A meniscus tear is one of the most common knee injuries, and arthroscopic surgery for a torn meniscus is one of the procedures Dr. Andrew Dold performs most often. The good news is that many tears can be treated without surgery, and when surgery is needed, today’s goal is to save as much of the meniscus as possible. Dr. Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, treats meniscus tears in athletes, active adults and older patients, and has published research on meniscal root repair.1
- Two C-shaped cartilage cushions, the medial (inner) and lateral (outer) menisci, absorb shock and spread load across the knee
- Tears happen from a twist or pivot in younger, active people, or gradually with age (degenerative tears)
- Many degenerative tears improve with physical therapy, without surgery2,3
- Tears that can heal are repaired (stitched); tears that cannot heal are trimmed (partial meniscectomy)
- Recovery after a trim is usually weeks; after a repair, Dr. Dold typically uses a hinged brace and about 6 weeks on crutches without weight on the leg
What is the meniscus?
Each knee has two menisci, rubbery C-shaped pads of cartilage that sit between the thighbone (femur) and shinbone (tibia). They act as shock absorbers, spread body weight over a larger area of joint cartilage and help keep the knee stable, especially when the ACL is torn.
The meniscus has a limited blood supply. Blood vessels reach only the outer 10% to 25% of the meniscus,4 which surgeons call the “red zone.” Tears in this outer zone have the greatest chance of healing after a repair. Tears in the inner “white zone” have little or no blood supply and usually cannot heal.
Types of meniscus tears
Meniscus tears fall into two broad groups:
- Traumatic (acute) tears happen with a twisting, pivoting or deep-squatting injury, often in sports. They are common together with an ACL tear.
- Degenerative tears develop gradually as the meniscus weakens with age. They are very common: in a study of adults aged 50 to 90 in the general population, MRI showed a meniscus tear in 19% of women aged 50 to 59 and in 56% of men aged 70 to 90, and 61% of the people with a tear had no knee pain, aching or stiffness in the previous month.5
Tears are also described by their shape:
- Vertical (longitudinal) tears run along the length of the meniscus and are often repairable.
- Bucket-handle tears are large vertical tears in which a piece flips into the middle of the knee and can lock it. These need prompt attention.
- Radial tears run from the inner edge outward and cut across the fibers that hold the meniscus together.
- Horizontal and complex (degenerative) tears are more common in older knees.
- Root tears occur where the meniscus anchors to the bone (see root tears below).
Symptoms
- Pain along the inner or outer side of the knee (the joint line)
- Swelling, often developing over a day or so after an injury
- Pain with twisting, squatting, kneeling or going up and down stairs
- Catching, clicking or a feeling that the knee gives way
- Locking, or being unable to fully straighten the knee, which can mean a torn piece is caught in the joint
Diagnosis
Dr. Dold starts with your history and a careful examination, checking for joint-line tenderness, swelling, range of motion and ligament stability. X-rays show the alignment of the knee and whether there is arthritis. An MRI shows the meniscus, the type and location of a tear, and other injuries such as an ACL tear or cartilage damage.
Because meniscus tears are so common on MRI in people over 50, including people without symptoms,5 Dr. Dold matches the MRI findings to your symptoms and examination before recommending treatment. A tear on an MRI is not, by itself, a reason for surgery.
Non-surgical treatment
For many degenerative tears, and for some small stable tears, non-surgical care is the first step:
- Physical therapy to strengthen the thigh and hip muscles and restore motion
- Activity changes to avoid deep squatting, pivoting and other painful movements while the knee settles
- Anti-inflammatory medicines, ice and, when appropriate, a short period of bracing
- Injections, such as a corticosteroid injection, or in selected patients platelet-rich plasma (PRP)
Research supports trying therapy first for degenerative tears. In a trial of 351 patients aged 45 and older with a meniscus tear and mild-to-moderate arthritis, function improved similarly at 6 months with physical therapy or with surgery, although 30% of the therapy group went on to have surgery within 6 months.2 In another trial of 321 patients aged 45 to 70 whose knees were not locking, physical therapy was as effective as partial meniscectomy over 2 years.3 In patients aged 35 to 65 with a degenerative tear and no arthritis, partial meniscectomy did no better than a placebo (sham) operation at 1 year.6 European consensus guidelines recommend that partial meniscectomy should not be the first treatment for degenerative tears.7
Surgery is considered when a degenerative tear causes symptoms that do not improve with good non-surgical care, or when there are true mechanical symptoms such as locking.
Surgery: trim or repair?
Meniscus surgery is done arthroscopically, through small incisions with a camera, usually as outpatient surgery. During the arthroscopy Dr. Dold examines the tear and decides between two main options:
| Partial meniscectomy (trim) | Meniscus repair | |
|---|---|---|
| What is done | The torn, unstable part is trimmed away and the edge smoothed; the healthy meniscus is left in place | The torn edges are stitched together so the meniscus can heal |
| Usually used for | Tears in the inner zone that cannot heal, and degenerative tears that have not improved with therapy | Tears in the outer zone with a blood supply, vertical and bucket-handle tears, root tears, tears that occur with an ACL tear, and younger, active patients |
| Recovery | Faster: usually walking within days and back to most activities within weeks | Longer: a hinged brace and about 6 weeks without weight on the leg in Dr. Dold’s practice, with return to sport after several months |
| Long term | Less meniscus remains to protect the cartilage | Saves the meniscus, which is linked with better long-term knee health |
Why repair when a trim heals faster? Because the meniscus protects the joint cartilage. International guidelines recommend preserving the meniscus whenever possible, which means repairing the tears that have a reasonable chance of healing.8 In a systematic review, meniscus repairs needed a second operation more often than partial meniscectomies (about 21% vs 4% at long-term follow-up), but repairs were associated with better long-term function scores and less arthritis on X-ray.9 In a study of traumatic medial meniscus tears followed for almost 9 years, there was no sign of progressing arthritis in 81% of knees after repair compared with 40% after partial meniscectomy, and 96% of repair patients returned to their pre-injury activity level compared with 50% after meniscectomy.10
Not every repair heals. In a review of studies with at least 5 years of follow-up, about 23% of meniscus repairs failed (needing another operation or causing symptoms again).11 Dr. Dold will discuss the likely chance of healing for your specific tear.
The final decision is often made during surgery, once the tear can be seen directly. Dr. Dold will explain before surgery which option is more likely and what each would mean for your recovery. For more detail, see arthroscopic meniscus repair and the meniscus surgery: trim vs. repair Q&A.
Meniscal root tears
The meniscus is anchored to the shinbone at its front and back “roots.” When a root tears, the meniscus can slide out of the joint (extrusion) and stop carrying load properly. A complete root tear can affect the knee in a way that is biomechanically similar to losing the whole meniscus.12 In laboratory testing, repairing the root restored more normal joint mechanics.13
Root tears are often repaired by passing sutures through a small tunnel in the shinbone and tying them over the bone (a transtibial pull-out repair).
Meniscal root repair: what MRI shows 2 years later
Dr. Dold co-authored a study of transtibial medial meniscal root repair published in Knee Surgery, Sports Traumatology, Arthroscopy (online November 2, 2017).1 In 18 patients followed for about 2 years, average knee function scores improved substantially (IKDC score from about 46 to 77, and Lysholm score from about 51 to 87). MRI, however, showed that most roots were only partially healed, the meniscus had shifted further out of the joint (extrusion), and cartilage wear had progressed.1
The authors concluded that patients should be counseled that short-term results can be encouraging while long-term arthritis risk is less predictable.1 Dr. Dold uses this research to set realistic expectations for each patient. Read the abstract on PubMed
Recovery
After a partial meniscectomy (trim): most patients put full weight on the leg right away and use crutches only until they walk normally, often a few days.14 Physical therapy usually starts within the first week or so, and many people return to desk work within about a week and to sports within weeks, based on progress.
After a meniscus repair: Dr. Dold typically has patients wear a hinged knee brace and use crutches without putting weight on the leg for about 6 weeks, to protect the repair while it heals. Bending is limited at first, and deep squatting, jumping and twisting are generally avoided for at least 4 months. Return to pivoting sports is commonly at least 4 months for simple tears, and complex tears may take 6 to 9 months.14
Timelines vary from person to person, and Dr. Dold will give you a specific plan.
“As a 56-year-old distance runner for more than 30 years, I’ve logged a lot of miles, so knee issues weren’t exactly a surprise… Within the past year, he performed two surgeries for me; one for a meniscus tear and the other to repair cartilage damage in my other knee. The results have been remarkable. My knees honestly feel 20 years younger, and thanks to his expertise, I’m confident I still have many miles of running ahead of me… He takes the time to explain things, answer questions, and make you feel confident in your treatment plan.”
— Cheri Z., Meniscus and cartilage surgery (Google review). Individual results vary.
Watch Dr. Dold’s meniscus surgery videos
These videos show real surgery, so some viewers may prefer not to watch.
More videos on Dr. Dold’s YouTube channel.
Mastering the Meniscus: Dr. Dold demonstrates meniscus repair techniques in this 11-minute video produced by Smith+Nephew. It shows real surgery.
Also on Smith+Nephew’s website and as a short Instagram clip.
For physicians and other healthcare professionals: Dr. Dold’s VuMedi lecture Mastering the Meniscus: Five Meniscal Tear Types Repaired covers bucket-handle, radial, root, horizontal cleavage and complex tear repairs (a VuMedi healthcare-professional account is required).
Video produced by Smith+Nephew. Dr. Dold is a consultant for Smith+Nephew.
What the research shows
Here is what major trials and reviews add about meniscus tears.
Degenerative tears: exercise first
Several randomized trials, including placebo-surgery trials, show that arthroscopic partial meniscectomy for degenerative tears is no better than exercise therapy or sham surgery, and long-term follow-up shows no protection against arthritis. A structured home exercise program is the foundation of treatment for most middle-aged and older patients.
Repair when possible
When a tear is repairable, repair is associated with less arthritis over time than removing meniscus tissue. Repairs do fail in a meaningful number of cases, roughly 1 in 4 for some medial tears in stable knees, so the decision balances the long-term benefit of saving the meniscus against the chance of another operation.
Root and ramp tears
Root tears act like a complete loss of meniscus function. Repairing them leads to less arthritis than meniscectomy or non-surgical care. Ramp lesions, found at the back of the medial meniscus with ACL tears, generally do well with repair at the time of ACL reconstruction.
When the meniscus is gone
For younger patients with pain after losing most of a meniscus, meniscal allograft transplantation has produced good short- and mid-term results.
Why see Dr. Dold
- Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
- Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
- Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
- Published research on knee ligament and meniscus surgery, including The Posteromedial Corner of the Knee (JAAOS, 2017) and transtibial meniscal root repair (KSSTA, 2017)
- Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
- D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google
Frequently asked questions
Can a torn meniscus heal on its own?
Tears in the outer part of the meniscus, which has a blood supply, can sometimes heal, especially small stable tears.4 Tears in the inner part usually do not heal, but many degenerative tears stop causing symptoms with physical therapy.2,3
Do I need surgery for a meniscus tear?
Not always. Degenerative tears are usually treated with physical therapy first.7 Surgery is considered for a locked knee, a large or displaced tear, a repairable tear in an active patient, or symptoms that do not improve with non-surgical care.
What is the difference between a meniscectomy and a meniscus repair?
A partial meniscectomy trims away the torn part that cannot heal. A repair stitches the tear so the meniscus can heal. Repairs take longer to recover from but save the meniscus, which is linked with better long-term knee health.9,10
How long is recovery after meniscus surgery?
After a trim, most patients walk within days and return to most activities within weeks. After a repair, Dr. Dold typically uses a hinged brace and about 6 weeks without weight on the leg, with return to sports usually after at least 4 months.14
Will I know before surgery whether my meniscus will be trimmed or repaired?
Dr. Dold will tell you which is more likely based on your MRI and examination, but the final decision is often made during the arthroscopy, once the tear can be seen directly.
Can a meniscus tear lead to arthritis?
Losing meniscus tissue increases stress on the joint cartilage, which is why saving the meniscus matters. In one long-term study, arthritis progressed less often after repair than after partial meniscectomy.10
What is a meniscal root tear?
A tear where the meniscus anchors to the bone. A complete root tear can affect the knee much like losing the whole meniscus, so repairable root tears are usually repaired.12
Does Dr. Dold accept insurance?
Dr. Dold accepts most major insurance plans, including Medicare and Tricare. Please call 469-850-0680 to confirm your coverage.
Hurt playing sports? See how Dr. Dold, a sports medicine doctor in Frisco, treats athletes of every age and level.
Research cited on this page
- Kaplan DJ, Alaia EF, Dold AP, Meislin RJ, Strauss EJ, Jazrawi LM, Alaia MJ. Increased extrusion and ICRS grades at 2-year follow-up following transtibial medial meniscal root repair evaluated by MRI. Knee Surg Sports Traumatol Arthrosc. 2018;26(9):2826-2834. PubMed
- Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368(18):1675-1684. PubMed
- van de Graaf VA, Noorduyn JCA, Willigenburg NW, et al. Effect of early surgery vs physical therapy on knee function among patients with nonobstructive meniscal tears: the ESCAPE randomized clinical trial. JAMA. 2018;320(13):1328-1337. PubMed
- Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982;10(2):90-95. PubMed
- Englund M, Guermazi A, Gale D, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008;359(11):1108-1115. PubMed
- Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013;369(26):2515-2524. PubMed
- European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). ESSKA consensus on degenerative and traumatic meniscus lesions (summarizing Beaufils P, Becker R, Kopf S, et al. Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2017;25:335-346). esska.org
- Knee Surgery, Sports Traumatology, Arthroscopy. Kopf S, Beaufils P, Hirschmann MT, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. 2020;28(4):1177-1194. link.springer.com
- Paxton ES, Stock MV, Brophy RH. Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy. 2011;27(9):1275-1288. PubMed
- Stein T, Mehling AP, Welsch F, et al. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med. 2010;38(8):1542-1548. PubMed
- Nepple JJ, Dunn WR, Wright RW. Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Joint Surg Am. 2012;94(24):2222-2227. PubMed
- Bhatia S, LaPrade CM, Ellman MB, LaPrade RF. Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med. 2014;42(12):3016-3030. PubMed
- Padalecki JR, Jansson KS, Smith SD, et al. Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics. Am J Sports Med. 2014;42(3):699-707. PubMed
- International Journal of Sports Physical Therapy. Pujol N, Giordano AO, Wong SE, et al. The formal EU-US Meniscus Rehabilitation 2024 Consensus. An ESSKA-AOSSM-AASPT initiative. Part I: rehabilitation management after meniscus surgery (meniscectomy, repair, reconstruction). 2025;20(6):918-930. ijspt.scholasticahq.com
- Kise NJ, Risberg MA, Stensrud S, et al. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ. 2016;354:i3740. PubMed
A Norwegian randomized trial found exercise therapy was as effective as partial meniscectomy at 2 years for degenerative meniscal tears in middle-aged patients. - Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. Br J Sports Med. 2020;54(22):1332-1339. PubMed
At 5 years, a placebo-surgery trial found partial meniscectomy gave no benefit over sham and slightly increased arthritis. - Berg B, Roos EM, Englund M, et al. Arthroscopic partial meniscectomy versus exercise therapy for degenerative meniscal tears: 10-year follow-up of the OMEX randomised controlled trial. Br J Sports Med. 2025;59(2):91-98. PubMed
At 10 years, partial meniscectomy and exercise therapy had similar arthritis progression for degenerative tears. - Katz JN, Collins JE, Bisson L, et al. A Randomized Trial of Physical Therapy for Meniscal Tear and Knee Pain. N Engl J Med. 2025;393(17):1694-1703. PubMed
A 2025 randomized trial found that adding supervised physical therapy or text reminders to a home exercise program did not reduce pain further for degenerative tears. - Migliorini F, Schäfer L, Bell A, et al. Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2023;31(12):5485-5495. PubMed
A meta-analysis found meniscal repair was associated with less progression to arthritis at about 6 years than partial meniscectomy. - Petersen W, Karpinski K, Bierke S, et al. A systematic review about long-term results after meniscus repair. Arch Orthop Trauma Surg. 2022;142(5):835-844. PubMed
A systematic review found good long-term outcomes after meniscal repair, alone or with ACL reconstruction, with a possible cartilage-protective effect. - Farinelli L, Meena A, Montini D, et al. Failure rate of isolated medial meniscus repair in the stable knee: Systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2025;33(4):1333-1344. PubMed
In knees with an intact ACL, repairs of the medial meniscus failed in about 26% of cases, so patients should know there is a meaningful chance of another operation. - Allende F, Dzidzishvili L, Garcia JR, et al. Partial Meniscectomy Yields Comparable Outcomes and Failure Rates to Meniscal Repair for Horizontal Cleavage Tears, With Fewer Complication Rates but Greater Progression of Degenerative Changes. Arthroscopy. 2025;41(7):2680-2694. PubMed
Repair of horizontal cleavage tears can give outcomes and failure rates similar to partial meniscectomy in selected patients. - Faucett SC, Geisler BP, Chahla J, et al. Meniscus Root Repair vs Meniscectomy or Nonoperative Management to Prevent Knee Osteoarthritis After Medial Meniscus Root Tears: Clinical and Economic Effectiveness. Am J Sports Med. 2019;47(3):762-769. PubMed
Repair of medial meniscus root tears led to less arthritis than meniscectomy or non-surgical treatment and was cost-saving. - Perry AK, Lavoie-Gagne O, Knapik DM, et al. Examining the Efficacy of Medial Meniscus Posterior Root Repair: A Meta-analysis and Systematic Review of Biomechanical and Clinical Outcomes. Am J Sports Med. 2023;51(7):1914-1926. PubMed
Medial meniscus root repair improved patient-reported outcomes, with greater gains when combined with a realignment osteotomy, although it did not reliably correct meniscal extrusion. - Cerasoli T, Rinaldi VG, Fogacci A, et al. All-inside repair is an effective treatment for medial meniscus posterior root tears: a systematic review and meta-analysis of biomechanical and clinical evidence. Knee. 2026;62:104501. PubMed
A 2026 review found all-inside root repair performed better than no repair and similarly to transtibial repair. - Kunze KN, Wright-Chisem J, Polce EM, et al. Risk Factors for Ramp Lesions of the Medial Meniscus: A Systematic Review and Meta-analysis. Am J Sports Med. 2021;49(13):3749-3757. PubMed
Ramp lesions with ACL tears were more common in males, patients under 30, chronic injuries and contact injuries. - Misir A, Yuce A. The fate of unrepaired stable ramp lesions: a systematic review. Acta Orthop Belg. 2024;90(3):543-548. PubMed
Unrepaired stable ramp lesions had similar return-to-sport rates, though return took longer. - Alessio-Mazzola M, Lovisolo S, Capello AG, et al. Management of ramp lesions of the knee: a systematic review of the literature. Musculoskelet Surg. 2020;104(2):125-133. PubMed
Repair of ramp lesions with ACL reconstruction gave good clinical results with a low failure rate. - Gilat R, Mitchnik IY, Mimouni T, et al. The meniscotibial ligament role in meniscal extrusion: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2023;143(9):5777-5786. PubMed
Injury to the meniscotibial ligament may cause about 3 mm of meniscal extrusion, and repair can reduce it. - Rosso F, Bisicchia S, Bonasia DE, et al. Meniscal allograft transplantation: a systematic review. Am J Sports Med. 2015;43(4):998-1007. PubMed
Meniscal allograft transplantation gave good short- and mid-term results with acceptable complication and failure rates. - Jauregui JJ, Wu ZD, Meredith S, et al. How Should We Secure Our Transplanted Meniscus? A Meta-analysis. Am J Sports Med. 2018;46(9):2285-2290. PubMed
Meniscal allograft transplantation improved outcomes, with low tear and failure rates, regardless of fixation method.
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Individual results vary.
