Reviewed by Dr Vishal Pai
A meniscectomy is keyhole surgery to trim away a torn, unstable piece of the meniscus, the shock-absorbing cartilage in the knee. Where possible, a torn meniscus is treated with physiotherapy rather than surgery. This page covers when a meniscectomy may be considered, what it involves, recovery, results and risks.
At a Glance
- A meniscectomy trims away the torn, unstable part of the meniscus through small (keyhole) cuts, keeping as much healthy meniscus as possible.
- Most degenerative (wear-related) tears cannot be repaired, and are best treated first with physiotherapy and exercise, not surgery.
- A meniscectomy is usually kept for specific situations, such as a knee locked by a torn fragment that cannot be repaired.
- It is a day procedure, and most people with an office-based job return to work within 1 to 2 weeks.
What is a meniscectomy?
The meniscus acts like a shock absorber in the knee, protecting the cartilage. It is C-shaped, and each knee has a meniscus on the inside (medial) and on the outside (lateral). An acute traumatic knee injury can cause the meniscus to tear. A torn meniscus may cause secondary cartilage damage, knee swelling, locking, or clicking.
With age, the quality of tissue within the meniscus declines. This can cause the meniscus to tear even in the absence of any trauma. This is referred to as a degenerative tear.
A meniscectomy involves removing the torn flap of the meniscus that can cause irritation and pain. As the meniscus protects the cartilage within the knee, only the minimum necessary amount is removed during surgery.
Who might need a meniscectomy?
Most people with a torn meniscus do not need a meniscectomy. Degenerative tears, which are common from the mid-40s, usually do best with physiotherapy. Non-surgical treatment means more than rest. It involves specific physiotherapy to rebuild strength, careful load management and, if the knee is inflamed early on, anti-inflammatory medication. Most people see clear improvement within 2 to 3 months of a structured programme.
Tears caused by an injury are a different problem. Where surgery is needed for an injury-related tear, a repair is preferred, because keeping the meniscus protects the knee in the long term. [1] Read more about meniscal repair and surgical and non-surgical treatment for meniscus tears.
A meniscectomy is usually kept for specific situations where the torn part cannot be repaired and is causing mechanical problems, for example:
- A displaced torn fragment that locks the knee or stops it straightening fully
- An unstable tear in the inner part of the meniscus, which has too little blood supply to heal after a repair
- A degenerative tear that still causes troublesome symptoms after at least 3 months of proper rehabilitation
International guidance does not recommend a meniscectomy as a first treatment for a degenerative tear, and considers it only after at least 3 months of rehabilitation has not helped. [2] Dr Vishal Pai will talk through with you whether your tear is best left to settle, repaired or trimmed.
What is involved in a meniscectomy?
The steps involved in meniscectomy surgery include:
1. Assessment before surgery
Assessment starts with an examination, including joint line tenderness, movement and specific knee tests. An MRI confirms the tear pattern and location. The combination of both, with your symptoms, guides the recommendation, not the scan alone.
2. Diagnostic arthroscopy
2 to 3 small (< 1 cm) portals are created to allow passage of a camera and surgical tools within the knee joint. The whole joint is inspected for damage.
3. Meniscal resection
If the torn meniscus is not suitable for repair, the torn portion is trimmed to a stable margin. This can relieve the pain and mechanical symptoms associated with a tear. Only the minimum necessary amount is removed, because trimming the meniscus reduces its shock-absorbing capacity and puts more pressure on the surrounding cartilage.
How long does it take to recover from a meniscectomy?
Physiotherapy starts after your first post-operative visit. Swelling can last up to 3 months. As a rough guide:
- Same dayYou will usually go home on the day of surgery.
- First weekYou may use crutches for comfort. Most people stop using them within a week.
- 1 to 2 weeksMost people with an office-based job are able to return to work. You may also return to driving.
- 2 weeksYour wound is checked at your first follow-up appointment, and Dr Vishal Pai explains what was found during surgery.
- Up to 6 weeksPeople in physically demanding jobs can usually return to work.
- 6 to 8 weeksMany people return to sport, depending on the tear and the demands of their sport.
- 8 weeksBy this stage, Dr Vishal Pai expects most people to straighten the knee fully and to bend it beyond 90 degrees.
What results can you expect?
When a torn fragment is causing locking or catching, trimming it aims to relieve those mechanical symptoms. A meniscectomy does not treat any underlying arthritis, and some people continue to have pain from arthritis even after a technically successful operation.
Recovery is quicker than after a repair. Many people return to sport 6 to 8 weeks after surgery, which is similar to the times reported in studies of athletes. [3] In the longer term, removing meniscus is linked with more arthritis and more knee replacements than repairing it, [4] and a small number of people need further surgery on the same knee. [5]
What are the risks and complications?
Every operation carries risks, and Dr Vishal Pai goes through them with you before you decide. The main risks of a meniscectomy are:
- Ongoing pain, swelling or stiffness. A small percentage of people still have symptoms after surgery, and some need a repeat arthroscopy.
- Arthritis. With less meniscus, the cartilage takes more load, and arthritis can develop over several years. [4]
- Numbness near the small cuts. Small skin nerves can be damaged. Occasionally a painful nerve swelling (neuroma) forms and may need removal.
- Blood clots. A clot in the leg (deep vein thrombosis) affects about 1 in 300 people in the first month, and a clot in the lungs fewer than 1 in 1,000. [6]
- Infection. A deep infection of the joint is uncommon, affecting fewer than 1 in 100 people, [7] and needs a washout of the knee and antibiotics.
- Bleeding. Bleeding into the knee usually settles, but occasionally needs another operation to wash it out.
Rarely, a heart attack, stroke or chest infection can occur, and the risk of some complications is higher in people above a healthy weight. You will receive a written information sheet with the full list of risks.
Where does Dr Vishal Pai consult and operate?
Dr Vishal Pai consults at Sandringham Orthopaedic Specialists, Suite 1, 60 Bay Road, Sandringham. He performs knee arthroscopy at Calvary Holmesglen Private Hospital, 490 South Road, Moorabbin, and The Avenue Hospital, 40 The Avenue, Windsor. Patients come from across Bayside, Glen Eira and the Mornington Peninsula, and some travel from regional Victoria.
References
Show all 10 referencesHide references
- Kopf S et al. 2020. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. Knee Surgery, Sports Traumatology, Arthroscopy.
- Beaufils P et al. 2017. Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surgery, Sports Traumatology, Arthroscopy.
- Lee YS et al. 2017. Return to sports after athletes undergo meniscal surgery: a systematic review. Clinical Journal of Sport Medicine.
- Migliorini F et al. 2023. Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy.
- Paxton ES et al. 2011. Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy.
- Bohensky MA et al. 2013. Adverse outcomes associated with elective knee arthroscopy: a population-based cohort study. Arthroscopy.
- Balato G et al. 2017. Knee septic arthritis after arthroscopy: incidence, risk factors, functional outcome, and infection eradication rate. Joints.
- Weiss CB et al. 1989. Non-operative treatment of meniscal tears. The Journal of Bone and Joint Surgery (American Volume).
- Kise NJ et al. 2016. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ.
- van de Graaf VA et al. 2018. Effect of early surgery vs physical therapy on knee function among patients with nonobstructive meniscal tears: the ESCAPE randomized clinical trial. JAMA.
Frequently asked questions
Can a torn meniscus heal on its own?
For smaller stable tears that are close to the outer edge of the meniscus, where the blood supply is rich, it is possible that the torn meniscus can heal. [8] This is unlikely to occur in larger and more unstable tears.
Can a torn meniscus get worse without surgery?
A torn meniscus can be made worse, especially in the setting of a concurrent torn anterior cruciate ligament (ACL). In this situation, the instability in the knee can exert more pressure on the tear and propagate it. This can potentially make a repairable tear irreparable.
Does a degenerative meniscus tear need surgery?
Why is a meniscus repaired rather than removed where possible?
Repair stitches the torn tissue together so it can heal. Partial meniscectomy removes the unstable fragment and leaves the healthy portion. Repair takes longer to recover from and is more likely to need a second operation, but it preserves more tissue, which is better for the joint in the long term. [4] [5] The choice depends on the tear location and tissue quality.
What is a meniscal cyst?
Meniscal cysts usually occur in conjunction with meniscal tears. It is thought that the meniscal tear allows fluid within the knee joint to leak through the tear and cause the cyst to form. If the cyst is large enough, it can cause discomfort from the pressure it exerts on the surrounding soft tissues. Meniscal cysts are treated by attending to the meniscal tear and excising the cyst. Sometimes the cyst can be excised using arthroscopic (key-hole) surgery, and other times an open incision is required.
When should I seek help after surgery?
Contact Dr Vishal Pai’s rooms or your GP, or go to your nearest emergency department, if you notice:
- Increasing swelling, redness or warmth around the wound
- A temperature above 38°C for 12 hours or more
- Drainage from the wound after 72 hours
- Pain or swelling in your calf
Call 000 if you have chest pain or shortness of breath.
Next step
Talk through your options
If you are weighing up a meniscectomy, Dr Vishal Pai can examine your knee, review your scans and explain all your options, including treatment without surgery.