Meniscus Repair vs. Meniscectomy: Why Saving the Meniscus Matters
When an athlete or active patient hears they have a “meniscus tear,” one of the first questions is often, “Can you fix it—or will you just remove it?”
That distinction, meniscus repair versus meniscectomy, is more than just surgical terminology. It can profoundly influence the long-term health and performance of your knee.
Understanding the Meniscus
The meniscus is a C-shaped piece of cartilage that cushions and stabilizes your knee. Each knee has two—one medial (inside) and one lateral (outside). It acts as a shock absorber, spreading forces across the joint and protecting the articular cartilage on the femur and tibia from wear. When the meniscus tears, whether from a twisting injury, sports trauma, or degeneration, the balance between stability and cushioning is disrupted.
Meniscus Repair: Preserving What Protects Your Knee
Meniscus repair means the torn tissue is sutured back together rather than removed. Advances in arthroscopic instrumentation and biologic augmentation have made more tears repairable than ever before.
Repairs are ideal for younger, active patients and for tears that occur in the “red-red” or “red-white” zones—areas of the meniscus that have better blood supply.
Healing depends on several factors:
Tear pattern: vertical or longitudinal tears heal better than complex or degenerative ones.
Location: peripheral tears near the capsule have greater healing potential.
Biologic environment: augmentation with platelet-rich plasma (PRP) or bone marrow aspirate concentrate (BMAC) can enhance healing, especially in borderline cases.
Preserving the meniscus helps maintain knee mechanics, lowers long-term risk of osteoarthritis, and supports return to sport with durable outcomes when healing succeeds.
That said, repairs require a longer rehabilitation—often with 4–6 weeks of limited weight bearing and restricted flexion—to protect the healing tissue.
Meniscectomy: The Traditional “Cleanup” Procedure
In some cases, a tear simply cannot be repaired. The tissue may be too frayed, located in a poorly vascularized area, or associated with chronic degeneration.
In those scenarios, a partial meniscectomy is performed to remove the unstable or torn fragment while preserving as much healthy tissue as possible.
This approach typically leads to faster short-term recovery—patients often return to normal activities within 4–6 weeks—but removing meniscus tissue changes the biomechanics of the knee. The loss of cushioning increases load on the articular cartilage, which over time can accelerate wear and increase the risk of early arthritis.
For that reason, modern surgeons emphasize minimal, selective removal and reserve meniscectomy only when repair isn’t feasible.
Failure Rate and Risk of Reoperation After Meniscus Repair
While meniscus repair offers the best chance for long-term joint preservation, it does come with a higher short-term risk of reoperation compared to meniscectomy. Studies show that roughly 20–25% of meniscus repairs fail, meaning the tear either doesn’t heal or re-tears over time. Failures may occur months or even years after surgery, particularly in patients who return to high-impact sports or have complex tear patterns.
If a repair fails, treatment options depend on the residual tissue quality:
Repeat repair may be possible in younger patients or if adequate tissue remains.
Partial meniscectomy can be performed to remove unstable remnants.
In select cases with significant tissue loss, meniscus transplant may be considered as a salvage procedure.
Despite this risk, in many cases the benefits of successful repair outweigh the potential downside of revision. Patients who heal their repair maintain more meniscus tissue, have lower rates of cartilage damage, and enjoy better long-term function than those who undergo meniscectomy.
Biologic Augmentation: Improving Healing Potential
In the last decade, biologic techniques have transformed how surgeons approach meniscus injuries.
Platelet-Rich Plasma (PRP): delivers concentrated growth factors to stimulate healing.
Bone Marrow Aspirate Concentrate (BMAC): provides stem cell–rich plasma to promote vascularity and tissue repair.
Fibrin clots and scaffolds: can fill gaps and enhance healing in borderline tears.
These techniques are particularly valuable in complex or revision meniscus repairs, where native healing potential is limited.
The Big Picture: Joint Preservation
Every millimeter of meniscus matters. Long-term studies show that even partial meniscectomy can double the risk of cartilage degeneration and early osteoarthritis. By contrast, successful repair, especially when augmented biologically, preserves shock absorption, protects cartilage, and delays or prevents arthritis. For active individuals, preserving the meniscus whenever possible isn’t just about the next season—it’s about the next decade.
Bottom Line
Modern sports medicine emphasizes preservation over removal.
If you’ve been diagnosed with a meniscus tear, make sure your surgeon evaluates whether the tear can be repaired and discusses biologic options to enhance healing. The right approach today can protect your knee for years to come.
