Meniscal Repair
The meniscus is a crescent-shaped cartilage structure in the knee that acts as a shock absorber, helps distribute load across the joint, and contributes to knee stability. Each knee has two menisci — a medial (inner) and a lateral (outer) meniscus.
Meniscal tears are common and can occur following a twisting injury, sporting activity, or gradually due to degeneration. Not all meniscal tears require surgery, and treatment depends on the type of tear, symptoms, age, activity level, and knee stability.
When is Meniscal Repair Recommended?
Meniscal repair aims to preserve and heal the meniscus, rather than remove it. Preserving the meniscus is important because removal increases the risk of early arthritis.
A meniscal repair may be recommended when:
- The tear is in a repairable zone (good blood supply)
- The tear pattern is suitable (e.g. longitudinal, bucket-handle)
- The knee is stable (or stability is being restored, e.g. with ACL reconstruction)
- Symptoms persist despite appropriate non-surgical treatment
- The goal is long-term joint preservation, particularly in younger or active patients
Some tears — particularly degenerative or complex tears — are not suitable for repair, and alternative treatments may be discussed.
Meniscal Repair vs Meniscectomy
There are two main surgical approaches to meniscal tears:
Meniscal Repair
- The torn meniscus is sutured and allowed to heal
- Longer rehabilitation period
- Better long-term protection of the knee joint
- Lower risk of developing arthritis in the future
Partial Meniscectomy
- The damaged portion of the meniscus is trimmed and removed
- Faster early recovery
- Higher long-term risk of cartilage wear and arthritis
Where a repair is possible, it is generally preferred to removal. Meniscal repairs have a higher re-operation rate than meniscectomy in the short term, but this reflects the goal of preserving tissue rather than removing it.
The Procedure
Meniscal repair is performed using keyhole (arthroscopic) surgery, usually under general or spinal anaesthetic.
- Small incisions are made around the knee
- A camera is used to assess the meniscus and joint surfaces
- The tear is repaired using specialised sutures or devices
- If required, additional procedures (e.g. ACL reconstruction) may be performed at the same time
The procedure typically takes 30–90 minutes, depending on complexity.
A large bucket handle type tear can require the placement of multiple sutures either using an ‘all inside’ technique, an ‘inside out’ technique or more typically a combination of both. Additional incisions maybe required if these ‘inside out’ sutures are required. If the meniscal tear is fresh and the location of the tear is towards the joint periphery, were the blood supply is better, then the chance of the meniscal repair healing is greater. In some circumstances a fibrin clot can be used to enhance the success of this healing process.
Recovery & Rehabilitation
Rehabilitation after meniscal repair is more protective than after meniscal trimming, as the meniscus needs time to heal.
Early Phase (0–6 weeks)
- Crutches are often required initially
- Full weight-bearing is commonly permitted
- A brace is frequently used to limit knee movements to protect the repair
- Early physiotherapy focuses on swelling control, range of motion, and muscle activation
Mid Phase (6–12 weeks)
- Gradual increase in range of movement and strengthening
- Weaning off the Knee brace
Later Phase (3–6 months)
- Progressive strengthening and functional exercises
- Return to higher-impact activity and sport is guided by healing, strength, and physiotherapy progression
Full recovery can take 4–6 months, and sometimes longer depending on the tear and associated procedures.
Frequently Asked Questions
Will my meniscus definitely heal after repair?
Most repairs heal successfully, but healing depends on tear type, blood supply, knee stability, and rehabilitation compliance. There will be a discussion about the likelihood of success based on the pattern and location of your tear.
Why is rehabilitation slower than after meniscus trimming?
The repaired meniscus needs time to heal. Protecting it early improves the chance of long-term success.
Can meniscal repair be done with ACL surgery?
Yes — meniscal repair is commonly performed at the same time as ACL reconstruction and healing rates are often better when the knee is stabilised.
When can I return to sport?
Return to sport is usually considered between 4–6 months, depending on healing, strength, and functional testing unless ACL reconstruction has been performed at the same time when the return to sport is >12 months.