Meniscus repair is a knee-preserving surgery used to stitch or secure a torn meniscus so that it can heal, rather than removing the damaged part. In my practice, I often explain to patients that this difference matters. The meniscus is not extra tissue that the body does not need. It is a very important shock absorber and stabilizer inside the knee [1][2].

For Bangladeshi patients and families, the most common question is simple: “Doctor, will you repair the meniscus or cut the torn part?” The answer depends on the type of tear, location of the tear, blood supply, age, activity demands, associated injuries, and the condition of the knee cartilage [1]. Meniscus repair is often preferred when healing is realistically possible because preserving the meniscus helps protect the knee joint over the long term [1][3].

What Is the Meniscus and Why Does It Matter?

Each knee has two menisci:

• the medial meniscus on the inner side
• the lateral meniscus on the outer side

These structures sit between the femur and tibia and help:

• absorb shock
• distribute load across the knee
• improve joint stability
• protect the cartilage surface

I usually explain to my patients that a healthy meniscus helps the knee tolerate walking, stairs, squatting, sports, and daily movement. When the meniscus is torn, the knee may become painful, swollen, unstable, or mechanically symptomatic.

One important point I want Bangladeshi patients to understand is that not every tear needs surgery, and not every surgery should be a repair. But when the tear is repairable, preserving the meniscus is often better for the future of the knee than removing meniscal tissue unnecessarily [1].

What Is Meniscus Repair?

Meniscus repair means the torn meniscal tissue is brought back together and fixed so it can heal. This is usually done with knee arthroscopy, using a camera and small instruments through small incisions [1][4].

Different repair techniques may be used depending on the tear pattern:

• all-inside repair
• inside-out repair
• root repair through bone tunnels in selected cases

Patients sometimes assume all meniscus surgery is the same. It is not. Meniscus repair is different from partial meniscectomy, where damaged tissue is trimmed away. Repair usually has a longer recovery because the tissue must biologically heal, but the long-term goal is to preserve knee function and protect cartilage [1][3].

When Meniscus Repair Is Recommended

Tears with healing potential

Meniscus repair is more often considered when the tear is in a part of the meniscus that has better blood supply. In general, the outer portion has better healing ability than the inner portion [1][2].

Repair is often more strongly considered in:

• younger active patients
• sports-related tears
• acute tears
• longitudinal or certain vertical tears
• some bucket-handle tears
• selected radial tears
• meniscus root tears in appropriate cases
• tears associated with ACL injury

In my practice, I look beyond age alone. A motivated adult with a repairable tear and reasonable joint condition may still be a good candidate. On the other hand, a severely degenerative tear in a worn arthritic knee may not be suitable for repair.

When repair may not be the best option

Not every tear can be repaired successfully. Repair may be less suitable when:

• the tear is in a poorly vascular inner zone
• the tissue quality is very weak or degenerative
• the tear pattern is not repairable
• the knee already has significant arthritis or cartilage wear
• the symptoms are mild and improving without surgery

If the torn piece is loose, unstable, or causing catching and pain in a low-healing zone, selective trimming may be recommended instead of repair [1].

Symptoms That May Lead to Evaluation for Meniscus Repair

Patients with a repairable meniscus tear may present with:

• pain along the inner or outer side of the knee
• swelling
• painful twisting
• difficulty squatting
• catching or locking
• the feeling that the knee is not moving normally
• pain with stairs, sports, or changing direction

In Bangladesh, I also see patients who continue walking on the injury because they can still bear weight. That can be misleading. Some meniscus tears allow walking but still cause significant internal knee damage or mechanical symptoms over time.

How I Evaluate a Suspected Meniscus Tear

History

When I evaluate a patient, I want to know:

• whether the injury happened suddenly or gradually
• whether there was twisting, pivoting, or sports trauma
• whether the knee locked
• whether swelling developed
• whether the pain is localized to the joint line
• whether the patient also feels instability, suggesting ACL injury or another associated problem

For Bangladeshi patients, the daily context matters. A university student, footballer, office worker, homemaker, police member, or manual laborer will stress the knee differently. That affects both the treatment choice and the rehabilitation plan.

Physical examination

On examination, I assess:

• joint line tenderness
• range of motion
• swelling
• mechanical signs
• ligament stability
• alignment
• associated patellofemoral or cartilage-related issues

I also want to know whether the knee is truly locked or simply too painful to bend or straighten comfortably.

Imaging

X-rays are useful to look for arthritis, fractures, or alignment issues, though they do not show the meniscus itself. MRI is often the most useful test for confirming a meniscal tear and helping assess whether repair may be possible [2][5].

However, I usually explain to my patients that treatment is not decided by MRI wording alone. The scan has to match the symptoms and examination findings.

Meniscus Repair vs Trimming: Why the Choice Matters

One of the most important counseling points is that meniscus preservation is usually the goal when appropriate. Removing meniscus tissue may relieve symptoms faster in some cases, but it can also increase contact stress on knee cartilage, which may contribute to earlier wear over time [1].