Arthroscopic meniscus surgery — repair before removal
Treating meniscal tears arthroscopically through small portals, favouring repair of the meniscus over removing it wherever the tear allows, because extensive removal accelerates knee arthritis later.
When does a meniscal tear need arthroscopy?
Not every meniscal tear needs surgery; many small and degenerate tears improve with physiotherapy. Surgery is considered when there is:
- Locking of the knee, or inability to fully straighten it
- Clicking or a sensation of something moving inside the joint
- Localised pain on one side of the knee, worse with twisting and squatting
- Recurrent swelling after activity
- A tear pattern prone to locking, such as a bucket-handle tear
- Failure of an adequate course of conservative treatment
Try conservative treatment first: in degenerate tears in patients over forty, studies have shown non-surgical treatment gives results comparable to arthroscopy in many cases. Arthroscopy is of most benefit in mechanical tears that lock the knee.
Types of meniscal intervention
The intervention is determined by the shape and site of the tear and its blood supply — the outer part of the meniscus heals, while the inner part usually does not.
Meniscal repair (suture)
The preferred option wherever possible, especially peripheral tears with good blood supply in younger patients, because it preserves the meniscus as a shock absorber.
Meniscus tear care →Limited partial meniscectomy
Removing only the torn fragment while preserving as much healthy meniscus as possible, when the tear lies in a zone that will not heal.
Bucket-handle tear
A large tear that displaces into the joint and locks the knee — close to an urgent problem, since early repair improves the chance of successful suturing.
Tear with ACL rupture
Repairing the meniscus and reconstructing the ligament in one session, the commonest pattern in sports injuries.
ACL reconstruction →Degenerate tear
Common after forty and associated with early arthritis; usually managed with physiotherapy and injections rather than arthroscopy.
Non-surgical treatment →Discoid meniscus
A congenital variation in meniscal shape that makes it more prone to tearing, usually presenting in children and adolescents.
Your treatment pathway, step by step
Examination and diagnosis
Clinical examination including meniscal provocation tests, with an MRI establishing the shape and site of the tear — the two factors that determine whether repair is possible.
Conservative treatment
For non-mechanical tears: relative rest, anti-inflammatory medication, and a physiotherapy programme strengthening the quadriceps and hamstrings.
Deciding on arthroscopy
Taken when conservative treatment fails or there is mechanical locking. Repair versus resection is discussed before surgery, because it changes the rehabilitation that follows.
The arthroscopy
Performed through two small portals with a fine camera, inspecting the whole joint first, then repairing the tear with sutures or trimming it as the tear allows.
Rehabilitation
After resection, weight-bearing starts early and recovery is quicker. After a suture repair, knee flexion and weight-bearing are restricted for weeks to protect the repair while it heals.
Return to activity
This differs substantially by intervention: weeks after a partial meniscectomy, months after a repair — a distinction to understand before surgery, not after.
Why we favour repair over removal
The meniscus is not a redundant structure but a shock absorber that distributes load across the joint surface. Removing much of it raises pressure on the articular cartilage and accelerates arthritis.
- Preserving shock absorptionRetaining the meniscus protects the joint surface from excess pressure and can delay arthritis by years.
- Tear location decides feasibilityThe outer third has good blood supply and heals; the inner third is poorly vascularised and rarely heals when sutured.
- Patient age and tear typeAcute tears in young patients are the best candidates for repair, while degenerate tears in older patients are usually not sutured.
- TimingEarly repair after injury gives a higher healing rate than repair delayed by months.
- Longer rehabilitation, better jointRepair requires longer post-operative restrictions, but it is an investment in long-term joint health.
- Addressing associated instabilityA meniscal repair in a knee made unstable by an ACL tear is at risk of failing unless the ligament is treated as well.
Why Prof. Dr. Ibrahim Shaarawi
- Assessment before any decision to operateSurgery is offered only after appropriate conservative treatment has been exhausted, because many patients improve without an operation.
- Academic backgroundMD and MSc in Orthopedic Surgery from Ain Shams University, with training in the Ain Shams University hospitals.
- International trainingVisiting professor and training at Ohio State University Hospital in the United States, applying the protocols used there.
- One plan from diagnosis to rehabilitationDiagnosis, surgery, physiotherapy and follow-up handled as a single pathway rather than split across separate providers.
Read patient success stories or review the full profile and credentials.
Cost and booking
The cost of meniscal arthroscopy varies with the intervention performed (suture repair versus partial resection), the fixation devices used for a repair, whether ACL reconstruction is carried out in the same session, and the hospital and anaesthesia.
A final figure is given after the MRI, because the shape of the tear is what determines the scope of the operation.
Important: bring all previous imaging and reports to your first visit, along with a list of your current medications, so an accurate plan can be made from the outset.
Frequently asked questions
Does a meniscal tear heal on its own?
It depends on where the tear lies. The outer third has a good blood supply and may heal or be successfully sutured, while the inner third is very poorly vascularised and usually will not heal, which is why it is trimmed rather than repaired.
Can a meniscal tear be treated without surgery?
Yes in many cases, particularly degenerate tears in patients over forty and small tears that do not lock the knee. A consistent physiotherapy programme strengthening the thigh muscles, combined with activity modification, gives good results in these cases.
How does recovery differ between repair and resection?
Substantially. After a partial meniscectomy, weight-bearing starts early and normal daily activity returns within weeks. After a suture repair, flexion and weight-bearing are restricted for weeks to protect the repair, and full return to sport may take months.
Does removing the meniscus cause arthritis?
Extensive removal raises pressure on the articular cartilage and increases the long-term likelihood of arthritis, which is why as little as possible is removed and the outer rim is preserved. Limited trimming has a much smaller effect.
What does a locked knee mean?
It is the inability to fully straighten or bend the knee because a torn fragment of meniscus has displaced into the joint and is blocking movement. This is a strong indication for arthroscopy, and early intervention is preferred.
Is arthroscopy major surgery?
It is performed through two small portals without a large incision, and most patients go home the same day or the following day. It remains a surgical procedure with its own risks, and is not performed without clear indications.
Book a knee assessment
If you have an MRI showing a meniscal tear, an assessment establishes whether your tear is the kind that should be sutured, trimmed, or treated without surgery at all.
Related reading
References
- American Academy of Orthopaedic Surgeons (AAOS) — Patient guidelines
- Mayo Clinic — Orthopedic procedures
- NICE — Joint replacement and arthroscopy guidance
- Cochrane Musculoskeletal reviews
Medical disclaimer: the content on this page is provided for medical education only. It is not a substitute for consultation and clinical examination, and must not be used as a basis for self-diagnosis or self-treatment. Read the full medical disclaimer.