1016/j.eats.2020.06.008)
• [L3] The long-term survival rate of repaired menisci was 91%, and magnetic resonance imaging is unsuitable for diagnosis of the healing process of a repaired meniscus. [254] (10.1177/03635465990270011001)
• [L4] MRI is successful in determining the presence or absence of tears in discoid menisci; however, its ability to determine the tear type is questionable. [257] (10.1007/s00167-013-2371-9)
• [L3] In this large, population-based cohort, the 5-year reoperation risk after meniscal repair was 32.7%. [258] (10.1002/ksa.70144)
• [L5] [261] (10.1016/j.csm.2011.09.002)
• [L2] MRI continues to be a poor predictor of meniscus tear reparability as assessed by arthroscopic criteria, even when using higher resolution 3-T scanners. [265] (10.1177/03635465211052526)
• [L3] Confusion between meniscal fraying and small tears is a major source of discrepancy between MRI and surgical findings. [267] (10.1007/s00402-007-0318-7)
• [L5] Robust fixation of segmental meniscal repairs may improve surgical outcomes for meniscal deficiency and offer an alternative to full meniscal transplantation. [271] (10.1177/23259671261468500)
• [L5] The authors describe a technique using an epidural sleeve and injection needle to stabilize the meniscal tear before all-inside repair, ensuring the reduction of the tear throughout the entire procedure. [274] (10.1016/j.eats.2024.102927)
• [L4] Analysis of the composite data in this systematic review reveals that no significant difference exists when evaluating meniscal repair failure rate as a function of age above or below the given age thresholds. [281] (10.1016/j.arthro.2017.08.287)
• [L3] While 15% of meniscal repairs failed, rates of subsequent surgery and 5- and 10-year professional sport participation did not differ significantly from those after partial meniscectomy. [283] (10.1177/03635465251362504)
• [L2] Successful medial meniscal repair reduces knee pain 10 years after anterior cruciate ligament reconstruction. [292] (10.1177/03635465251317742)
• [L3] A majority of isolated meniscal repair patients perform well on functional testing by 4 months post-operatively and similar to patients undergoing isolated ACL reconstruction at 6 months post-operatively. [296] (10.1016/j.jisako.2024.04.007)
• [L5] Meniscal repair is critical to prevent degenerative changes, with success dependent on tear location, vascularity, and appropriate fixation techniques. [297] (10.1016/j.csm.2011.08.007)
• [Paper] In the long-term after meniscal repair, osteoarthritis is limited and meniscal function seems preserved. [299] (10.1016/j.otsr.2016.12.014)
• [L3] Patients with concomitant meniscal resection are able to reach the same subjective knee function as isolated ACL reconstructions as early as 6 months postoperatively. [303] (10.1007/s00167-017-4793-2)
• [L3] Meniscal repair leads to significantly lower rates of reoperation and higher rates of early complications with a higher total cost compared with meniscectomy in a large database study. [307] (10.1177/0363546520935453)
• [L1] Better outcomes were seen after meniscal repair compared with partial meniscectomy for medial meniscus root tears, with greater improvements in Lysholm scores, lower rates of progression to knee osteoarthritis, and lower reoperation rates. [309] (10.1177/2325967120962078)
• [L1] The overall meniscus repair failure rate remains nineteen percent in long-term studies. [310] (10.1007/s00167-021-06770-x)
• [L3] At 6-year follow-up, overall meniscal failure rate as defined by reoperation was 13% in this revision cohort. [311] (10.1177/2325967124s00001)
• [L3] At 6-year follow-up, overall meniscal failure rate as defined by reoperation was 13% in this revision cohort. [312] (10.1177/2325967124s00274)
• [L5] Meniscus root repairs are cost beneficial and prevent the early need for total knee arthroplasty, with most patients showing significantly improved patient-reported outcomes, though further clinical outcome studies and refinement of surgical technique are necessary to prevent recurrent meniscal extrusion. [316] (10.1016/j.arthro.2023.06.023)
• [L3] All-inside revision meniscal repair demonstrated a high failure rate of 50% at mid-term follow-up. [317] (10.1002/ksa.70503)
• [L4] While a high proportion of patients required additional procedures on their operative knee at 8‐year follow‐up, few of these patient's additional procedures were related to failure of their primary surgery. [318] (10.1002/ksa.12321)
• [L2] The clinical failure rate of the repair group was 22%, supporting meniscal repair in selected patients aged 60 years and older. [321] (10.1177/23259671221117491)
• [L3] Meniscus repair failure rate was not different in patients who were younger than 40 years versus those who were 40 years or older at time of meniscus index surgery. [323] (10.1177/0363546515591260)
• [L3] Arthroscopic meniscus repair and meniscectomy are both low-risk procedures with 30-day complication rates < 1% overall and < 1.3% among patients aged > 40 years. [324] (10.1007/s00167-023-07507-8)
• [L4] Patients undergoing repair had higher complication rates than those undergoing partial meniscectomy. [325] (10.1007/s00167-019-05557-5)
• [L3] Concurrent medial meniscal posterior root repair during proximal tibial osteotomy appears to improve the arthroscopic appearance regarding healing of tears and cartilage regeneration during second-look arthroscopy. [326] (10.1016/j.arthro.2020.04.038)
• [L3] Generally, meniscal repair in conjunction with ACLR does not significantly alter the recovery of limb symmetry in strength at 6 months postoperatively. [327] (10.1007/s00402-020-03347-0)
• [L4] Repeat repair of retorn menisci had a 72% survival rate with relief of symptoms and return to high levels of function. [328] (10.1177/03635465030310062401)
• [L1] Modern meniscal repair had an overall failure rate of 19.5% at a minimum of 5 years postoperatively. [333] (10.2106/jbjs.21.01303)
• [L4] The long-term evaluation of the anterior cruciate ligament–reconstructed knees with concurrent successful meniscal repairs demonstrated a low rate of radiographic arthritis. [334] (10.1177/0363546510392014)
• [L4] The meniscus repair failure rate after the staged procedure was 36.7% at 3 years. [335] (10.1002/ksa.12593)
• [L4] More than 80% of all failures occurred during the first 3 postoperative years, suggesting that the initial refixation potential of the Meniscus Arrow is low. [337] (10.1016/j.arthro.2006.11.027)
• [L2] Meniscal repair in the revision ACLR setting has a 16% failure rate at 6 years. [339] (10.1177/03635465251387333)
• [L1] The outcomes of meniscal repair at a minimum 5 years postoperatively had an overall failure rate of 21.8%. [340] (10.1177/2325967121s00421)
• [L4] Septic arthritis following meniscus repair can be successfully treated with sequential arthroscopic I&Ds. [342] (10.1007/s00167-018-4890-x)
• [L3] The reoperation rate following meniscus suture was 31.9% at 5 years. [343] (10.1016/j.jisako.2025.100655)
• [L3] When meniscus repair is performed, this is associated with lower rate of future total knee arthroplasty. [344] (10.1016/j.arthro.2025.05.006)
• [L3] After 13 years, the incidence and severity of arthrosis did not differ significantly between meniscus repair and meniscectomy groups. [345] (10.1007/s001670050002)
• [L3] The use of absorbable sutures leads to comparable healing rates to and lower incidence of additional tears than nonabsorbable sutures in patients undergoing meniscal repair with anterior cruciate ligament reconstruction. [346] (10.1016/j.arthro.2019.08.045)

See Also

• Meniscal root tear
• ACL reconstruction
• Meniscal tear
• Knee osteoarthritis
• Partial meniscectomy

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[299] Long-term assessment of meniscal extrusion after meniscal repair. Orthopaedics & Traumatology: Surgery & Research. 2017. DOI: 10.1016/j.otsr.2016.12.014

[303] Meniscal repair results in inferior short-term outcomes compared with meniscal resection: a cohort study of 6398 patients with primary anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4793-2

[307] Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546520935453

[309] Clinical and Radiological Outcomes of Meniscal Repair Versus Partial Meniscectomy for Medial Meniscus Root Tears: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120962078

[310] Nineteen percent of meniscus repairs are being revised and failures frequently occur after the second postoperative year: a systematic review and meta‐analysis with a minimum follow‐up of 5 years. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06770-x

[311] Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: 6-Year Follow-up Results from the MARS Cohort. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00001

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