Innovative Approaches to Meniscus Tear Repair

The meniscus is a C-shaped cartilage structure that acts like a cushion between the femur (thigh bone) and tibia (shinbone). There are 2 menisci in each knee, one on the inner surface of the knee, and one on the outer surface. When the meniscus is torn, whether due to an injury or gradual wear with age, it’s important to see a specialist orthopaedic knee surgeon to discuss if repairing the tissue is necessary to relieve any symptoms, maintain knee function, and prevent long-term complications like arthritis. 

 

Book a consultation with Dr Arjuna Imbuldeniya at The West London Knee & Hip Clinic to explore your personalised treatment options. 

 

 

Several surgical techniques are available to repair a torn meniscus, each suited to specific types of tears. Arthroscopic meniscus repair is recommended for younger patients or patients with tears in the outer third of the meniscus (the 'red zone'), an area with a rich blood supply that supports healing. Arthroscopic meniscus repair requires special training and can take between 30 minutes to 2 hours to perform under general or regional anaesthesia. 

 

 

Arthroscopic all inside repair is the most common technique for meniscus repair. It is commonly used for tears in the posterior horn of the meniscus, which is near the back of your knee. During the procedure, your surgeon will insert a small camera (arthroscope) through tiny incisions in the knee, providing a clear view of the joint and the tear. Your surgeon will then introduce specialised instruments through additional small incisions to suture the torn meniscus back together, with the entire procedure being formed inside the joint. Anchored sutures are placed through the torn meniscus tissue to secure the edges, so it can heal over 8-12 weeks 

 

 

This is a different technique often used for tears in the middle third of the meniscus where specialised, flexible long needles attached to repair sutures are placed inside the knee join and passed outward through the joint capsule. The sutures then exit the knee through an additional small incision on the skin on the side of you knee. Surgical knots are tied over the knee capsule but under the skin. This repair construct is typically the strongest as compared to other arthroscopic meniscus repair methods and is considered the gold standard in particular for large bucket handle type meniscus tears where the entire length of the meniscus is torn and at risk of becoming devitalised tissue. 

 

 

This technique is normally reserved for tears at the front of the meniscus or the anterior horn. Long firm needles, similar to spinal needles are passed through the skin at the front of the knee, into the knee capsule and then into the torn meniscus on either side of the tear under visualisation with the small camera (arthroscope).Suture material is then passed through one needle through the meniscus, the suture end in the knee joint is then retrieved and passed through the other needle and out of the knee again. The surgeon ties a knot outside of the knee and then slides it through a small incision to snug it down onto the knee capsule. 

 

 

When a tear is too severe to be repaired such that the damaged tissue is dead or devitalised, your surgeon will opt for removing the torn fragment, this is called a partial meniscectomy. During the procedure, your surgeon will create small incisions around the knee joint. An arthroscope will then be inserted through one of these incisions to project an image of the inside of the knee joint on a monitor. Additional specialised instruments will be introduced through the other incisions. 

 

Your surgeon will carefully examine the meniscus and surrounding structures to evaluate the extent of the damage. Any torn or damaged parts of the meniscus not suitable for a successful will be precisely trimmed and removed. The remaining cartilage which lines the bones and normally provides a smooth, friction free cushion will be smoothed and stabilised, with your surgeon trying to preserve as much healthy meniscus as possible to maintain knee function. 

 

This technique is normally chosen for tears in the inner region of the meniscus (the ‘white zone’), where blood supply is limited, making healing difficult. Meniscectomy is also performed arthroscopically and typically takes 15-30 minutes to perform. 

 

Though it is important to keep all viable meniscus tissue in the knee, torn fragments are often not contributing to cushioning the joint by distributing your bodies force and load, so if they are not viable, removing them does not necessarily accelerate “wear and tear” or osteoarthritis, but can help with mechanical symptoms of knee locking, catching or sharp pain on rotation or deep knee bending. 

 

 

In cases where the meniscus is severely damaged or removed, a meniscus transplantation may be considered. During the procedure, your surgeon will make small incisions around the knee joint and insert an arthroscope to evaluate the joint’s suitability for transplantation. 

 

The site where the new meniscus will be placed will be prepared by cleaning out remaining meniscal or scar tissue. Bone tunnels or attachment points will then be created to secure the new meniscus. 

 

The donor meniscus will be carefully prepared and shaped to match the recipient's knee anatomy before being positioned in the joint through arthroscopic portals or a small open incision. Your surgeon will secure it using sutures, anchors, or screws to ensure proper alignment and stability. If the allograft includes bone plugs, these will be inserted into pre-drilled tunnels to firmly anchor the meniscus. 

 

Meniscus transplantation is a complex procedure, typically reserved for younger, active patients without significant arthritis. The operation can take 1.5-3 hours to complete, as precise matching of the donor meniscus to the patient’s knee is essential. 

 

80 % of patients have significant symptom relief and 80% of grafts now last 10 years. 

 

 

Recovery times vary depending on the type of surgery performed and your overall health and activity level. On average: 

 

Arthroscopic meniscus repair: Patients will need to use crutches for the first few weeks, with full weight-bearing possible around 6 weeks and deep knee bend with weight after 8 weeks. Full recovery typically takes 4-5 months as the repaired meniscus takes 2-3 months to heal. 

 

Partial Meniscectomy: Most patients will resume normal activities within 2 weeks. Fully recovery will take 4-6 weeks, though high-impact sports may require more time. 

 

Meniscus allograft transplantation: Full rehabilitation can take 6-12 months, as the transplanted tissue integrates with the knee. 

 

 

Rehabilitation plays a crucial role in recovery. A tailored physiotherapy programme with a specialist sports knee physiotherapist helps rebuild strength, improve flexibility, and ensure optimal knee function. Following your surgeon’s advice and avoiding premature return to activities is also essential to prevent re-injury. 

 

 

Meniscus repair surgery is highly successful, especially in younger patients and those with tears located in the ‘red zone’. Studies indicate success rates of 85-90% for arthroscopic repairs. 

 

Arthroscopic partial meniscectomy also provides effective symptom relief in most cases. 

 

Similarly, meniscus transplantation has proven successful in reducing pain and improving knee stability, with success rates and functional improvements reported at 75-90%. However, it remains a specialised procedure performed for select cases normally performed in specialised centres. 

 

 

In recent years, biologic therapies like platelet-rich plasma (PRP) and stem cell therapy have gained attention for their potential to support healing. 

 

 

PRP therapy involves extracting the patient’s blood, concentrating the platelets, and injecting them into the injured area. These platelets contain growth factors that stimulate tissue repair and help reduce inflammation. Although evidence is promising, PRP is generally more effective for mild injuries and isn’t typically used as a standalone treatment for complete meniscus tears. Some surgeons are using it to augment or help their meniscus repair to heal. 

 

 

Stem cell therapy involves using cells derived from the patient’s bone marrow or fat tissue to regenerate damaged meniscus tissue. These cells can differentiate into cartilage-like tissue and may provide relief for degenerative meniscal injuries. Research on stem cell therapy is ongoing, and while early results are encouraging, it hasn’t yet become a standard treatment that is proven to be either clinically or cost effective. 

 

 

Meniscus injuries don’t always present in dramatic ways. While some occur during obvious twisting or impact trauma, others develop slowly over time, especially in older patients with age-related degeneration. That’s why recognising the subtler signs is key to early intervention and better outcomes. 

 

Some patients describe a vague sense of instability in the knee, or a feeling that the joint isn’t quite “right”. You may notice increased fatigue in the leg after walking or climbing stairs. Localised swelling that comes and goes is another red flag, especially if it flares up after activity and subsides with rest. 

 

Mechanical symptoms are particularly important. If your knee catches, locks, or clicks during movement, or you’re unable to fully straighten the leg, these may point to a torn fragment interfering with joint mechanics. Pain is often localised along the joint line and can worsen during deep flexion, such as squatting or kneeling. 

 

If these symptoms persist beyond a few days, or if they start to interfere with daily activities or sleep, it’s time to consult a specialist knee surgeon. Early assessment with clinical examination and imaging (such as MRI) allows for a precise diagnosis and treatment plan—whether that means rest and physiotherapy or a more advanced surgical approach. 

 

 

If you're experiencing any of the above symptoms, early expert input can make all the difference. The West London Knee & Hip Clinic offers personalised, consultant-led care using the latest techniques in meniscus repair and joint preservation. 

 

Book a consultation with Dr Arjuna Imbuldeniya at one of our London clinics today to take the first step toward restoring comfort, confidence and long-term joint health. 

 

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