Meniscus Tears and Surgery: 48 Questions Patients Ask

Each knee has two menisci: C-shaped pads of tough, rubbery cartilage that sit between the thighbone and shinbone, one on the inner side (medial) and one on the outer side (lateral). They cushion the joint, spread out the load on the cartilage and help keep the knee stable.

The meniscus protects the cartilage surfaces of the knee. In laboratory testing, removing part of a torn meniscus increased peak pressure on the cartilage by about 65%, and removing the whole meniscus increased it by about 235%.¹ Over 21 years, patients who had a meniscus removed were far more likely to develop knee arthritis than people who had not (48% vs 7%).² This is why Dr. Dold saves the meniscus whenever possible.

A tear in this cartilage. Tears are described by their shape and location, such as vertical (longitudinal), bucket-handle, radial, horizontal, flap, complex, root and ramp tears. The pattern and location decide whether a tear can be repaired. See meniscus tears.

In younger, active people, tears usually happen with a twist or pivot on a bent knee, often in sports, sometimes together with an ACL tear. In people over about 40, the meniscus can weaken with age and tear with a simple movement such as squatting or standing up from a crouch. These are called degenerative tears.

Very common, particularly with age. In an MRI study of adults in the community, meniscus tears were seen in 19% of women aged 50 to 59 and up to 56% of men aged 70 to 90, and 61% of people with a tear had no knee pain in the previous month.³ A tear on an MRI is not always the cause of knee pain.

Pain along the inner or outer joint line, swelling (often the next day), stiffness, pain with twisting or squatting, and sometimes catching. A large torn piece can flip into the joint and lock the knee so it will not straighten fully.

Only the outer rim of the meniscus has a good blood supply, about the outer 10% to 25%.⁴ Small, stable tears in this zone can sometimes heal. Tears in the inner part, which has little blood supply, generally do not heal on their own, which is why location matters so much for repair.

An abnormally shaped meniscus, usually on the outer side, that is thicker and more disc-shaped than normal and more likely to tear. It is often found in children and teens. Reported rates of discoid lateral meniscus range widely, from under 1% to 17%, and are higher in Asian populations.⁵ See discoid meniscus.

Dr. Dold takes a history of the injury and examines your knee for joint-line tenderness, swelling, motion and specific tests that stress the meniscus. X-rays are taken in our office to check alignment and look for arthritis, which affects treatment choices.

An MRI is the best imaging test for the meniscus and shows the tear pattern, its location and any other injuries, such as ligament or cartilage damage. A systematic review found MRI highly accurate compared with arthroscopy.⁶ Because many people over 50 have tears that cause no symptoms,³ Dr. Dold always interprets the MRI together with your symptoms and exam.

Yes, some can. Tears at the back of the inner meniscus, called ramp lesions, are often hidden. In one study of patients having ACL reconstruction, about 4 in 10 had a medial meniscus tear, and 40% of those tears were ramp lesions, many of which were found only by looking carefully at the back of the knee during arthroscopy.⁷ Dr. Dold checks for these at surgery.

Usually not, but a knee that is locked and cannot straighten should be seen promptly, because a displaced bucket-handle tear is often best repaired early. Most other tears can be evaluated in a routine visit.

Yes, many can, especially degenerative tears in people over about 40 and small stable tears. Treatment includes physical therapy focused on strengthening, activity changes, anti-inflammatory medication and, sometimes, an injection.

Usually not at first. For most degenerative tears, Dr. Dold recommends physical therapy first, based on strong evidence. A trial in patients with a tear and mild arthritis found similar improvement at 6 months with therapy or surgery, although 30% of the therapy group later chose surgery.⁸ Another trial found exercise therapy as effective as partial meniscectomy at 2 years.⁹ A third found partial meniscectomy no better than placebo (sham) surgery.¹⁰ International guidelines and research reviews advise against arthroscopic surgery as the first treatment for degenerative tears and degenerative knee disease.^11,12,13

When symptoms continue despite a good course of therapy, or when a torn fragment is clearly causing the knee to lock. The AAOS guideline says partial meniscectomy can be used for patients with mild to moderate arthritis who have not improved with physical therapy or other non-surgical treatment.¹⁴ Interestingly, one trial found that occasional catching or locking from a degenerative tear did not improve more after meniscectomy than after sham surgery.¹⁵

For tears in younger, active patients that are unstable or repairable, bucket-handle tears that lock the knee, tears that occur with an ACL tear, and root tears. For these tears, international experts recommend saving the meniscus as the first choice whenever possible.¹⁶

A tear that changes how the meniscus carries load, especially a root tear or a large tear, can increase wear on the cartilage over time. Removing meniscus tissue also increases arthritis risk.^1,2 Repairing tears that can be repaired helps protect the knee.¹⁷ If you already have arthritis, see knee osteoarthritis.

A steroid injection may relieve pain and swelling, mainly in knees that also have arthritis, but it does not heal the tear. Biologic injections such as PRP are sometimes discussed; research is ongoing, they are not FDA-approved to heal meniscus tears, and they are often not covered by insurance. Dr. Dold will discuss whether an injection makes sense for you.

Knee arthroscopy, through small incisions with a camera, allows Dr. Dold to either repair the tear with stitches so it can heal, or perform a partial meniscectomy, trimming away only the torn, unstable part and keeping as much healthy meniscus as possible. For some root tears, a root repair reattaches the meniscus to the bone, and for patients who have lost most of a meniscus, a meniscal allograft transplant may be an option.

Dr. Dold’s approach is to save the meniscus whenever the tear pattern and tissue allow it. The decision depends on the tear’s type, location and blood supply, tissue quality, your age and activity, and whether the ACL is also being reconstructed. The final decision is often made at surgery, once the tear can be seen directly, so Dr. Dold will discuss both possibilities with you beforehand.

Trimming has a faster recovery, but it permanently removes cushioning. Repair has a longer recovery and a higher chance of needing another surgery, but better long-term protection. In a review, reoperation was needed after about 20.7% of repairs vs 3.9% of partial meniscectomies, but repairs had better function scores and less arthritis on imaging.¹⁸ In a long-term study, 80.8% of repaired knees showed no progression of arthritis vs 40% after meniscectomy, and 96.2% vs 50% returned to their previous sport level.¹⁷

Dr. Dold uses all-inside repair devices, which place strong sutures across the tear from inside the joint through the arthroscopy portals, usually without extra incisions. A review found similar failure rates for all-inside and inside-out techniques (about 10% vs 11%).¹⁹ See arthroscopic meniscus repair.

Small holes are made in the bone in the notch of the knee to release bone marrow, which contains healing cells and growth factors, into the joint around the repair. Dr. Dold uses it to support healing of meniscus repairs. In a randomized trial, tears repaired with marrow venting healed in 100% of patients vs 76% without it.²⁰ Repairs done together with an ACL reconstruction benefit from a similar effect from the tunnels, and isolated repairs with marrow venting have shown similar failure rates to repairs done with ACL reconstruction.²¹

Platelet-rich plasma (PRP) or bone marrow aspirate concentrate (BMAC), taken from your own body, are options Dr. Dold may add to support healing. A small randomized trial found higher healing rates when PRP was added to bucket-handle repairs (85% vs 47%).²² Research is ongoing, these treatments are not FDA-approved for this use and may not be covered by insurance, and Dr. Dold will discuss whether they are right for you.

Dr. Dold repairs repairable meniscus tears at the same surgery as the ACL reconstruction. In a large multicenter study, about 14% of meniscus repairs done with ACL reconstruction had failed at 6 years, and patients’ outcome scores remained improved.²³ See the ACL surgery Q&A.

Age alone does not rule out repair. A systematic review found that failure rates after repair did not differ between patients above and below ages 25, 30, 35 or 40.²⁴ Tear type and tissue quality matter more.

General anesthesia, usually with an adductor canal nerve block that numbs the front and inner knee for several hours. In a randomized trial of knee arthroscopy, the block reduced pain and opioid use after surgery.²⁵

Yes. Meniscus surgery is outpatient, and patients go home the same day.

Yes. Dr. Dold takes photos inside your knee during surgery and reviews them with you at your first post-operative visit, so you can see the tear and how it was treated.

The roots are the attachments that anchor the front and back of each meniscus to the shinbone. When a root tears, the meniscus can slide out of the joint and stop carrying load. These tears are common in middle-aged patients, can follow a minor squat or twist, and are often felt as a sudden pop at the back of the knee.

A root tear can be as damaging as having the whole meniscus removed. In laboratory testing, a medial root tear increased peak cartilage pressure by 25%, similar to removing the meniscus, and repair restored it to normal.²⁶ Similar findings were seen for the lateral root.²⁷ Left untreated, medial root tears often lead to worsening arthritis: in one study, 87% of patients treated without surgery failed treatment and 31% needed a knee replacement within about 2.5 years.²⁸

Dr. Dold performs a transtibial pull-out repair: sutures are passed through the torn root and pulled through a small tunnel in the shinbone, then secured, to reattach the root where it belongs.

In a study with at least 5 years of follow-up, all knees with a root repair were still functioning without failure, compared with 75% after partial meniscectomy, with better clinical and X-ray results after repair.²⁹ A modelling study estimated that over 10 years, repair would lower the rate of arthritis (53% vs 99% after meniscectomy and 95% without surgery) and knee replacement (33.5% vs 51.5% and 45.5%) and cost less.³⁰ Results are best before significant arthritis has developed.

For younger patients with pain after losing most of a meniscus, a donor meniscus can be transplanted and secured in the knee. The goal is to restore cushioning, relieve pain and protect the cartilage. In a review with at least 10 years of follow-up, about 73.5% of transplants were still in place at 10 years and 60.3% at 15 years.³¹ Alignment and cartilage problems are often addressed at the same time; see knee osteotomy and cartilage transplantation.

A repaired meniscus needs time to heal back together. Keeping weight off the leg, or only resting the toes on the ground (toe-touch weight bearing), and avoiding deep bending protect the stitches while the tissue heals. This is the main trade-off for keeping your meniscus.

It is similar to other repairs at first: non-weight bearing or toe-touch weight bearing on crutches for about 6 weeks and avoiding deep bending, then a gradual return to strengthening. Running usually starts at about 5 to 6 months, later than after other meniscus repairs.

Within a week of surgery. Early therapy focuses on swelling control, getting the knee straight and quadriceps activation, then progresses to motion, strength, balance and finally sport-specific training.

Usually at about 4 to 6 months, once strength and control have returned. A review of isolated meniscus repairs found that 89% of athletes returned to their pre-injury level, typically at about 4 to 6.5 months.³²

Ice, elevation, a compression wrap and your prescribed medication, especially for the first few days. Most patients need narcotic pain medication only briefly, if at all.

Most repairs heal. Across studies, about 1 in 5 isolated repairs eventually needs another procedure,^18,32 and failure rates are lower when the repair is done with an ACL reconstruction.²³ If a repair does not heal, the torn part can usually be trimmed later.

Short-term results for tears from an injury are usually good, with a quick return to activity, and only about 4% of patients need another operation.¹⁸ The long-term concern is a higher risk of arthritis because cushioning has been removed.^2,17

Serious complications are uncommon. Risks include failure of the repair to heal, stiffness, infection, nerve irritation around the knee, blood clots and anesthesia-related risks. Symptomatic blood clots after knee arthroscopy are uncommon.³³ Dr. Dold will review your individual risks at your consultation.

Call for fever, increasing redness or drainage from the incisions, increasing calf pain or swelling, or pain not controlled by your medication. Go to the emergency room for chest pain or shortness of breath.

Meniscus surgery is covered by most insurance plans when it is medically necessary. Biologic add-ons such as PRP or BMAC may not be covered. Dr. Dold accepts most major insurance plans, including Medicare and Tricare; please call 469-850-0680 to confirm your coverage. See insurance.

Practice using crutches before surgery, set up your home so you can move around safely, arrange a ride and help for the first few days, and plan time off work and driving based on which knee and which procedure.

Request an appointment online or call 469-850-0680. Walk-in visits are welcome Monday, Wednesday and Friday, 8:30 to 10:30 am.