Overview
Each knee has two menisci: one on the inner side (medial) and one on the outer side (lateral). They are C-shaped wedges of tough cartilage that sit between the rounded end of the femur and the flat top of the tibia. They act as shock absorbers, spreading force over a wider area of cartilage. Only the outer third of each meniscus (the "red zone") has a meaningful blood supply. The inner two-thirds (the "white zone") gets no direct blood flow and cannot heal on its own after a tear. When a tear falls within the zone that has blood supply, there is a reasonable chance that stitching the torn edges back together will let the tissue heal. That preserves the meniscus and its protective role. Trimming away a torn meniscus (partial meniscectomy) relieves pain quickly but speeds up cartilage wear over the following years. Meniscus repair takes longer to recover from. But for patients with healable tears, the long-term benefit to the joint is substantial.
How the Procedure Works
We choose the stitch technique based on where in the meniscus the tear sits. Tears at the back of the meniscus are repaired with stitches placed entirely through the scope, with no extra incisions. Tears in the middle often need stitches tied through a small incision on the back of the knee, which gives the strongest possible hold. Tears near the front are stitched through the skin. Before any stitch goes in, we freshen the torn edges so they can heal. A tear stitched over unprepared tissue heals much less reliably. We place enough stitches to close the tear fully, then move the knee through its range of motion before finishing. If the repair opens under load, we add more stitches. An ACL reconstruction done at the same time actually helps the meniscus heal, so we do not avoid fixing a meniscus when an ACL reconstruction is also planned.
When to Consider Meniscus Repair
Meniscus repair is generally offered when symptoms, imaging, and a trial of non-operative care together point to surgery as the next step. The typical picture includes:
Traumatic longitudinal tear
A vertical tear in the outer zone of the meniscus, where the blood supply is. This is the pattern most likely to heal.
Younger patient, active lifestyle
Healing potential is higher and the long-term benefit of preserving the meniscus is greatest in patients with decades of activity ahead.
Root tears
A root tear pulls the meniscus off its bony anchor, which uncaps the joint. These tears should almost always be repaired rather than trimmed away.
Treats: Meniscus Tear
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a tear that grows, a knee that catches, and a meniscus that loses the shock-absorbing role protecting the cartilage behind it. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss with you before meniscus repair include:
- bleeding and infection
- anesthesia risk
- stiffness
- failure of the repair to heal, sometimes requiring a second procedure
- irritation of a skin nerve (the saphenous nerve) on the inner side of the knee
- blood clot in the leg or lung
We proceed when the tear pattern is repairable and the meniscus is worth saving. That typically means younger, active patients with tears in the blood-supplied outer zone. If the operation is not right for you, we will say so.
Frequently Asked
questions we hear in clinicWhy not just trim the tear out?
Trimming away a torn meniscus (partial meniscectomy) relieves pain quickly but speeds up cartilage wear over the following years. Repair takes longer to recover from, but for patients with healable tears the long-term benefit to the joint is substantial: the meniscus keeps its shock-absorbing, protective role.
Can every tear be stitched?
No. Only the outer third of each meniscus (the "red zone") has a meaningful blood supply; the inner two-thirds gets no direct blood flow and cannot heal on its own. We proceed when the tear pattern is repairable and the meniscus is worth saving, typically in younger, active patients with tears in the blood-supplied outer zone.
Will I need extra incisions?
It depends on where the tear sits. Tears at the back of the meniscus are repaired with stitches placed entirely through the scope, with no extra incisions. Tears in the middle often need stitches tied through a small incision on the back of the knee, which gives the strongest hold. Tears near the front are stitched through the skin.
What if I also need an ACL reconstruction?
An ACL reconstruction done at the same time actually helps the meniscus heal, so we do not avoid fixing a meniscus when an ACL reconstruction is also planned.
What happens if the repair doesn't heal?
Failure of the repair to heal, sometimes requiring a second procedure, is one of the risks we discuss before surgery. To stack the odds, we freshen the torn edges before any stitch goes in, place enough stitches to close the tear fully, and test the repair through a range of motion before finishing.
Further Reading
External patient-education references and related OSI pages for additional background:
