Key Points:

• Meniscus tears can be treated with arthroscopic surgery
• Most tears can be carefully shaped to preserve most of the meniscus.
• Loss of sections of the meniscus leads to pain and arthritis
• Meniscus repair is preferred whenever the tissue is healthy
• Meniscus replacement is possible with a donor meniscus allograft

After suffering injury to the meniscus, there are a variety of appropriate treatment options. Once a definitive diagnosis has been made by correlating clinical exam and MRI results, an appropriate plan can be formulated (Fig 1).

Figure 1: An MRI documenting a torn medial meniscus.	Figure 2: An MRI documenting a more complex “bucket handle” tear.

For minor tears with mild symptoms, occasionally focused rehabilitation and strengthening are all that is needed for adequate stabilization. For more significant tears (Fig 2), treatment depends on the exact location and type of tear the meniscus has sustained. The ideal is to retain as much of the meniscus as possible. Tears toward the outer 1/3 have a good blood supply, and generally respond well to a meniscus repair, which allows for retaining the maximum amount of meniscus. Even large meniscus tears that involve the inner third of the meniscus can be repaired if the tissue is healthy and, in our hands, we can create a stable repair. This is true when we are able to stimulate the peripheral blood supply to grow into the repair tissue.

For other substantial tears, especially toward the inner 2/3 or when the tissue is hardened and calcified meniscectomy is usually indicated, which involves trimming the torn edges of the meniscus. The goal is to eliminate torn pieces that can cause pain, swelling, and locking. Only the amount of tissue that is necessary to eliminate is actually removed, as it is important to retain as much of the meniscus as possible. Done properly, the result is a clean, smooth edge of the meniscus that avoids impingement and yet provides adequate cushion and stability.