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Partial meniscectomy

141 citationsUpdated Sep 2026

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Overview

Partial meniscectomy offers limited benefit for nonobstructive meniscal tears, and determining the presence of osteoarthritis is necessary to establish indications for surgical versus nonsurgical treatment [1]. Randomized clinical trials generally do not support the efficacy of arthroscopic partial meniscectomy for degenerative meniscal tears, particularly in patients with osteoarthritis [22]. Consequently, there is currently no compelling evidence to support arthroscopic partial meniscectomy versus physical therapy for degenerative meniscus lesions [77]. While some surgeons believe the procedure provides dramatic pain relief for specific indications [22], the editors challenge the statement that partial meniscectomy has no value beyond placebo, asserting that when proper indications are chosen, the surgery works [71]. The role of arthroscopic partial meniscectomy remains controversial [22].

Arthroscopic partial meniscectomy improved pain and function at the first year post-operatively [10]. A majority of patients receiving arthroscopic partial meniscectomy achieved MCID, SCB and PASS by 6 months [84], although proportions of patients achieving these milestones decrease over time [84]. For traumatic meniscal tears in patients aged under 45 years, arthroscopic partial meniscectomy leads to a similar quality of life, but higher costs, compared to physical therapy plus optional delayed arthroscopic partial meniscectomy [32]. Specifically, arthroscopic partial meniscectomy generated significantly more cost than non-operative management ($3842.57 versus $411.05) [13]. The procedure is associated with higher rates of progression to knee arthroplasty compared to non-operative management [13]. Meniscectomy offers a fast return to play with good short-term results [15], but the long-term risk of osteoarthritis must be weighed when making the appropriate patient selection [15].

Preservation of the meniscus should be considered as the first line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to meniscus repair [81]. Meniscal repairs are associated with better long-term outcomes than partial meniscectomies [83], though they have a higher reoperation rate [83]. 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 [41]. Partial meniscectomy for a complete medial meniscus posterior root tear provides no benefit in halting arthritic progression [2]. Arthroscopic partial meniscectomy may be indicated in patients with radial tear if conservative treatment fails [72], and for flap tears yielded favorable 12-month outcomes [36]. Radiographic outcomes are better with partial meniscectomy than with total meniscectomy for symptomatic discoid lateral meniscus, while clinical outcomes are similar between the two [5].

Anatomy & Pathophysiology

Meniscal Anatomy and Structure

The menisci are C-shaped, wedge-shaped fibrocartilaginous disks situated between the femoral condyles and tibial plateau, providing shock absorption, increasing joint congruency, enhancing stability, and aiding synovial fluid distribution [46, 102]. Macrostructurally, they consist of tibial attachments at the anterior and posterior roots, curved horns, and a midportion body [102]. The medial meniscus is semicircular, covering approximately 50% to 60% of the medial tibial plateau in adulthood [102]. Its posterior horn averages 11 mm in the anterior-posterior dimension, while the anterior horn is narrower [102]. The anterior horn attaches to the tibia anterior to the anterior cruciate ligament near the intercondylar fossa, with significant variability [102]. The posterior root lies in the posterior intercondylar fossa between the lateral meniscus and posterior cruciate ligament [102]. The transverse, or intermeniscal, ligament connects the anterior horns of the medial and lateral menisci [102].

The lateral meniscus has a more circular C-shape with symmetric anterior and posterior horns [102]. It is larger than the medial meniscus and carries a greater share of lateral compartment pressure [46]. The anterior root attaches anterior to the intercondylar eminence and just lateral to the ACL insertion site [102]. The posterior root attaches posterior to the lateral tibial spine, just anterior to the medial meniscus posterior root [102]. Popliteomeniscal fascicles extend from the lateral meniscus to the posterior capsule, creating the popliteal hiatus [102]. Meniscofemoral ligaments, which are variably present, connect the posterior horn of the lateral meniscus to the medial femoral condyle; the ligament of Humphrey crosses anterior to the PCL, while the ligament of Wrisberg crosses posteriorly [102].

Vascular Supply and Tissue Zones

The menisci contain type I collagen fibers arranged obliquely, radially, and vertically [106]. Vascular supply derives from geniculate arteries, penetrating 20% to 30% of the peripheral medial meniscus and 10% to 25% of the peripheral lateral meniscus [106]. Based on vasculature and extracellular matrix composition, the meniscus is divided into three zones: White-white (ww) zone: The inner one-third, which is avascular [102]. Red-white (rw) zone: The middle zone, characterized by limited vasculature [102]. Red-red (rr) zone: The back one-third, the most vascularized region with blood supply from geniculate arteries [102].

Bony Anatomy

The knee comprises the distal femur, proximal tibia, and patella [46]. The medial femoral condyle is larger and projects farther posteriorly and distally than the lateral condyle [91]. Conversely, the lateral femoral condyle projects farther anteriorly and is wider in the medial-lateral direction [91]. The tibial articular surface slopes 7° to 10° in the sagittal plane [91]. The medial tibial plateau is larger than the lateral plateau and is concave in both frontal and sagittal planes [91]. The lateral tibial plateau is smaller, more circular, concave in the frontal plane, and convex in the sagittal plane [91]. Mean posterior slope is 10.7° in the medial plateau and 7.2° in the lateral plateau [106]. The medial compartment features a large surface area with a convex femoral condyle and concave tibial plateau [106]. The lateral compartment has a smaller surface area, containing a convex femoral condyle and convex lateral plateau in the sagittal plane [106].

Ligamentous Anatomy

The anterior cruciate ligament (ACL) travels from the medial border of the lateral femoral condyle to its insertion anterolateral to the medial tibial spine, preventing anterior translation and rotation of the tibia on the femur [46]. The ACL is composed of 90% type I collagen and 10% type III collagen [91]. Its mean length is 33 mm and mean midsubstance width is 11 mm [91]. The femoral attachment is a semicircular area (20 mm long and 10 mm wide) on the posteromedial aspect of the lateral femoral condyle [91]. The tibial attachment is a broad, irregular, oval-shaped area (30 mm long and 10 mm wide) slightly medial and anterior to the midline, between the tibial spinous processes [91]. The ACL is intra-articular but technically extrasynovial, surrounded by synovium [104]. Length varies from 22 to 41 mm and width from 7 to 12 mm, consistently narrowest in the midsubstance [104]. The femoral origin is on the posteromedial edge of the lateral femoral condyle, posterior to the lateral intercondylar ridge [104]. The tibial footprint is in the anterior intercondylar fossa between the tibial spines [104]. The tibial insertion is 120% larger than the femoral insertion [104].

The posterior cruciate ligament (PCL) prevents posterior subluxation of the tibia on the femur [46]. It runs from the lateral aspect of the medial femoral condyle to the posterior aspect of the tibia, just below the joint line [46]. The PCL has a mean length of 38 mm and mean width of 13 mm [106]. Its femoral attachment is broad and crescent-shaped on the anterolateral medial femoral condyle, averaging 30 mm in length and 5 mm in width [106]. The tibial insertion is located 10 to 15 mm distal to the joint line in the posterior central sulcus [106].

The medial collateral ligament has superficial and deep portions stabilizing the knee against valgus stresses [46]. The lateral collateral or fibular collateral ligament runs from the lateral femoral condyle to the head of the fibula, serving as the main stabilizer against varus stress [46]. The popliteofibular ligament is present in 90% of knees, running from the popliteus tendon to the styloid on the posterior fibular head [46]. The posteromedial corner includes the posterior oblique ligament, semimembranosus tendon and expansions, oblique popliteal ligament, posteromedial joint capsule, and the posterior horn of the medial meniscus [101]. The posterior horn of the medial meniscus is linked to the posteromedial capsule, deep MCL, posterior oblique ligament, and semimembranosus expansion [101]. It serves as a chock block on the tibial plateau [101]. Absence of the posterior horn increases instability in both ACL and PCL deficient knees [101].

Meniscal Mobility and Attachment

The medial meniscus is firmly attached to the joint capsule along its entire peripheral edge and to the deep medial collateral ligament, limiting its mobility [46, 102]. The meniscotibial (coronary) ligament stabilizes the medial meniscus via attachment from the inferior aspect of the posterior horn to the tibia [102]. The lateral meniscus is attached to the anterior and posterior capsule but has a region posterolaterally where it is not firmly attached, allowing for greater mobility [46, 102]. The less continuous attachment of the lateral meniscus to the capsule permits greater excursion [102]. Thompson et al reported a mean lateral meniscus excursion of 11.2 mm versus a mean medial meniscus excursion of 5.1 mm from knee extension to flexion [102]. Other data indicate lateral meniscus mobility of 10 mm and medial meniscus mobility of 5 mm [106]. The medial meniscus has less mobility than the lateral meniscus and is more susceptible to tearing when trapped between the femoral condyle and tibial plateau [46].

Biomechanics and Pathophysiology

The primary function of the meniscus is to redistribute forces across the tibiofemoral articulation, decreasing contact pressure and stress on articular cartilage [88]. Menisci also play a secondary role in stabilizing the knee and a possible role in joint lubrication [88]. They help with load transmission and bear one-third to one-half body weight [107]. If menisci are absent, convex femoral condyles articulate with relatively flat tibial plateaus, resulting in incongruent joint surfaces [46]. This absence decreases contact surface area and increases pressure on articular cartilage, potentially leading to rapid joint deterioration [46]. Removal of menisci increases contact stresses up to four times the load transfer to bone [107]. Biomechanically, as the portion of the meniscus removed increases, greater contact pressures are experienced by the cartilage, altering knee mechanics [16]. Meniscectomy alters stress distribution, decreases contact area, and increases contact pressure between femur and tibia; these alterations are more pronounced in the lateral than in the medial compartment [177].

Meniscal root tears are frequently unrecognized injuries that significantly alter knee biomechanics and kinematics, leading to accelerated degenerative changes [25]. The integrity of the posterior root of the medial meniscus plays an important role in maintaining normal tibial-femoral joint contact mechanics [73]. The biomechanical consequences of a lateral meniscus root tear depend on the state of the meniscofemoral ligament [154]. In vitro tests applying uniaxial loads combined with static knee flexion angles or very low flexion-extension speeds appear to underestimate meniscus attachment forces [132]. Motion and weight loading of the knee can generate considerable tensile forces in repaired posterior medial meniscal roots [141].

Meniscal injury negatively affects knee biology within a short period, with degenerative changes of articular cartilage becoming apparent within a decade [161]. Meniscectomy increases the risk of developing knee osteoarthritis (OA), particularly in female patients with obesity who undergo large meniscal resection [88]. Consequently, there is an increased likelihood of total knee arthroplasty following meniscectomy [88]. Varus or valgus deformities, preexisting degenerative changes, and anterior cruciate ligament deficiency negatively impact outcomes following meniscectomy [88]. The decreased displacement of the medial meniscus after partial medial meniscectomy may explain higher pressure on knee components, indicating potential biomechanical risk of knee degeneration [125]. Meniscus status significantly impacts knee kinematics in the ACL-deficient knee [124]. A longitudinal tear of the medial meniscus posterior horn in an ACL-deficient knee alters knee kinematics, particularly anterior-posterior tibial translation [151].

Synovitis contributes to OA progression through upregulation of pro-inflammatory cytokines such as interleukin-1β and tumour necrosis factor-α, as well as matrix-degrading enzymes like matrix metalloproteinases [226]. Meniscal tears are a known risk factor for OA and may initiate or amplify synovial inflammation, even in the absence of radiographic OA [226]. Intraoperative and histological studies have reported synovitis in up to half of patients undergoing arthroscopic partial meniscectomy, correlating with worse baseline symptoms and potentially mediating cartilage loss and OA progression [226]. Findings of increased OA associated with meniscus injury may be explained by decreased stability and altered contact mechanics after partial or total meniscectomy [210]. The decreased tibiofemoral joint space associated with meniscectomy can change the relationship of the patella to the femoral trochlea, causing patellofemoral cartilage degeneration [210]. Once meniscal functions are impaired, chondroprotection is disrupted, increasing the risk of degenerative change and increased morbidity [209].

Classification

Degenerative vs. Traumatic Indications

Arthroscopic partial meniscectomy is not a first-line treatment for degenerative meniscus lesions; non-operative management must be initiated first, with surgery considered only after its failure [29]. For nonobstructive meniscal tears, the procedure offers limited benefit, necessitating a determination of osteoarthritis status to establish surgical versus nonsurgical indications [1]. Medial meniscal tears present a specific dilemma where partial meniscectomy must be weighed against long-term degenerative consequences, with many tears correctly managed non-operatively [68]. Economic and prognostic data indicate that arthroscopic partial meniscectomy generates significantly higher costs ($3842.57 versus $411.05) and is associated with higher rates of progression to knee arthroplasty compared to non-operative management [13].

Tear Morphology and Specific Pathologies

Meniscus root repair results in significantly less arthritis progression and subsequent knee arthroplasty compared with nonoperative management and partial meniscectomy in matched cohorts [45]. Secondary tears frequently manifest as complex medial meniscal tears, leading to high rates of partial meniscectomy [30]. In complete-type discoid meniscus, total meniscectomy yields better short-term clinical results, whereas partial meniscectomy provides superior long-term radiological outcomes; partial meniscectomy is superior for incomplete types [38]. For symptomatic discoid lateral meniscus, radiographic outcomes favor partial over total meniscectomy, though clinical outcomes are similar [5]. In children with torn discoid lateral menisci, partial meniscectomy yields better radiologic results than subtotal or total meniscectomy, despite no difference in clinical results [40]. Patients undergoing repair of horizontal cleavage tears experience higher complication rates than those undergoing partial meniscectomy [42].

Preoperative Cartilage and Osteoarthritis Status

Simultaneous partial meniscectomy does not further decrease knee function; rather, the meniscal injury and surgery cause a higher degree of osteoarthritis in knees with localized, severe chondral damage [6]. Arthroscopic partial medial meniscectomy is associated with adverse effects on articular cartilage, potentially increasing the severity and size of cartilage lesions [31]. The procedure is strongly associated with the progression of articular cartilage damage, even in the presence of anatomical anterior cruciate ligament reconstruction [90]. Meniscal repair is associated with lower progression to knee osteoarthritis at approximately six years of follow-up compared to partial meniscectomy [24]. The prevalence of articular cartilage changes defined by the Outerbridge classification is high in patients undergoing arthroscopic meniscal procedures, with the greatest prevalence observed in the medial compartment (48%) [196]. Molecular events associated with osteoarthritis are present in articular cartilage and meniscus at the time of partial meniscectomy, even without gross evidence of degeneration [206]. Previous knee surgery, particularly meniscectomy, is associated with full-thickness cartilage loss, with the lateral compartment at greater risk [11].

Biomechanical and Kinematic Effects

Partial meniscectomy significantly alters the loading situation of the meniscus and its attachments [82]. Total medial meniscectomy leads to significantly worsened load distribution within the knee [44]. Alterations in knee kinematics following partial medial meniscectomy are activity-dependent, suggesting both a structural element and a potential muscular element for the observed differences [54].

Outcomes and Prognosis

Partial medial meniscectomy in stable knees causes only mild joint space narrowing (mean, 1.2 mm) at a mean 12-year follow-up [9]. As an isolated factor, partial medial meniscectomy does not appear to have the deleterious effect on joint space narrowing reported with total meniscectomy [12]. In a series of 291 consecutive arthroscopic partial meniscectomies, 84 per cent of patients with meniscal damage only were symptomatically cured by the operation [8]. In a series of isolated arthroscopic partial meniscectomies, 82 percent of patients had satisfactory knee function and maintained activity level at a minimum follow-up of 5 years [26]. Patients with grade II, III, or IV chondromalacia had an unsatisfactory result rate of 33 percent compared with 9 percent in patients with less than grade II chondromalacia following isolated arthroscopic partial meniscectomy [26]. Statistically derived formulae can predict the outcome of one knee scoring system when the result of another is known in patients with meniscal tears before and after arthroscopic meniscectomy [181].

Clinical Presentation

General Indications and Prevalence

Asymptomatic meniscal tears are relatively common findings on magnetic resonance imaging (MRI) [50]. In a study of healthy volunteers with no knee symptoms, 13% of those younger than age 45 years and 36% of those older than age 45 years had meniscal tears by MRI [50]. In the Western world, as many as 300 in 100,000 people undergo arthroscopic partial meniscectomy annually [49]. In Denmark, the surgery rate for arthroscopic partial meniscectomy doubled from 2000 to 2011, with three out of four patients aged more than 35 years [49]. In patients undergoing arthroscopic partial meniscectomy, most meniscal tears are degenerative and might be regarded as the first sign of osteoarthritis [49].

Indications for arthroscopy include symptoms of meniscal injury that affect activities of daily living, work, and/or sports, such as instability, locking, effusion, or pain [50]. Indications for arthroscopy include positive physical findings of joint line tenderness, joint effusion, limitation of motion, and provocative signs such as pain with squatting, a positive pinch test, or a positive McMurray test [50]. Surgical intervention is suggested only when nonsurgical treatment fails and knee symptoms are determined to be related to meniscal pathology [50]. Indication for meniscectomy includes meniscus tears that are unrepairable with symptoms that are resistant to conservative treatment, symptoms that interfere with daily activities, or mechanical symptoms [48].

Specific Tear Types and Pathologies

Secondary tears in patients with anterior cruciate ligament injury often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy [30]. In symptomatic patients after arthroscopic partial meniscectomy for a torn discoid lateral meniscus, the thickness and width of the residual meniscus decreases over time and arthritic change of the lateral compartment of the knee progresses [75]. The presenting symptoms in cases of accessory lateral discoid meniscus may be due to a medial meniscus tear, while the accessory lateral meniscus is found incidentally [170].

Symptom Characteristics and Patient-Reported Outcomes

Over half of patients undergoing arthroscopic partial meniscectomy report preoperative pain at night [70]. A history of “locking” of the knee was reported by 44.0% of patients in a retrospective multicentre study of arthroscopic medial meniscectomy [61]. In a prospective study of patients with an initial diagnosis of a meniscal tear, inclusion criteria required pain over the joint line during weightbearing and/or mechanical symptoms such as a history of locking episodes or a complaint of a ‘‘pop’’ or ‘‘clunk’’ sensation [143]. Meniscal allograft transplantation may result in important pain relief and functional improvement in patients with a history of (sub)total meniscectomy and pain localized in the affected compartment [4]. Meniscus transplantation is a viable surgical option for patients with severe cartilage damage and missing or irreparable menisci to provide significant improvements in pain and function levels in the medium to long term [17]. Treatment of post-meniscectomy knee symptoms with medial meniscus replacement results in greater pain reduction and functional improvement than non-surgical care [139].

Prognostic Factors and Risk Stratification

Patients aged 40 years and younger who underwent partial meniscectomy surgery within 6 months after a meniscal tear were more likely to have a shorter time to return to activity [74]. Female patients with obesity (BMI ≥27 kg/m²), especially those with medial meniscal tears, tended to have inferior clinical outcomes after partial meniscectomy [74]. Among patients who underwent arthroscopic partial medial meniscectomy with an average follow-up of 20 years, those with concurrent focal cartilage defect in the medial compartment had clinically and radiologically worse outcomes than patients without any cartilage defect [37]. The lateral compartment appears to be at greater risk for full-thickness cartilage loss, and previous knee surgery, particularly meniscectomy, is associated with these lesions [11]. Post-meniscectomy pain syndrome and post-meniscectomy knee osteoarthritis are common findings after meniscus resection [65]. In a retrospective multicentre study of 894 consecutive patients who had undergone arthroscopic medial meniscectomy, the mean age at the time of surgery was 38±11 years (range 11–66 years) [61].

Investigations

Plain radiography: Plain radiographs serve as the appropriate initial imaging study for most knee conditions, allowing assessment of traumatic injury, arthritis, patellofemoral alignment, osteochondral injury, bone neoplasm, and surgical implants [111]. Weight-bearing AP and lateral views, along with an axial view of the patellofemoral joint, should be reviewed for articular cartilage evaluation [115]. A semiflexed PA view may improve the detection of subtle narrowing or isolated chondral defects on the flexion surface [115]. While radiographs can underestimate isolated chondral lesions, they may demonstrate joint space narrowing, osteophytes, sclerosis, and cysts [115]. In the arthritic patient population, MRI is grossly overused and is not indicated if the joint space is significantly narrowed on radiograph [120].

MRI: MRI provides an accurate depiction of knee anatomy and pathology and is widely accepted as a critical tool for clinical evaluation [89]. The diagnostic validity of MRI for meniscal tears is similar in acute knee trauma and in knee symptoms lasting over 6 months in young adults [212]. MRI can be used to evaluate articular cartilage morphology [115]. For symptomatic knees after meniscal surgery, MRI is a valuable diagnostic study; it is sufficient for partial meniscectomy of less than 25%, whereas direct or indirect MRA should be considered for greater than 25% resection or after repair [63]. A supplementary MRI increases diagnostic accuracy when fewer than three clinical findings are present in a symptomatic meniscal repair patient [201]. However, MRI is not always useful in predicting the reparability of symptomatic isolated lateral semilunar meniscus tears, as most symptomatic cases with normal MRI were reparable [207]. In symptomatic patients after arthroscopic partial meniscectomy for discoid lateral meniscus, MRI reveals that the thickness and width of the residual meniscus decrease over time, accompanied by progression of arthritic change in the lateral compartment [75].

Other Considerations: Radiographic signs of osteoarthritis are significant at 8 to 16 years' follow-up after knee arthroscopic partial meniscectomy, although clinical symptoms of knee arthritis are not significant [55]. Partial medial meniscectomy, as an isolated factor, does not appear to have the deleterious effect reported with total meniscectomy [12]. Radiographic evidence of abnormal stress transfer to articular cartilage and subchondral bone, evidenced by Fairbank’s changes, has been seen after arthroscopic partial meniscectomy [26]. Partial meniscectomy is strongly associated with the progression of articular cartilage damage despite anatomical ACL reconstruction [90]. Patients with femoral bone marrow lesions are more likely to gain benefit from arthroscopic partial meniscectomy in the middle term [87]. Partial meniscectomy should be considered cautiously in patients with varus-aligned knees, as progression of radiographic osteoarthritis after partial meniscectomy in degenerative medial meniscal posterior root tears was greater in varus- than in neutral-aligned knees [69].

Radiographic outcomes are better with partial meniscectomy than with total meniscectomy for symptomatic discoid lateral meniscus, but clinical outcomes are similar [5]. In complete-type discoid meniscus, partial meniscectomy showed better long-term radiological results than total meniscectomy, while partial meniscectomy was superior for incomplete types [38].

In a controlled trial involving patients without clinical or radiographic osteoarthritis of the knee but with symptoms considered attributable to a degenerative medial meniscus tear, outcomes after arthroscopic partial meniscectomy were no better than those after a sham procedure [35]. Knee arthroscopic surgery, in most cases consisting of partial meniscectomy or diagnostic arthroscopy, in addition to exercise therapy in middle-aged patients with meniscal symptoms, did not increase the rates of radiographic or symptomatic OA and resulted in similar patient-reported outcomes at the 10-year follow-up compared with exercise therapy alone [28]. Early arthroscopic partial meniscectomy for symptomatic irreparable tears in stable knees without preoperative arthrosis had better improvement in clinical results than in delayed intervention [14].

Although arthroscopic partial meniscectomy for complete posterior medial meniscus root tear significantly improved ML scores postoperatively, only 56% of patients had improvement in pain, 67% were satisfied with the outcome of the procedure, and 35% showed radiographic progression of osteoarthritis at a mean follow-up of 77 months [23]. Patients with grade II, III, or IV chondromalacia had a higher rate of unsatisfactory results (33%) compared with patients with less than grade II chondromalacia (9%) following isolated arthroscopic partial meniscectomy [26]. Younger patients had a high percentage of satisfactory results that are maintained at relatively long-term followup of 5 years following isolated arthroscopic partial meniscectomy [26]. Arthroscopic repair may result in slower progression of radiological deterioration compared with meniscectomy and nonoperative management for acute meniscus root tears [199]. Arthroscopic repair of isolated medial degenerative meniscus tears in patients over 45 years resulted in good to excellent clinical outcomes with low clinical failure rates, despite unhealed menisci being observed on MRI in 41% of patients [218].

The findings from determining the Patient Acceptable Symptomatic State allow researchers and clinicians to determine if partial meniscectomy is meaningful to patients and will be helpful for responder analysis in future trials related to knee arthroscopy and the treatment of meniscal pathology [18]. These findings allow researchers and clinicians to determine whether partial meniscectomy is meaningful to patients at the individual level and will be helpful for responder analysis in future trials related to the treatment of meniscal abnormality [21].

Treatment

Non-Operative

For patients with knee pain and nonobstructive meniscal tears, physiotherapy is noninferior to arthroscopic partial meniscectomy for knee function over a 24-month period [59]. Consequently, there is currently no compelling evidence to support arthroscopic partial meniscectomy versus physical therapy [77]. An international EU–US consensus established recommendations for prevention strategies and describes the rehabilitation of non-operated patients [33].

Operative

Indications: The role of arthroscopic partial meniscectomy remains controversial; while some surgeons believe it provides dramatic pain relief for specific indications, randomized clinical trials generally do not support its efficacy for degenerative meniscal tears, particularly in patients with osteoarthritis [22]. Arthroscopic partial meniscectomy was not better than sham surgery for medial meniscal tear [203]. However, the editors respectfully challenge the statement that partial meniscectomy has no value beyond placebo, asserting that when proper indications are chosen, the surgery works [71]. Partial meniscectomy offers pain relief and functional improvement for medial meniscus tear with intact posterior root [34]. In younger populations, partial meniscectomy may provide equal long-term symptom relief, earlier return to play, and lower revision surgery rate compared with meniscal repair [16]. Partial meniscectomy should be considered cautiously in patients with varus-aligned knees [69].

Surgical Approach / Technique: Partial meniscectomy for meniscus tears is one of the most common procedures performed by orthopaedic surgeons [16]. Meniscectomy remains a frequent orthopedic procedure despite the existence of meniscus repair techniques with good clinical outcomes [157]. In the 217 cases in which there was meniscal damage only, 183 (84 per cent) were symptomatically cured by their arthroscopic operation and have not reported any further knee symptoms [8]. In 13 patients (6 per cent), arthroscopic partial meniscectomy either failed to give any symptomatic improvement at all or resulted in only short-term relief [8]. In four cases, arthroscopic partial meniscectomy failed to bring about any symptomatic improvement and a second arthroscopy revealed meniscal damage [8]. Many of the studies of arthroscopic partial meniscectomy reported 80% to 90% satisfactory clinical results with, however, only short-term follow-up (<2 years) [78]. The major advantages over both open partial and total meniscectomy included decreased hospitalization, shorter recovery time, and a reduction in patient care costs [78]. A number of long-term studies have questioned whether partial meniscectomy is, in fact, a benign procedure [78]. 0.9% of primary arthroscopies performed under local anaesthesia could not be performed safely due to patient discomfort [200].

Pain Management: Based on the findings of this study, 82% of patients who undergo arthroscopic partial meniscectomy and/or chondroplasty can achieve satisfactory pain control with nonopioid pain management [135]. There were no differences in pain severity and analgesic intake between intra- or extra-articular bupivacaine administration after arthroscopic partial meniscectomy [176]. Intraarticular tramadol plus periarticular bupivacaine combination provides better pain relief and less analgesic requirement following arthroscopic outpatient partial meniscectomy surgery [188].

Other Considerations: Meniscectomy offers a fast return to play with good short-term results, but the long-term risk of osteoarthritis must be weighed when making the appropriate patient selection [15]. Partial meniscectomy is not considered to be a risk factor for graft failure at short-term follow-up [7]. However, partial meniscectomy adversely affects return-to-sport outcome after anatomical double-bundle anterior cruciate ligament reconstruction [7]. Good long-term clinical results in terms of stability, subjective outcomes and objective evaluation were reported both for medial CMI implant and partial medial meniscectomy [80]. Patients with an anxiety or depressive disorder have higher rates of health care utilization, medical complications, opioid prescriptions, and subsequent knee surgery after isolated primary arthroscopic partial meniscectomy [214]. In patients undergoing arthroscopic meniscal surgery, the chronicity of preoperative opioid intake and degree of knee osteoarthritis were found to have a significant effect on postoperative opioid use [223]. Temporary postoperative treatment with compartment-unloading knee braces or wedge insoles does not improve clinical outcome after partial meniscectomy [217]. The findings can allow researchers and clinicians to determine if partial meniscectomy is meaningful to patients and will be helpful for responder analysis in future trials related to knee arthroscopy and the treatment of meniscal pathology [18].

Degenerative Tears and Root Tears: Partial meniscectomy for a complete medial meniscus posterior root tear provides no benefit in halting arthritic progression compared to non-operative treatment [142]. Partial meniscectomy for complete medial meniscus posterior root tears provides no benefit in halting arthritic progression compared to non-operative treatment [150]. Partial meniscectomy for a medial meniscus posterior root tear provides no benefit in halting arthritic progression compared to non-operative treatment [152]. Partial meniscectomy for a complete MMPRT provides no benefit in halting arthritic progression [2].

Long-Term Outcomes and Osteoarthritis Risk: Partial meniscectomy may result in earlier development of osteoarthritis [16]. Simultaneous partial meniscectomy did not decrease knee function further; instead, the meniscal injury and surgery caused a higher degree of osteoarthritis [6]. Patients treated with primary meniscectomy have over three times higher odds to undergo subsequent knee arthroplasty compared to those treated with meniscal repair [43]. Post-meniscectomy pain syndrome and post-meniscectomy knee OA are common findings after meniscus resection [65]. In the mid- to long-term follow-up (15–22 years), 27% of patients who had a prior meniscus surgery developed symptomatic radiographic tibiofemoral OA [58]. In only 10% of non-operated control OA was present, meaning a relative risk of 2.6 times for patients with meniscus interventions [58]. The amount of meniscus loss was identified as a risk factor for degenerative changes in the knee joint, suggesting that patients with partial meniscectomy have a lower risk compared to those having subtotal or total meniscectomy [58]. The relative risk of symptomatic OA after subtotal meniscectomy is 2.2, whereas for total meniscectomy is 3.6 compared to partial meniscectomy [58]. Early radiographic signs of knee joint degeneration in addition to clinical symptoms of premature arthritis and disability after meniscectomy in a paediatric and adolescent population seem to be even more compelling than in adults [58]. After a mean follow-up of 5.5 years (3–14), only 40% showed excellent (25%) or good results (15%) in children with a mean age of 15 years by the time of surgery [58]. Eighty percentage of the patients showed signs of radiographic changes in a study of meniscectomy in children with a mean age of 15 years [58]. After meniscectomy, the tibiofemoral contact area decreases by approximately 50%, whereas the contact forces increase 2- to 3- fold [76]. Meniscectomy frequently leads to irreparable joint damage, including flattening of articular surfaces, subchondral bone sclerosis, tibiofemoral joint narrowing, and articular cartilage degeneration [76]. Poor long-term clinical results have been reported by many investigators following partial and total meniscectomy [76]. Longitudinal studies report poorer results with the passage of time following partial and total meniscectomy [76].

Biomechanics: Net improvements in contact biomechanics after transplant, relative to the meniscectomy state, support meniscus transplant [64]. While both keyhole and bone plug fixation methods improved lateral compartment contact mechanics relative to the meniscectomized knee, keyhole fixation restored contact mechanics closer to that of the intact knee [66].

Rehabilitation: This international EU–US consensus established recommendations for prevention strategies, describes rehabilitation of non-operated patients and of patients after partial meniscectomy, meniscus repair and meniscus reconstruction, and establishes return to sport criteria [33].

Complications

Surgical Adverse Events and Safety Profile

Arthroscopic partial meniscectomy carries a low adverse event rate of 0.95% [195]. Complications are associated with medical comorbidities, older age, and longer operative times [195]. In a cohort of 1347 patients undergoing meniscectomy, 4 patients were excluded from analysis due to postoperative complications [186].

Long-Term Joint Degeneration and Osteoarthritis

Partial medial meniscectomy in stable knees causes mild joint space narrowing with a mean of 1.2 mm at a mean 12-year follow-up [9]. Radiographic evidence of abnormal stress transfer to articular cartilage and subchondral bone, evidenced by Fairbank’s changes, was seen after arthroscopic partial meniscectomy [26]. Previous knee surgery, particularly meniscectomy, is associated with full-thickness cartilage loss in the lateral compartment [11]. Simultaneous partial meniscectomy in knees with localized, severe chondral damage caused a higher degree of osteoarthritis rather than decreasing knee function further [6]. Meniscectomy increases the risk of developing knee osteoarthritis, particularly in female patients with obesity who undergo large meniscal resection [88]. Patients developing a meniscal tear undergoing arthroscopic partial meniscectomy are at greater risk of knee arthroplasty than the general population, with the risk being three-times greater in the affected knee than in the contralateral knee [239].

Reoperation and Revision Rates

Revision rates are increased in patients undergoing lateral meniscectomy compared to medial meniscectomy [88]. In a propensity-matched study of horizontal cleavage tears, 5 (19%) of the partial meniscectomy patients had reoperations or failures at a minimum of 2-years postoperative [231]. In a series of 291 arthroscopic partial meniscectomies, 13 patients (6%) required further arthroscopy due to failure of the initial procedure [8]. The overall secondary partial meniscectomy rate after ramp repair is 10.8% [235]. 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 [95]. In a matched cohort analysis, meniscal repair leads to significantly lower rates of reoperation compared with meniscectomy [129].

Functional Outcomes and Failure Definitions

In a series of 291 arthroscopic partial meniscectomies, 183 patients (84%) were symptomatically cured and reported no further knee symptoms [8]. Conversely, 13 patients (6%) experienced failure to give any symptomatic improvement or only short-term relief [8]. Of these failures, 4 cases failed to bring about any symptomatic improvement and subsequent arthroscopy revealed meniscal damage [8]. Additionally, 21 patients (10%) failed to attend for review [8]. Patients with satisfactory results were younger (mean age 29 versus 36 years) and had symptoms for a shorter duration of time (9 versus 20 months) compared to those with unsatisfactory results [26]. Grade II or greater chondromalacia is associated with unsatisfactory results after isolated arthroscopic partial meniscectomy [26]. Specifically, 33% of patients with grade II, III, or IV chondromalacia had an unsatisfactory result compared with 9% of patients with less than grade II chondromalacia [26].

Comparative Outcomes and Risk Stratification

A majority of patients receiving arthroscopic partial meniscectomy achieved the Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State by 6 months, with increasingly smaller proportions achieving these metrics over time [84]. In a randomized controlled trial of young patients with traumatic meniscal tears, early arthroscopic partial meniscectomy was not superior to a strategy of physical therapy with optional delayed arthroscopic partial meniscectomy at 24-month follow-up [27]. In a controlled trial involving patients without clinical or radiographic osteoarthritis but with degenerative medial meniscus tears, outcomes after arthroscopic partial meniscectomy were no better than those after a sham procedure [35]. For complete posterior medial meniscus root tears with early osteoarthritis, only 56% of patients had improvement in pain and 35% showed radiographic progression of osteoarthritis at a mean follow-up of 77 months after partial meniscectomy [23].

Prognostic Factors and Alternative Strategies

A high preinjury activity level, younger age, medial meniscectomy, and smaller meniscal resection play a role in reducing the time until patients are able to return to sport [88]. Improved clinical outcomes can be expected for male patients without obesity who are undergoing medial meniscectomy with minimal meniscal resection [88]. Meniscal repair is associated with a lower progression to knee osteoarthritis at approximately six years of follow-up compared to partial meniscectomy [24]. Meniscus root repair leads to significantly less arthritis progression and subsequent knee arthroplasty compared with partial meniscectomy [45]. A greater degree of ipsilateral compartment degeneration is seen after partial meniscectomy compared to repair for horizontal cleavage tears [179]. When meniscus repair is performed, this is associated with a lower rate of future total knee arthroplasty compared to partial meniscectomy in patients with concurrent meniscus and anterior cruciate ligament tears [240].

Recovery

Light activity (weeks): The evidence provided does not specify a typical week range for light activities such as desk work, driving, or light ADLs. However, patients with concomitant meniscal resection are able to reach the same subjective knee function as isolated ACL reconstructions as early as 6 months postoperatively [172].

Full activity (months): Athletes who return to sport at approximately 3 months following a partial lateral meniscectomy may employ compensation strategies during landing, evidenced by reduced quadriceps recruitment and functional outcome scores [153]. In non-work-related patients, results of partial meniscectomy were excellent to good, with 96% return to daily activities [56].

Rehabilitation protocol: Standard exercise therapy under the supervision of a physiotherapist improved the functional recovery of the knee after partial arthroscopic meniscectomy [138]. An international formal consensus established clear, updated and structured recommendations for both surgeons and physiotherapists treating patients after meniscus surgery [164]. Additionally, an international EU–US consensus established recommendations for prevention strategies, describes rehabilitation of non-operated patients and of patients after partial meniscectomy, meniscus repair and meniscus reconstruction, and establishes return to sport criteria [33].

Other Considerations: Meniscectomy for discoid medial meniscus produced promising short-term results but deteriorating long-term results with secondary degeneration of cartilage in the medial compartment [205]. 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 [173]. 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 [79]. In young patients with isolated traumatic meniscal tears, early arthroscopic partial meniscectomy was not superior to a strategy of physical therapy with optional delayed arthroscopic partial meniscectomy at 24-month follow-up [27]. Arthroscopic partial meniscectomy leads to a similar quality of life, but higher costs, compared to physical therapy plus optional delayed arthroscopic partial meniscectomy in patients aged under 45 years [32]. Arthroscopic partial meniscectomy was not more effective than physical therapy for meniscal tear and knee osteoarthritis in patients aged 45 years or older [62]. The use of partial meniscectomy to manage degenerative meniscus tears in knees with mild preexisting arthritis and mechanical symptoms may be beneficial; however, its routine use in the degenerative knee over physical therapy alone is not supported [16].

Key Evidence

• [L5] Knee partial meniscectomy has limited benefit for nonobstructive meniscal tears, but it is necessary to determine if included patients have osteoarthritis to establish indications for surgical versus nonsurgical treatment. [1] (10.1016/j.arthro.2016.07.013)
• [L3] Partial meniscectomy for a complete MMPRT provides no benefit in halting arthritic progression. [2] (10.1016/j.arthro.2017.08.003)
• [L4] Meniscal allograft transplantation may result in important pain relief and functional improvement in patients with a history of (sub)total meniscectomy and pain localized in the affected compartment. [4] (10.1177/0363546510375399)
• [L1] Radiographic outcomes are better with partial meniscectomy than with total meniscectomy, but clinical outcomes are similar. [5] (10.1016/j.otsr.2019.02.023)
• [L3] Simultaneous partial meniscectomy did not decrease knee function further; instead, the meniscal injury and surgery caused a higher degree of osteoarthritis. [6] (10.1177/036354659602400302)
• [L3] Partial meniscectomy is not considered to be a risk factor for graft failure at short-term follow-up. [7] (10.1007/s00167-018-5213-y)
• [L4] [8] (10.1016/0020-1383(85)90003-8)
• [L4] Partial medial meniscectomy in stable knees causes only mild joint space narrowing (mean, 1.2 mm) at a mean 12-year follow-up. [9] (10.1177/0363546506288019)
• [L4] Arthroscopic partial meniscectomy improved pain and function at the first year post-operatively. [10] (10.1007/s00167-015-3590-z)
• [L4] The lateral compartment appears to be at greater risk for full-thickness cartilage loss, and previous knee surgery, particularly meniscectomy, is associated with these lesions. [11] (10.1016/j.arthro.2011.11.010)
• [L4] Partial medial meniscectomy, as an isolated factor, does not appear to have the deleterious effect reported with total meniscectomy. [12] (10.5435/00124635-200709000-00002)
• [L3] Arthroscopic partial meniscectomy generated significantly more cost than non-operative management ($3842.57 versus $411.05) and was associated with higher rates of progression to knee arthroplasty. [13] (10.1007/s00167-019-05481-8)
• [L3] Early arthroscopic partial meniscectomy for symptomatic irreparable tears in stable knees without preoperative arthrosis had better improvement in clinical results than in delayed intervention. [14] (10.1055/s-0036-1579668)
• [L4] Meniscectomy offers a fast return to play with good short-term results, but the long-term risk of osteoarthritis must be weighed when making the appropriate patient selection. [15] (10.1016/j.csm.2016.05.010)
• [L5] [16] (10.5435/jaaos-d-17-00256)
• [L4] Meniscus transplantation is a viable surgical option for patients with severe cartilage damage and missing or irreparable menisci to provide significant improvements in pain and function levels in the medium to long term with the majority of patients achieving their goal of participation in sporting activities. [17] (10.1007/s00167-014-3246-4)
• [L3] The findings can allow researchers and clinicians to determine if partial meniscectomy is meaningful to patients and will be helpful for responder analysis in future trials related to knee arthroscopy and the treatment of meniscal pathology. [18] (10.1177/2325967117s00122)
• [L4] Partial meniscectomy for irreparable medial meniscal tears, applied during the same surgery with anterior cruciate ligament reconstruction, negatively affects the clinical outcomes in the short-term follow-up. [19] (10.1007/s00167-014-2960-2)
• [L4] These findings allow researchers and clinicians to determine whether partial meniscectomy is meaningful to patients at the individual level and will be helpful for responder analysis in future trials related to the treatment of meniscal abnormality. [21] (10.1177/0363546520904017)
• [Paper] The role of arthroscopic partial meniscectomy remains controversial; while some surgeons believe it provides dramatic pain relief for specific indications, randomized clinical trials generally do not support its efficacy for degenerative meniscal tears, particularly in patients with osteoarthritis. [22] (10.1097/01.blo.0000533615.20926.05)
• [L4] Although arthroscopic partial meniscectomy for complete PMMRT significantly improved ML scores postoperatively, only 56% of patients had improvement in pain, 67% were satisfied with the outcome of the procedure, and 35% showed radiographic progression of osteoarthritis at a mean follow-up of 77 months. [23] (10.1016/j.arthro.2010.01.032)
• [L1] Meniscal repair is associated with a lower progression to knee osteoarthritis at approximately six years of followup compared to partial meniscectomy. [24] (10.1007/s00167-023-07600-y)
• [L5] Meniscal root tears are frequently unrecognized injuries that significantly alter knee biomechanics and kinematics, leading to accelerated degenerative changes. [25] (10.1177/0363546514524162)
• [L4] [26] (10.1177/036354659302100318)
• [L1] [27] (10.1136/bjsports-2021-105059)
• [L1] Knee arthroscopic surgery, in most cases consisting of partial meniscectomy or diagnostic arthroscopy, in addition to exercise therapy in middle-aged patients with meniscal symptoms, did not increase the rates of radiographic or symptomatic OA and resulted in similar patient-reported outcomes at the 10-year follow-up compared with exercise therapy alone. [28] (10.1177/03635465241255653)
• [L5] Arthroscopic partial meniscectomy should not be proposed as a first-line treatment for degenerative meniscus lesions; non-operative treatment should always be started first, with surgery only envisaged after its failure. [29] (10.1007/s00167-017-4458-1)
• [L3] Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy. [30] (10.1177/0363546519844481)
• [L4] Arthroscopic partial medial meniscectomy is associated with adverse effects on articular cartilage and may lead to an increase in the severity and size of cartilage lesions. [31] (10.1007/s00167-015-3542-7)
• [L1] Arthroscopic partial meniscectomy leads to a similar quality of life, but higher costs, compared to physical therapy plus optional delayed arthroscopic partial meniscectomy. [32] (10.1302/0301-620x.105b11.bjj-2023-0107.r1)
• [L1] This international EU–US consensus established recommendations for prevention strategies, describes rehabilitation of non-operated patients and of patients after partial meniscectomy, meniscus repair and meniscus reconstruction, and establishes return to sport criteria. [33] (10.1002/ksa.12689)
• [L4] Partial meniscectomy offers pain relief and functional improvement for medial meniscus tear with intact posterior root. [34] (10.1007/s00167-019-05634-9)
• [L1] In this controlled trial involving patients without clinical or radiographic osteoarthritis of knee but with symptoms considered attributable to a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham procedure. [35] (10.1016/j.arthro.2014.04.082)
• [L4] Arthroscopic partial meniscectomy for flap tears yielded favorable 12-month outcomes. [36] (10.1186/s13018-025-05535-3)
• [L3] Among patients who underwent arthroscopic partial medial meniscectomy with an average follow-up of 20 years, those with concurrent focal cartilage defect in the medial compartment had clinically and radiologically worse outcomes than patients without any cartilage defect. [37] (10.1007/s00167-022-07086-0)
• [L3] In complete-type discoid meniscus, total meniscectomy showed better short-term clinical results, but partial meniscectomy showed better long-term radiological results, while partial meniscectomy was superior for incomplete types. [38] (10.1007/s00167-007-0391-z)
• [L4] Although there were no differences in clinical results between the partial and subtotal/total meniscectomy groups, partial meniscectomy yielded better radiologic results than subtotal/total meniscectomy for torn DLMs in children. [40] (10.1016/j.arthro.2008.10.025)
• [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. [41] (10.1016/j.arthro.2024.11.058)
• [L4] Patients undergoing repair had higher complication rates than those undergoing partial meniscectomy. [42] (10.1007/s00167-019-05557-5)
• [L3] Patients treated with primary meniscectomy have over three times higher odds to undergo subsequent knee arthroplasty compared to those treated with meniscal repair. [43] (10.1002/ksa.12216)
• [L5] Total medial meniscectomy leads to significantly worsened load distribution within the knee. [44] (10.1177/0363546519870179)
• [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. [45] (10.1177/0363546519888212)
• [L1] [48] (10.1186/s12891-021-04990-3)
• [L1] [49] (10.1136/bjsports-2016-i3740rep)
• [L2] [50] (10.5435/00124635-200711000-00003)
• [L4] These results suggest both a structural element and a potential muscular element for the differences in kinematics after partial medial meniscectomy and highlight the importance of challenging the knee with activities of increased demands to detect differences in kinematics from the contralateral limb. [54] (10.1177/0363546515577360)
• [L1] Radiographic signs of osteoarthritis are significant at 8 to 16 years' follow-up after knee arthroscopic partial meniscectomy, but clinical symptoms of knee arthritis are not significant. [55] (10.1016/j.arthro.2010.08.016)
• [L3] The results of partial meniscectomy in non-work-related patients were excellent to good, with 96% return to daily activities. [56] (10.1177/2325967118s00195)
• [L4] [58] (10.1007/s00167-016-4069-2)
• [L1] In patients with knee pain and nonobstructive meniscal tears, physiotherapy was noninferior to arthroscopic partial meniscectomy for knee function over a 24-month period. [59] (10.2106/jbjs.19.00177)
• [L3] [61] (10.1007/s001670000146)
• [L1] [62] (10.2106/jbjs.9522.ebo745)
• [L4] MRI of the symptomatic knee after meniscal surgery is a valuable diagnostic study; for partial meniscectomy of less than 25%, MRI is sufficient, whereas for greater than 25% resection or after repair, direct or indirect MRA should be considered. [63] (10.1016/j.arthro.2008.08.013)
• [L3] Net improvements in contact biomechanics after transplant, relative to the meniscectomy state, support meniscus transplant. [64] (10.5435/jaaos-d-22-00832)
• [L4] Post-meniscectomy pain syndrome and post-meniscectomy knee OA are common findings after meniscus resection. [65] (10.1007/s00167-019-05424-3)
• [L5] While both keyhole and bone plug fixation methods improved lateral compartment contact mechanics relative to the meniscectomized knee, keyhole fixation restored contact mechanics closer to that of the intact knee. [66] (10.1177/0363546519860113)
• [L5] Medial meniscal tears pose a more challenging dilemma where partial meniscectomy must be balanced against long-term degenerative consequences, and many tears are correctly treated non-operatively. [68] (10.1007/s00167-021-06694-6)
• [L3] Partial meniscectomy should be considered cautiously in patients with varus-aligned knees. [69] (10.1007/s00167-020-05905-w)
• [L3] Over half of patients undergoing arthroscopic partial meniscectomy report preoperative pain at night. [70] (10.1177/2325967124s00237)
• [L5] The editors respectfully challenge the statement that partial meniscectomy has no value beyond placebo, asserting that when proper indications are chosen, the surgery works. [71] (10.1016/j.arthro.2014.08.003)
• [L3] Arthroscopic partial meniscectomy may be indicated in patients with radial tear if conservative treatment fails. [72] (10.1007/s00167-018-5238-2)
• [L5] The integrity of the posterior root of the medial meniscus plays an important role in maintaining normal tibial-femoral joint contact mechanics. [73] (10.1186/s12891-022-06069-z)
• [L3] Patients aged 40 years and younger who underwent partial meniscectomy surgery within 6 months after a meniscal tear were more likely to have a shorter time to return to activity, and female patients with obesity (BMI ≥27 kg/m2), especially those with medial meniscal tears, tended to have inferior clinical outcomes. [74] (10.1177/23259671221080787)
• [L4] In symptomatic patients after arthroscopic partial meniscectomy for DLM, the thickness and width of the residual meniscus decreases over time and the arthritic change of the lateral compartment of the knee progressed. [75] (10.1016/j.arthro.2016.04.012)
• [L4] [76] (10.1177/0363546510392014)
• [L2] There is currently no compelling evidence to support arthroscopic partial meniscectomy versus physical therapy. [77] (10.1016/j.arthro.2018.04.018)
• [L4] [78] (10.5435/00124635-200205000-00004)
• [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. [79] (10.1177/2325967120962078)
• [L3] Good long-term clinical results in terms of stability, subjective outcomes and objective evaluation were reported both for medial CMI implant and partial medial meniscectomy. [80] (10.1007/s00167-014-3136-9)
• [L2] Preservation of the meniscus should be considered as the first line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to meniscus repair. [81] (10.1007/s00167-020-05847-3)
• [L5] Partial meniscectomy significantly alters the loading situation of the meniscus and its attachments. [82] (10.1007/s00167-014-2951-3)
• [L4] Whereas meniscal repairs have a higher reoperation rate than partial meniscectomies, they are associated with better long-term outcomes. [83] (10.1016/j.arthro.2011.03.088)
• [L3] A majority of patients receiving arthroscopic partial meniscectomy achieved MCID, SCB and PASS by 6 months, with increasingly smaller proportions of patients achieving these metrics over time. [84] (10.1016/j.arthro.2019.11.021)
• [L3] Patients with femoral bone marrow lesions are more likely to gain benefit from arthroscopic partial meniscectomy in the middle term. [87] (10.1007/s00167-020-05883-z)
• [L4] [88] (10.2106/jbjs.19.00082)
• [L4] [89] (10.1016/j.csm.2013.03.005)
• [L3] Partial meniscectomy was found to be strongly associated with the progression of articular cartilage damage despite anatomical ACL reconstruction. [90] (10.1302/0301-620x.100b3.bjj-2017-0837.r1)
• [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. [95] (10.1002/ksa.12791)
• [L5] The meniscus status does have a significant impact on knee kinematics in the ACL-deficient knee. [124] (10.1007/s00264-014-2581-x)
• [Paper] The decreased displacement of the medial meniscus may explain the higher pressure on the knee components, indicating potential biomechanical risk of knee degeneration. [125] (10.1186/s12891-021-04187-8)
• [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. [129] (10.1177/0363546520935453)
• [L5] In vitro tests applying uniaxial loads combined with static knee flexion angles or very low flexion-extension speeds appear to underestimate meniscus attachment forces. [132] (10.1177/0363546520988039)
• [L2] Based on the findings of this study, 82% of patients who undergo arthroscopic partial meniscectomy and/or chondroplasty can achieve satisfactory pain control with nonopioid pain management. [135] (10.1016/j.arthro.2019.03.028)
• [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. [138] (10.1007/s001670050181)
• [L1] [139] (10.1007/s00167-021-06573-0)
• [L5] Motion and weight loading of the knee can generate considerable tensile forces in repaired posterior medial meniscal roots. [141] (10.1016/j.arthro.2012.09.004)
• [L3] Partial meniscectomy for a complete medial meniscus posterior root tear provides no benefit in halting arthritic progression compared to non-operative treatment. [142] (10.1016/j.arthro.2017.04.099)
• [L2] [143] (10.1007/s00167-011-1636-4)
• [L3] Partial meniscectomy for complete medial meniscus posterior root tears provides no benefit in halting arthritic progression compared to non-operative treatment. [150] (10.1007/s00167-017-4454-5)
• [L5] This study shows that an MMPH longitudinal tear in an ACL-deficient knee alters the knee kinematics, particularly the anterior-posterior tibial translation. [151] (10.1177/0363546511416597)
• [L3] Partial meniscectomy for a medial meniscus posterior root tear provides no benefit in halting arthritic progression compared to non-operative treatment. [152] (10.1177/2325967117s00241)
• [L3] Athletes who return to sport at approximately 3 months following a partial lateral meniscectomy may employ compensation strategies during landing as evidenced by reduced quadriceps recruitment and functional outcome scores. [153] (10.1007/s00167-011-1490-4)
• [L5] The biomechanical consequences of a lateral meniscus root tear depend on the state of the meniscofemoral ligament. [154] (10.1007/s00402-013-1716-7)
• [L5] Meniscectomy remains a frequent orthopedic procedure despite the existence of meniscus repair techniques with good clinical outcomes. [157] (10.1007/s00167-021-06612-w)
• [L4] Meniscal injury has a negative effect on the biology of the knee within a very short period of time, with degenerative changes of the articular cartilage becoming apparent within a decade. [161] (10.1016/j.csm.2019.08.001)
• [L1] This international formal consensus established clear, updated and structured recommendations for both surgeons and physiotherapists treating patients after meniscus surgery. [164] (10.1002/ksa.12674)
• [L4] The presenting symptoms were due to a medial meniscus tear, while the accessory lateral meniscus was found incidentally. [170] (10.1007/s00167-006-0093-y)
• [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. [172] (10.1007/s00167-017-4793-2)
• [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. [173] (10.1177/0363546510364052)
• [L1] There were no differences in pain severity and analgesic intake between intra- or extra-articular bupivacaine administration after arthroscopic partial meniscectomy. [176] (10.1177/23259671221147514)
• [L4] [177] (10.1007/s00167-008-0508-z)
• [L2] However, a greater complication rate can be expected with repair, especially in patients aged 42 years and younger, while a greater degree of ipsilateral compartment degeneration is seen after partial meniscectomy. [179] (10.1016/j.arthro.2024.10.009)
• [L3] Statistically derived formulae can be used to predict the outcome of one knee scoring system when the result of another is known in patients with meniscal tears before and after arthroscopic meniscectomy. [181] (10.1016/j.otsr.2021.102803)
• [L3] [186] (10.1177/0363546517697302)
• [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. [187] (10.1007/s00167-020-06299-5)
• [L2] Intraarticular tramadol plus periarticular bupivacaine combination provides better pain relief and less analgesic requirement following arthroscopic outpatient partial meniscectomy surgery. [188] (10.1007/s00167-006-0221-8)
• [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. [195] (10.1016/j.arthro.2023.12.017)
• [L4] [196] (10.1016/j.arthro.2012.02.029)
• [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. [199] (10.1177/03635465211031250)
• [L4] 0.9% of primary arthroscopies performed under local anaesthesia could not be performed safely due to patient discomfort. [200] (10.1007/s001670050171)
• [L3] A supplementary MRI will increase diagnostic accuracy when fewer than three clinical findings are present in a symptomatic meniscal repair patient. [201] (10.1007/s00167-019-05523-1)
• [L1] [203] (10.2106/jbjs.9616.ebo521)
• [L4] Meniscectomy for discoid medial meniscus produced promising short-term results but deteriorating long-term results with secondary degeneration of cartilage in the medial compartment. [205] (10.1007/s00167-012-1979-5)
• [L4] Articular cartilage and meniscus exhibit molecular events associated with OA at the time of partial meniscectomy despite no gross evidence of degeneration in the knee. [206] (10.1177/2325967115s00065)
• [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. [207] (10.1007/s00167-002-0280-4)
• [L5] [209] (10.1177/0363546513498503)
• [L5] [210] (10.1016/j.csm.2012.08.017)
• [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. [212] (10.1177/0363546508329543)
• [L3] Patients with an anxiety or depressive disorder have higher rates of health care utilization, medical complications, opioid prescriptions, and subsequent knee surgery after isolated primary arthroscopic partial meniscectomy. [214] (10.1016/j.arthro.2025.01.067)
• [L4] Partial meniscal substitution using acellular scaffolds in selected patients with irreparable loss of tissue may be a safe and promising procedure. [216] (10.1016/j.arthro.2011.08.283)
• [L1] [217] (10.1007/s00167-018-5106-0)
• [L4] Arthroscopic repair of isolated medial degenerative meniscus tears in patients over 45 years resulted in good to excellent clinical outcomes with low clinical failure rates, despite unhealed menisci being observed on MRI in 41% of patients. [218] (10.1007/s00167-022-07133-w)
• [L4] Arthroscopic treatment for patients with chronic segmental meniscal loss using a polyurethane meniscal implant can achieve sustainable midterm results regarding pain reduction and knee function. [222] (10.1007/s00167-015-3759-5)
• [L3] In patients undergoing arthroscopic meniscal surgery, the chronicity of preoperative opioid intake and degree of knee osteoarthritis were found to have a significant effect on postoperative opioid use. [223] (10.1016/j.arthro.2018.10.122)
• [L4] The meniscal allograft transplantation without bone plugs effectively treats painful and functional sequellae of meniscectomies. [225] (10.1007/s00167-013-2476-1)
• [L3] [226] (10.1002/ksa.70202)
• [L4] This study demonstrated that an arthroscopic meniscal allograft transplantation without bone plugs improved knee function and symptoms after a total meniscectomy. [227] (10.1007/s00167-010-1123-3)
• [L3] At a minimum of 2-years postoperative, 4 (15%) of the circumferential repair patients had reoperations or failures, while 5 (19%) of the partial meniscectomy patients had reoperations or failures. [231] (10.1177/2325967126s00376)
• [L3] The overall secondary partial meniscectomy rate after ramp repair is 10.8%, and anterolateral ligament reconstruction appears to confer a protective effect on the ramp repair. [235] (10.1177/0363546518800717)
• [L2] Patients developing a meniscal tear undergoing APM are at greater risk of knee arthroplasty than the general population, with the risk being three-times greater in the affected knee than in the contralateral knee. [239] (10.1302/0301-620x.101b9.bjj-2019-0335.r1)
• [L3] When meniscus repair is performed, this is associated with lower rate of future total knee arthroplasty. [240] (10.1016/j.arthro.2025.05.006)

See Also

• Meniscal repair
• Knee osteoarthritis
• Anterior cruciate ligament injury
• Meniscal tear
• Anatomy
• ACL reconstruction
• Knee arthroscopy

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