Sports MedicineKneeSurgery Center

Meniscus Repair

Fellowship-trained sports medicine surgeons Christopher Raffo, MD, John Christoforetti, MD, and James Gardiner, MD perform arthroscopic meniscus repair with a repair-first philosophy, removing tissue only when the tear pattern makes healing biologically unlikely.

Duration: 45–75 minutesAnesthesia: General or regional

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What is meniscus repair?

Meniscus repair is a minimally invasive arthroscopic surgery that stitches a torn meniscus back together rather than removing tissue. The goal is to preserve the meniscus — the knee's shock absorber — because long-term studies show that keeping meniscus tissue reduces the risk of early-onset knee arthritis. Surgery takes 45 to 75 minutes at an ambulatory surgery center.

Why this approach — at MOS

At MOS, we operate with a repair-first philosophy: if a tear has any reasonable prospect of healing, we attempt repair before considering removal. This requires more demanding post-operative restrictions than meniscectomy — a longer period of non-weight-bearing and protected flexion — but the long-term benefit to joint preservation is well established in the literature, and we believe it is the correct choice for the appropriately selected patient.

We use a combination of suture techniques chosen for each tear pattern: all-inside implants for posterior horn tears, inside-out sutures for mid-body tears where the extra-capsular knot placement can be precisely controlled, and augmentation with fibrin clot or platelet-rich plasma in selected complex repairs to improve the biological environment for healing.

One clinical context where we are particularly attentive to meniscus repair is concurrent ACL reconstruction. The ACL reconstruction itself creates a biological environment — marrow elements released during tunnel drilling circulate through the joint — that appears to improve meniscus healing rates. We therefore make an active effort to repair repairable tears at the time of ACL reconstruction rather than leaving them alone or removing tissue. Patients who come to Bethesda or any of our other offices for ACL reconstruction with a co-existing meniscus tear are counseled that simultaneous repair, when the tear is in a repairable zone, is generally the preferred approach.

Who is a candidate?

Indications

Peripheral longitudinal (red-zone) tear: the ideal repair candidate — good blood supply, tear runs parallel to the meniscal rim
Bucket-handle tear: large longitudinal tear that displaces and locks the knee; usually repairable in younger patients
Acute traumatic tear in an athlete or active adult, especially in association with ACL reconstruction (combined repair performed at the same surgery)
Radial tear extending into the vascular zone in a young patient
Symptomatic tear causing pain, swelling, locking, or giving way that has not improved with conservative management

Contraindications

White-zone (central) tear with poor vascularity and degenerative tissue quality — tissue cannot heal and partial meniscectomy is more appropriate
Irreparable macerated or complex tear pattern seen at arthroscopy
Advanced osteoarthritis in the same knee compartment (repair will not reduce symptoms if joint space is already collapsed)
Significant medical comorbidities making surgery unsafe
Degenerative tear in an older, low-demand patient who has not tried conservative treatment

Conservative Treatment First

Many meniscus tears — particularly degenerative tears in patients over 40 with low-grade symptoms — respond to non-surgical management. A structured program includes rest and activity modification to reduce provocation of symptoms, anti-inflammatory medication (NSAIDs), physical therapy focused on quadriceps and hip strengthening to reduce joint load, and occasionally a corticosteroid injection for acute pain and swelling. Research has shown that for middle-aged and older patients with degenerative meniscus tears and minimal or no osteoarthritis, supervised physical therapy produces outcomes equivalent to arthroscopic surgery at 2 years.

However, conservative management has clear limits. Locked knees (where a displaced bucket-handle fragment blocks full extension) require urgent surgical intervention. Young athletes with traumatic tears in the repairable zone, and patients with persistent mechanical symptoms — locking, catching, giving way — despite 6–8 weeks of therapy are appropriate surgical candidates. The presence of a concurrent ACL tear that will require reconstruction also changes the calculus, since addressing the meniscus tear at the time of ACL surgery adds minimal additional morbidity and repairs heal better in the biological environment created by marrow elements released during tunnel drilling.

The procedure

What Is Meniscus Repair?

The knee has two menisci: the medial (inner) and lateral (outer). These C-shaped wedges of fibrocartilage sit between the femur (thighbone) and tibia (shinbone) and serve multiple functions simultaneously — they distribute load across the joint surface, provide secondary stability, guide normal joint motion, and nourish the articular cartilage. Losing meniscus tissue through removal (meniscectomy) significantly increases contact pressure on the articular cartilage, which accelerates wear over time.

Meniscus tears are among the most common knee injuries in both athletes and active adults. They happen acutely from a twisting injury — a sudden pivot while the foot is planted — or they develop gradually as the tissue degenerates with age. Tears are classified by their location, pattern (longitudinal, radial, horizontal, bucket-handle), and their blood supply zone. The outer one-third of the meniscus has a good blood supply (the "red zone") and heals reliably when repaired. The inner two-thirds (the "white zone") has poor vascularity and does not heal well; tears in this zone are generally treated with partial removal rather than repair.

Repair is the preferred option when the tear pattern and location allow healing. Not every tear is repairable — the surgeon determines this based on MRI findings and, critically, direct arthroscopic inspection at the time of surgery. When repair is possible, the long-term benefit to joint preservation makes it worth the additional rehabilitation time that repair requires compared to meniscectomy.

What Happens During Meniscus Repair?

Before Surgery

You arrive at the ambulatory surgery center and meet your anesthesia team. Most patients have general anesthesia; regional anesthesia (femoral or adductor canal nerve block) may be added for enhanced post-operative pain control. A nerve block does not replace general anesthesia but reduces opioid requirements afterward. Your knee is marked and confirmed before you enter the operating room.

Positioning

You are positioned supine on the operating table with the operative leg in a leg holder. A lateral post helps stabilize the thigh while the knee is flexed and the joint opened. A tourniquet is placed on the upper thigh.

Arthroscopic Inspection

Small portal incisions are made — typically one on the outer (lateral) side for the camera and one on the inner (medial) side for instruments. The surgeon methodically examines the entire joint: articular cartilage surfaces, the medial and lateral menisci, the ACL, PCL, and other structures. The tear is identified and characterized — its zone, pattern, length, and tissue quality are assessed to confirm that repair is feasible.

Tear Preparation

The torn edges of the meniscus are freshened — the surgeon uses a small shaver or rasp to remove the thin layer of non-vascular fibrous tissue on the tear surfaces and stimulate bleeding. This step is essential: it improves the blood supply to the repair site and is directly correlated with healing success. A small notch or channel may be made in the adjacent vascular zone to further enhance vascularity.

Suture Placement

Sutures are passed through the meniscus using specialized curved needles or suture-passing devices. Several techniques are used depending on tear pattern and location: inside-out (needles passed from inside the joint through the capsule, tied over the capsule), outside-in (needles passed from outside the skin through the meniscus), or all-inside (suture anchors deployed entirely within the joint). Vertical mattress sutures provide better tissue capture and stronger fixation than horizontal sutures; most contemporary repairs use a combination of vertical mattress and other configurations to achieve biomechanical security.

Closure and Dressing

Portal sites are closed with sutures or staples. The knee is wrapped with compressive dressing, and a hinged brace is fitted in the recovery room.

Recovery Room

Most patients spend 1–2 hours in recovery before going home. You need an adult driver. Weight-bearing restrictions and brace instructions are reviewed before discharge.

Recovery timeline

Weeks 1–2 (Acute Phase)

Non-weight-bearing or toe-touch weight-bearing with crutches. Brace locked in extension. Ice and elevation essential for swelling. Quadriceps activation exercises begin immediately.

Weeks 3–6 (Protected Weight-Bearing)

Gradual weight progression depending on tear location and repair complexity. Brace typically unlocked for motion but flexion limited to 90° to reduce meniscal stress.

Weeks 6–12 (Progressive Loading)

Full weight-bearing without crutches for most patients. Range of motion progressed toward full flexion. Stationary bike and water walking introduced.

Months 3–4 (Functional Phase)

Light straight-line jogging when strength criteria are met. No squatting below 90° or pivoting activities.

Months 4–6 (Return to Sport)

Gradual return to pivoting, cutting, and sport-specific activities after passing strength and functional tests. Most athletic patients return to unrestricted sport at 4–6 months.

Meniscus repair requires significantly more patience than partial meniscectomy. The non-weight-bearing restriction in the first 4–6 weeks is not arbitrary — excessive load on the repair during early healing is a leading cause of re-tear. Deep knee flexion (beyond 90°) is also restricted because it compresses the posterior horn of the meniscus against the tibial plateau. These restrictions can be frustrating, but they exist to protect the repair during the biologically critical healing window.

MOS physical therapists follow a protocol designed specifically for meniscus repair patients and coordinate directly with the surgical team. If you are also recovering from a concurrent ACL reconstruction, your combined protocol accounts for both surgeries. Most patients are very satisfied with the results of successful repair — returning to the sports and activities they enjoy with a preserved knee — and report that the additional rehabilitation time was worth it.

Frequently Asked Questions

How do I know if my meniscus tear can be repaired?

Repairability depends on tear location, pattern, and tissue quality — factors that can be partially assessed on MRI but are confirmed at the time of arthroscopy. Peripheral (red-zone) tears close to the outer vascular rim are the best candidates. Inner white-zone tears have poor blood supply and do not heal reliably. Your surgeon will discuss MRI findings with you before surgery, but the final decision is made based on what the tear looks like under the arthroscope.

What is the difference between meniscus repair and meniscectomy?

Repair stitches the torn meniscus together so it can heal, preserving the tissue. Meniscectomy removes the torn portion of the meniscus. Repair is preferred because the meniscus performs important functions — load distribution, joint stability, and cartilage nourishment — that are lost when tissue is removed. The trade-off is that repair requires a longer, more restrictive recovery. Meniscectomy allows faster return to activity but removes tissue permanently.

What happens if my meniscus tear fails to heal after repair?

Reported healing rates for properly selected meniscus repairs are approximately 75–90% for peripheral tears. If a repair fails — confirmed on MRI or re-arthroscopy — the options are to attempt a revision repair (if tissue quality is adequate), or to perform partial meniscectomy of the unhealed portion. Re-tears after initially successful repair are less common but can occur with a new traumatic episode.

Can I avoid surgery for a meniscus tear?

Many tears, particularly degenerative tears in patients over 40, respond to physical therapy and do not require surgery. Acute traumatic tears in athletes, locked knees, and tears causing persistent mechanical symptoms despite conservative treatment are more likely to need surgery. Your surgeon will review your MRI and symptoms to advise whether a trial of therapy is reasonable before committing to surgery.

How long before I can play sports again after meniscus repair?

Most athletes return to full unrestricted sport at 4–6 months after isolated meniscus repair. Athletes who also had a concurrent ACL reconstruction typically return at 9–12 months. Return is based on passing objective strength and functional tests, not on a specific calendar date.

Will my meniscus grow back if removed?

No. Once meniscus tissue is removed surgically, it does not regenerate. This is why preservation through repair — when biologically feasible — is so important. For patients who have had significant prior meniscectomy and develop pain from a deficient meniscus, meniscus allograft transplantation (replacing the entire meniscus with a donor meniscus) is a separate procedure that can be considered in appropriate candidates.

Is meniscus repair performed as outpatient surgery?

Yes. Meniscus repair is performed at an ambulatory surgery center (ASC) and patients go home the same day. You will need a responsible adult to drive you home. Most patients find they need only over-the-counter pain medication by 48–72 hours after surgery, though prescription pain medication is provided for the first few days.