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.
Medial meniscus posterior root tear (MMPRT)
A posterior root tear is a distinct — and increasingly recognized — pattern of meniscus injury, most common in middle-aged and older patients. It's often triggered by a simple, everyday movement such as squatting, kneeling, or twisting, rather than a sports injury. Because the posterior root anchors the meniscus firmly to the tibia, a root tear releases the meniscus from that anchor point and effectively disables its ability to distribute load across the joint — biomechanically similar to a total meniscectomy, even though the meniscus tissue itself is largely intact.
Left untreated, an MMPRT accelerates cartilage wear and the progression of osteoarthritis in the affected compartment, sometimes rapidly. Patients often describe a sudden, sharp pain on the inner side of the knee, followed by swelling, rather than a single dramatic injury.
Who is a good candidate for root repair?
- Mild to moderate pre-existing arthritis on X-ray (advanced arthritis reduces the benefit of repair)
- Mild leg malalignment (significant varus/bow-leg deformity may need to be corrected first or at the same time)
- Acute or subacute presentation — the sooner it's addressed, the better the joint environment for repair
- Willingness to follow a protected weight-bearing protocol for several weeks after surgery
Repair typically uses a transtibial pullout technique — the torn root is re-anchored to its native footprint on the tibia arthroscopically, restoring the meniscus's ability to resist hoop stress. According to PubMed, a systematic review by Lee et al. (Hanyang University, Medicine, 2020) analyzing 655 patients across 17 studies found that repair produced significantly better functional outcomes than non-repair treatment in appropriately selected patients, though neither approach fully prevented arthritic change on long-term imaging. DOI: 10.1097/MD.0000000000019499
According to PubMed, a Japanese cohort study (Furumatsu et al., Okayama University Hospital, The Knee, 2022) followed 32 patients for a mean of 36 months after pullout repair and found consistent improvement in clinical scores — though it also noted that repair does not fully halt the progression of arthritis, and recommended monitoring the opposite knee as well, since a new MMPRT or the need for knee replacement occasionally occurred there too. DOI: 10.1016/j.knee.2022.08.010
If your leg is already significantly bowed: a root repair alone may not be enough to protect the joint. In that situation, realigning the leg (HTO) is sometimes performed together with, or before, the root repair.
Driving, Work & Follow-Up
Typical logistics (individual recovery varies — we'll set your specific timeline together)
- Driving: After meniscectomy: often within 1–2 weeks. After repair: typically 2–4 weeks, reflecting the more protected recovery.
- Desk / remote work: Meniscectomy: often within a few days to a week. Repair: 1–2 weeks.
- Physical or manual work: Meniscectomy: 2–4 weeks. Repair: several weeks to a few months, tied to the protected weight-bearing protocol.
- Follow-up visits: A wound/progress check around 2 weeks, then further visits timed to your specific tear pattern and treatment.
Frequently Asked Questions
Can I travel to Japan or coordinate this from abroad?
Yes. I regularly coordinate care for international and expatriate patients. Initial questions and your imaging can often be reviewed remotely, with the consultation and surgery itself scheduled around a visit to Tokyo. I'll help you plan the timing, and follow-up afterward can be managed with a mix of in-person visits and remote communication with you or your local physician.
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
Lee JK, Jung M, Yang JH, et al. Repair versus nonrepair of medial meniscus posterior root tear: a systematic review of patients' selection criteria, including clinical and radiographic outcomes. Medicine (Baltimore). 2020;99(10):e19499. DOI: 10.1097/MD.0000000000019499
Furumatsu T, Miyazawa S, Kodama Y, et al. Clinical outcomes of medial meniscus posterior root repair: a midterm follow-up study. Knee. 2022;38:141–147. DOI: 10.1016/j.knee.2022.08.010