Informed Surgery
Patient guide

Meniscus surgery, explained

Meniscus tears range from sudden sports injuries in teenagers to slow wear that shows up on almost every MRI after middle age. The right treatment depends heavily on which kind you have. This guide walks through the evidence for both.

Independent and sourced. Written by a non-physician author with a medical device background, and not reviewed by a physician. Not medical advice. Last reviewed November 2026. How we write these guides.

The short version

  • For degenerative tears in middle-aged and older adults, trimming the meniscus (partial meniscectomy) did no better than sham surgery in a blinded trial.[1]
  • Physical therapy was as good as surgery for most people with these tears in two large trials, though about 3 in 10 people in the therapy groups went on to have surgery.[2][3]
  • A BMJ guideline panel made a strong recommendation against arthroscopic surgery for degenerative knee disease.[4]
  • Sudden, injury-related tears in younger people are different. Repairing the meniscus to save it is often the goal, and long-term results of repair are generally good.[5][6]
  • Catching and occasional locking weren't improved by trimming any more than by sham surgery.[8] A knee that is truly stuck and can't straighten is a different situation, and was excluded from the main trials.[3]

What the meniscus does

Each knee has two menisci, C-shaped pads of tough cartilage that sit between the thigh bone and the shin bone. They spread load across the joint, absorb shock and help keep the knee stable. Losing meniscus tissue raises the stress on the joint surface, which is why surgeons try to save as much as they reasonably can.

Only the outer part of the meniscus has a good blood supply. Tears in that outer zone are much more likely to heal after repair than tears in the inner part.

Two very different kinds of tear

Traumatic tears happen with a twist or pivot, often in sport, and often alongside an ACL tear. The tissue is usually healthy, and some tear patterns can be stitched back together.

Degenerative tears develop slowly as the meniscus wears with age. They are extremely common on MRI in people over 40, including many with no knee pain at all. They often come with early arthritis, and the torn tissue usually can't be repaired.

How common? In a study of 991 randomly selected adults aged 50 to 90 in Framingham, Massachusetts, meniscal tears showed up on MRI in 19% of women in their 50s and 56% of men aged 70 to 90. Of the people with a tear, 61% had no knee pain, aching or stiffness in the past month.[7]

Finding a tear on MRI doesn't prove the tear is causing your pain. Ask your surgeon how confident they are that it is.

Degenerative tears: what the trials found

Partial meniscectomy for degenerative tears has been tested in some of the most rigorous trials in orthopedics.

  • Sham surgery. In a Finnish trial, 146 people aged 35 to 65 with a degenerative tear and no arthritis were randomly assigned to real meniscectomy or a sham procedure, without knowing which they got. At 12 months, both groups improved by the same amount.[1]
  • Surgery vs physical therapy with arthritis. In the US METEOR trial, 351 people aged 45 and older with a meniscal tear and mild to moderate arthritis improved by similar amounts with surgery or a structured physical therapy program. About 30% of the therapy group chose surgery within 6 months.[2]
  • Surgery vs physical therapy without locking. In the Dutch ESCAPE trial, 321 people aged 45 to 70 with tears that didn't cause locking did as well with 16 sessions of exercise therapy over 8 weeks as with surgery over two years. 29% of the therapy group later had surgery.[3]

Two more trials and the long-term follow-ups point the same way:

  • In a Norwegian trial of 140 people averaging 50 years old, 12 weeks of supervised exercise gave the same knee function at two years as surgery, and built more thigh strength early on.[9]
  • At five years, the ESCAPE trial still found exercise therapy as good as surgery, with similar progression of arthritis on X-ray.[13]
  • At five years in METEOR, pain had improved a lot in both groups and stayed stable. People who ended up having meniscectomy had knee replacements more often, a finding the authors said needs more study.[12]
  • Pooling nine trials, a BMJ meta-analysis found arthroscopic surgery gave only a small, short-lived pain benefit that was gone by one to two years, with real if uncommon harms such as blood clots.[10]

On catching and locking: in the Finnish sham-surgery trial, about half the patients in each group reported catching or occasional locking before surgery, and trimming the meniscus didn't relieve these symptoms any better than the sham.[8]

Based on this body of evidence, a BMJ guideline panel made a strong recommendation against arthroscopic surgery for nearly all people with degenerative knee disease.[4]

Traumatic tears: repair or trim

When a healthy meniscus tears in an injury, surgeons can often stitch it (repair) instead of trimming it away. Repair keeps more of the cushion, which matters most for younger people who have decades of use ahead.

A systematic review of long-term studies, with at least 7 years of follow-up, found good results after meniscus repair, both alone and with ACL reconstruction, and only minor arthritis changes on X-ray in several studies. Failure rates were higher in studies of children and teens than in adults.[5]

A separate review of repairs in patients under 18 found good knee scores and a low failure rate overall, with about half done together with ACL reconstruction.[6]

A systematic review comparing repair and trimming found the trade-off clearly: repairs were reoperated more often (about 17 to 21% vs 1 to 4% for trimming), but where long-term data existed, repaired knees scored better and showed less wear on X-ray.[11]

Root tears

A root tear is where the meniscus tears off its anchor point on the bone, which lets it slide out of place and stop working as a cushion. It's most common at the back of the inner meniscus in middle-aged women. A review of 28 studies of root repair found consistent improvement in symptoms, but about half the patients still showed arthritis progression on X-ray over about four years, so repair seems to slow joint wear without stopping it.[14] Another review found repair was mostly used in knees with mild arthritis and good alignment, and that careful patient selection matters for both repair and non-repair.[15]

Repair has a trade-off: recovery is slower and more protected than after trimming, and some repairs don't heal and need another operation.

What happens in surgery

Meniscus surgery is done arthroscopically, through small incisions with a camera, usually as a same-day procedure.

  • Partial meniscectomy trims away the torn, unstable part and smooths the edge.
  • Repair uses sutures or small devices to hold the torn edges together while they heal. Some techniques need a small extra incision on the side of the knee.

Surgeons often can't be certain which they'll do until they see the tear. Ask what they expect and what you should prepare for in each case.

Recovery

Recovery depends much more on what was done than on the tear itself. This is a rough guide only.

  1. After trimmingMost people walk the same day or within a few days. Swelling settles over a few weeks, with gradual return to normal activity over roughly 4 to 6 weeks as strength comes back.
  2. After repairOften several weeks of limited weight-bearing and/or a brace that limits bending, to protect the stitches. Return to pivoting sport is commonly several months away, and longer when combined with ACL reconstruction.

Ask your surgeon which recovery plan applies if they end up trimming instead of repairing, or the other way around.

Risks

  • Repair failure, meaning the tear doesn't heal and may need more surgery.[5]
  • Faster wear of the joint after removing meniscus tissue, especially larger amounts.
  • Swelling and stiffness, usually temporary.
  • Infection and blood clots, which are uncommon.

Questions to ask your surgeon

  1. Is my tear from an injury or from wear? How sure are you that it's causing my symptoms?
  2. Have I tried enough physical therapy first? What would a good therapy plan look like?
  3. Does my knee actually lock, or does it catch and feel stiff?
  4. If I have surgery, do you expect to repair or trim? How likely is a repair to heal?
  5. How much meniscus would be removed if you trim it?
  6. What will recovery look like for each option, and when can I return to sport or work?

Recovery supplies

We're putting together vetted picks at a range of prices. For now, these are the usual categories:

  • Ice packs
  • Compression sleeve
  • Crutches (for repairs)
  • Leg elevation pillow
  • Resistance bands
  • Stationary bike access

If you have a repair, ask whether a brace is included before buying one.

Sources

  1. Sihvonen R, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013;369:2515-24. https://doi.org/10.1056/NEJMoa1305189
  2. Katz JN, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis (METEOR). N Engl J Med. 2013;368:1675-84. https://doi.org/10.1056/NEJMoa1301408
  3. van de Graaf VA, et al. Effect of early surgery vs physical therapy on knee function among patients with nonobstructive meniscal tears: the ESCAPE randomized clinical trial. JAMA. 2018;320:1328-37. https://doi.org/10.1001/jama.2018.13308
  4. Siemieniuk RAC, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline. BMJ. 2017;357:j1982. https://doi.org/10.1136/bmj.j1982
  5. Petersen W, et al. A systematic review about long-term results after meniscus repair. Arch Orthop Trauma Surg. 2022;142:835-44. https://doi.org/10.1007/s00402-021-03906-z
  6. Liechti DJ, et al. Meniscal repair in pediatric populations: a systematic review of outcomes. Orthop J Sports Med. 2019;7:2325967119843355. https://doi.org/10.1177/2325967119843355
  7. Englund M, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008;359:1108-15. https://doi.org/10.1056/NEJMoa0800777
  8. Sihvonen R, et al. Mechanical symptoms and arthroscopic partial meniscectomy in patients with degenerative meniscus tear: a secondary analysis of a randomized trial. Ann Intern Med. 2016;164:449-55. https://doi.org/10.7326/M15-0899
  9. Kise NJ, et al. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ. 2016;354:i3740. https://doi.org/10.1136/bmj.i3740
  10. Thorlund JB, et al. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ. 2015;350:h2747. https://doi.org/10.1136/bmj.h2747
  11. Paxton ES, et al. Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy. 2011;27:1275-88. https://doi.org/10.1016/j.arthro.2011.03.088
  12. Katz JN, et al. Five-year outcome of operative and nonoperative management of meniscal tear in persons older than forty-five years. Arthritis Rheumatol. 2020;72:273-81. https://doi.org/10.1002/art.41082
  13. Noorduyn JCA, et al. Effect of physical therapy vs arthroscopic partial meniscectomy in people with degenerative meniscal tears: five-year follow-up of the ESCAPE randomized clinical trial. JAMA Netw Open. 2022;5:e2220394. https://doi.org/10.1001/jamanetworkopen.2022.20394
  14. Chang PS, et al. Midterm outcomes of posterior medial meniscus root tear repair: a systematic review. Am J Sports Med. 2022;50:545-53. https://doi.org/10.1177/0363546521998297
  15. Lee JK, 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:e19499. https://doi.org/10.1097/MD.0000000000019499

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