What is the meniscus?
The menisci are two C-shaped fibrocartilage pads that sit between the femur and tibia in each knee. They distribute load across the joint, provide stability, and absorb shock. Losing meniscus tissue — either through injury or surgery — increases the risk of developing osteoarthritis over time. This is why preserving as much meniscus as possible is a core principle of modern knee surgery.
Repair vs resection — how we decide
The decision depends primarily on the location of the tear. The outer third of the meniscus (the "red zone") has a blood supply and can heal after repair. The inner two-thirds (the "white zone") are avascular and cannot heal — tears in this area are treated with partial resection (removing the unstable fragment).
Tear characteristics favouring repair
- Location in the vascular outer third (red-red or red-white zone)
- Vertical or longitudinal tear pattern
- Tear length suitable for suture fixation (≥10mm)
- Younger patient, stable knee
- Concurrent ACL reconstruction (improves healing environment)
What the long-term evidence shows: A systematic review (Smuin et al., Arthroscopy, 2017) found that at long-term follow-up (greater than 4 years), preservation of meniscus tissue (partial resection rather than total meniscectomy) is associated with significantly better patient-reported outcomes. This reinforces the principle that meniscal tissue should be preserved whenever technically feasible.
Partial meniscectomy (resection)
When repair is not possible — due to tear location, poor tissue quality, or complex tear pattern — partial meniscectomy removes only the unstable fragment while preserving as much healthy meniscus as possible. It is performed arthroscopically and is one of the most common orthopaedic procedures. Recovery is fast: most patients are weight-bearing within days and return to normal activity within 4–6 weeks.
Meniscus repair
Repair is preferred whenever possible. Sutures are placed arthroscopically to close the tear. Recovery is longer than after resection — protected weight-bearing for 4–6 weeks, and return to sport at 4–6 months. The trade-off in longer rehabilitation is preservation of long-term joint health.
Meniscus tears frequently occur alongside ligament injuries. If you have a concurrent ACL or PCL injury, see the article on ACL reconstruction.
References (PubMed)
Smuin DM, Swenson RD, Dhawan A. Saucerization Versus Complete Resection of a Symptomatic Discoid Lateral Meniscus at Short- and Long-term Follow-up. Arthroscopy. 2017;33(9):1733–1742. DOI: 10.1016/j.arthro.2017.03.028