What the meniscus is

The Knee's Shock Absorber

The knee has two menisci — the medial (inner) and the lateral (outer). They are C-shaped structures, made of fibrocartilage, that act as shock absorbers between the femur and the tibia.

The menisci distribute joint load, stabilise the knee, lubricate the cartilage and limit excessive extension and flexion. Preserving them is essential: removing more than 20% of the meniscus significantly increases stress on the cartilage and the risk of osteoarthritis.

A meniscal tear can occur through acute trauma (sport, a fall, a twist) or through progressive degeneration (older patients, chronic overload). Symptoms include pain, swelling, a sense of locking and crepitus.

The current philosophy is to preserve as much of the meniscus as possible. Partial meniscectomy can triple the joint load in the affected compartment — accelerating cartilage degeneration.

The Zones of the Meniscus Determine the Treatment

Meniscal healing depends on the blood supply. Only the periphery of the meniscus is vascularised — and it is there that tears can heal and be repaired. The avascular centre has very limited healing capacity.

Red Zone (Red-Red)

Vascularised periphery. Best healing potential. Meniscal repair is possible and preferable — especially in younger patients.

Mixed Zone (Red-White)

Intermediate vascularisation. Variable healing. Repair may be attempted, depending on the type and extent of the tear.

White Zone (White-White)

Avascular centre. Very limited healing. Tears here are usually treated with partial meniscectomy — preserving as much as possible.

Types of Tear

What Type of Tear Do I Have?

The type, location and extent of the tear are the main determinants of the treatment decision.

Longitudinal (Vertical) Tear

In the vascularised periphery. Common after ACL injury. A good candidate for arthroscopic repair with sutures.

Frequently repaired

Bucket Handle

Extensive longitudinal tear with a displaced fragment. Can cause knee locking. Repair when the tissue is of sufficient quality.

Repair if possible

Radial Tear

Perpendicular to the fibres. Harder to repair. Treatment depends on location and extent.

Case by case

Flap Tear

Unstable, partially detached fragment. In the avascular zone, partial meniscectomy is often the best option.

Partial meniscectomy

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Horizontal Tear

Parallel to the joint plane. Common in degeneration. Difficult to repair — conservative treatment or partial meniscectomy.

Conservative / partial

Degenerative Tear

Poor-quality tissue, multiple cleavages. Conservative treatment is first line — surgery only if it fails after 3 months.

Conservative first line

Conservative, Repair or Remove?

The current philosophy is to preserve the meniscus as much as possible. Partial meniscectomy can triple the joint load in the compartment and accelerate osteoarthritis — it should be reserved for cases where repair is not feasible.

Conservative Treatment

Small, stable and peripheral tears
Degenerative tears (first line for 3 months)
Patient with low functional demand
RICE (rest, ice, compression, elevation)
Anti-inflammatories and physiotherapy
Follow-up with MRI

Arthroscopic Surgery

Repair: peripheral tear, younger patient, good tissue quality
Repair: especially when associated with ACL injury
Partial meniscectomy: avascular zone, degenerated tissue
Mechanical locking of the knee — urgent indication
Failure of 3 months of conservative treatment
Athlete needing a rapid return to sport

ESSKA/AOSSM 2024 consensus: Meniscus preservation is the reference surgical philosophy. Partial meniscectomy is second line for degenerative tears (after 3 months of conservative treatment) and the option when repair is not technically feasible.

Recovery

What to Expect After Treatment

Recovery time varies significantly between partial meniscectomy and meniscal repair.

Partial Meniscectomy

Return to work: 1–2 weeks

Immediate walking, without crutches in most cases
Physiotherapy for muscle recovery and range of motion
Return to sedentary work: 1–2 weeks
Return to sport: 4–8 weeks
Long-term monitoring of the cartilage

Meniscal Repair

Return to sport: 4–6 months

Partial weight-bearing with crutches for the first 4–6 weeks
Restricted flexion in the first few weeks (to protect the suture)
Longer, more progressive physiotherapy
Return to sedentary work: 2–4 weeks
Return to sport: 4–6 months (meniscal healing)

Questions About the Meniscus

In most cases, not immediately. Small, stable tears, especially degenerative ones, often respond to conservative treatment. Surgery is reserved for mechanical locking, failure of conservative treatment after 3 months, or unstable tears in active patients.

Whenever technically possible, repair is preferable. The meniscus has vital functions of shock absorption and load distribution. Removing more than 20% of the meniscus significantly increases stress on the cartilage and the long-term risk of osteoarthritis. Repair requires more recovery, but it protects the knee in the long term.

A combined ACL + meniscal tear is very common. In these cases, meniscal repair has better outcomes when performed at the same time as ACL reconstruction, because the postoperative biological environment favours healing. The decision to repair or remove the meniscus is made arthroscopically, assessing the quality of the tissue.

Yes. After partial meniscectomy, most patients return to sport within 4–8 weeks. After meniscal repair, the process is more gradual — return to contact sport between 4 and 6 months, waiting for the repaired meniscus to heal.

Meniscal Tear — Surgery Is Not Always the Answer