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The meniscus consists of two crescent-shaped pads of fibrocartilage that sit between the thigh bone and the shin bone in each knee, acting as shock absorbers, load distributors and secondary stabilisers of the joint. Treating a meniscal tear is not one single operation but a decision between three routes: non-surgical care, suture repair of the tear, or trimming only the torn fragment when repair is not feasible. Tears occur in two patterns. Traumatic tears affect younger and athletic patients after twisting the knee with the foot planted, while degenerative tears develop gradually in middle-aged and older people alongside arthritic change and may begin with no clear injury at all. Usual symptoms are joint-line pain, swelling that appears over hours rather than instantly, difficulty squatting and pivoting, and sometimes catching or true locking that prevents the knee straightening. The choice of route depends on the location and pattern of the tear, the patient's age and the state of the surrounding cartilage. Tears in the outer, better-vascularised zone have the best healing potential, so repair is preferred in suitable patients because preserving meniscal tissue protects the joint in the long term. Degenerative tears without mechanical catching are usually managed with physiotherapy, quadriceps strengthening and weight reduction, and current evidence shows outcomes in this group are broadly comparable to those after arthroscopic trimming. What treatment cannot do must be equally clear. Neither repair nor trimming restores the meniscus to its original state; trimming removes tissue that never comes back and increases the long-term risk of arthritis; neither procedure treats arthritis that is already present; and neither removes the need for rehabilitation. A repair also imposes longer restrictions on weight-bearing and deep bending than a trim does. Candidacy is decided by clinical examination together with imaging. A tear reported on MRI does not by itself mean surgery is needed, because silent asymptomatic tears are common.
Clinical examination of the joint line, full extension and rotational tests, weight-bearing X-rays to assess arthritis and alignment, and MRI to show the location and pattern of the tear and the state of adjacent cartilage.
For degenerative tears without mechanical locking, a physiotherapy programme strengthens the thigh and hip and improves control, alongside activity modification, weight and pain management, with the result reviewed after an adequate trial before surgery is considered.
General or spinal anaesthesia, then two small portals and introduction of the camera to inspect the whole joint and assess the tear directly: its site, stability and healing potential, which settles the final decision.
If the tear is repairable, sutures or implants are passed to approximate its edges and the site is prepared to improve healing. If the tissue is frayed or outside the vascular zone, only the unstable fragment is trimmed while preserving as much healthy rim as possible.
After trimming, loading and movement start early with graded strengthening. After a repair there are longer restrictions on weight-bearing, deep flexion and rotation to protect healing, and sport is resumed gradually once strength and control return.
Tell your doctor about all your medicines, especially blood thinners and aspirin, and do not stop any prescribed medicine on your own. Mention diabetes, heart disease, drug allergies and any previous knee injury or surgery. Ask directly whether the plan is repair or trimming, because the answer determines how long you will use crutches, what bending restrictions apply and when you can return to work and sport, and you are entitled to know before consenting. Follow the fasting instructions before anaesthesia and do not shave the knee yourself. Prepare ice packs, a pillow to elevate the leg and crutches if requested. Arrange transport both ways, do not drive after anaesthesia, and if possible book your first physiotherapy session before the operation.
Elevate the leg and apply ice in short intervals during the first days, move your ankle regularly and take short frequent walks to reduce clot risk. Respect the weight-bearing and bending limits you were given: restrictions are longer after a repair, and breaking them early can cause the repair to fail and mean another operation. Start activating your quadriceps from day one and do not postpone it, because weakness of that muscle is the commonest reason the knee keeps feeling unsafe. Expect swelling that settles gradually over weeks, and avoid deep squatting and sudden pivoting until you are cleared. **Seek care immediately for fever or chills, redness, warmth or discharge from the portals, pain and swelling increasing after the third day instead of settling, calf or behind-knee pain and swelling, breathlessness or chest pain, or a new inability to straighten the knee.**
Usually 30 to 75 minutes depending on whether the tear is repaired or trimmed, with same-day discharge in most cases.
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