What are the modern treatment options for a meniscus tear?

A meniscus tear is one of the most common knee injuries. It frequently occurs in athletes during sports activities, but also in older individuals due to degeneration and loss of elasticity in the meniscus.

The latest guidelines from the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) and the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS), under the motto “Save the Meniscus”, aim to preserve as much of the meniscus as possible. When feasible, repairing the meniscus with sutures is preferred over removing the damaged tissue.

Preserving the meniscus improves knee function and helps prevent early onset of arthritic changes (osteoarthritis).

What are the menisci and what is their role?

The menisci are two cartilaginous structures inside the knee, positioned between the femur and the tibia. They are composed of a mesh of collagen fibers, proteoglycans, and glycoproteins. Their main function is to evenly distribute load during weight-bearing and walking, while also contributing to knee stabilization and lubrication. In this way, they protect the joint surfaces from wear and degeneration, helping to maintain a healthy knee joint.

Loss of part or all of the meniscus due to a tear can predispose the knee to degenerative changes and associated symptoms over time.

The healing potential of the meniscus after a tear is limited due to poor blood supply. Only the outer 10–30% of the meniscus is vascularized; the inner portion, which is deeper inside the joint, lacks blood supply.

When possible, meniscus repair with sutures is a key treatment option

How is a meniscus tear diagnosed?

Diagnosis is made through medical history, clinical examination, and MRI findings.
In athletes, a meniscus tear is often accompanied by other injuries, such as an anterior cruciate ligament (ACL) tear.

How is a meniscus tear treated?

Prompt treatment is recommended—either conservative or surgical—since delays may further damage the cartilage or enlarge the tear.

In cases of degenerative tears with mild symptoms, conservative treatment may include rest, cryotherapy, elastic knee support, and anti-inflammatory medication.

If the tear is traumatic with significant or worsening symptoms (e.g., swelling, inability to fully extend the leg), surgical intervention with arthroscopy is advised.

Arthroscopic Treatment

Through arthroscopy, the orthopedic surgeon uses two small incisions (just a few millimeters), a miniature camera (arthroscope), and specialized micro-instruments to locate and treat the damage.

There are three options: partial meniscectomy (removal of the damaged area), meniscal repair (suturing), or a combination of both.

The choice of method depends on the location and type of tear, any coexisting injuries, and other factors such as the patient’s age, activity level, and the knee’s anatomical structure. Postoperative recovery time also plays a key role in the decision-making process.

The orthopedic surgeon will discuss all available options with the patient beforehand. However, since the extent and type of damage cannot be fully assessed until the arthroscopy, the final decision is made during the procedure.

The patient is usually discharged on the same day.

Partial Meniscectomy (Removal)

When the tear is located in the central part of the meniscus—an area with poor blood supply—the surgeon carefully removes only the damaged tissue up to the edge of healthy meniscus and smooths any remaining frayed areas.

Recovery

Most patients return to daily activities within a few days and to sports activities within 10–20 days. A personalized strengthening program for the knee is also recommended.

When a sufficient amount of healthy meniscus remains, the patient typically has a good postoperative outcome with fast recovery and minimal complications. Unfortunately, removal of a large portion or the entire meniscus can gradually lead to the development of arthritis.

Meniscus Repair (Suturing)

In younger patients, as well as in older but active individuals—particularly when the tear is located on the outer edge of the meniscus (an area with good blood supply)—the orthopedic surgeon may choose to repair the torn part in order to preserve the meniscus.

Meniscus repair is a highly demanding procedure and is performed by specialized orthopedic surgeons.

Injuries affecting the “root” of the meniscus or the connection between the posterior horn of the meniscus and the joint capsule (known as Ramp lesions) should always be identified and repaired when possible.

Root Lesions

Recent studies have shown that if root lesions are not repaired, the protective function of the meniscus is lost, which is essentially equivalent to removing it. This can lead to early onset arthritis or even spontaneous osteonecrosis.

Treatment involves reattaching the root to its anatomical position using specialized arthroscopic techniques.

Ramp Lesions

These are often referred to as “hidden” injuries because they may not be visible on MRI or even during standard arthroscopy. These lesions cause meniscal instability, and if left untreated, can lead to persistent knee symptoms and eventual arthritis.

Their diagnosis and treatment require the use of a third posterior arthroscopic portal through which the lesion can be identified and sutured.

Recovery

Although the patient is typically discharged from the hospital a few hours after surgery, a complex rehabilitation program is necessary.

Recovery time after meniscus repair is longer than after partial meniscectomy. The patient must avoid bearing weight on the operated leg (non-weight bearing with crutches) for 4–6 weeks, followed by a muscle strengthening program (focusing on the knee) and physiotherapy.

Return to sports activities can gradually resume after approximately 3–4 months.