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Meniscus Surgery

A serious tear to the cartilage in the knee known as the meniscus is typically treated through surgery. There are several different surgical approaches to addressing  a meniscus tear, and it’s important to know what to expect from each. 

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Each of our knees includes two pieces of cartilage called menisci (the plural of meniscus). The four menisci act like shock absorbers between the bones of the upper and lower leg, cushioning the knee joint. If you tear your meniscus, it can cause problems for the knee joint. Depending on the severity of the tear, you may need surgery to remove or repair the meniscus.

What is meniscus surgery?

Meniscus surgery is an umbrella term for several kinds of surgery that resolve problems when the meniscus, the rubbery cushion inside the knee joint, gets torn or damaged. Depending on the severity of the tear, meniscus surgery might mean repairing or removing all or part of the meniscus.

Types of meniscus surgery

There are two main types of meniscus surgery: meniscus repair and meniscus removal (meniscectomy). Both of these surgeries for a torn meniscus are arthroscopic, meaning that they are minimally invasive procedures in which the surgeon uses a small camera and tiny surgical tools to operate through incisions that heal more easily than those made in traditional surgery.

There's a third option, called a meniscus transplant, but it's a relatively uncommon procedure and not suitable for all meniscus tear patients.

In a meniscus repair surgery, the surgeon uses arthroscopic techniques to sew the damaged portion of the meniscus back together. As the meniscus heals, your surgeon will either remove the stitches or they will dissolve naturally, and you'll eventually have a whole meniscus again.

If your torn meniscus can't be repaired, your surgeon may perform a meniscectomy. In this meniscus surgery, the surgeon will make a few small incisions in your knee and insert the arthroscopic camera and tools. Then, they'll remove the damaged bits of meniscus that can't be repaired. Depending on the severity of the tear, they may perform a partial or total meniscectomy:

  • Partial: In a partial meniscectomy, the surgeon uses arthroscopic tools to cut away the damaged portion of the meniscus and remove it. The undamaged portion is left in the knee to continue serving as a shock absorber.
  • Total: In a total meniscectomy, the meniscus is so damaged that none of it can be saved. The surgeon will remove the entire meniscus.

In some cases, a surgeon may perform a meniscus transplant, putting a donor meniscus from a cadaver into the knee joint of a patient with a severely damaged meniscus. However, this procedure is rare, because it requires very specific conditions to be successful. First, the patient must meet strict eligibility requirements:

  • Under 45 years old
  • Physically active
  • Already missing a large portion of the meniscus from a previous surgery OR with a severely damaged meniscus that needs to be removed
  • Persistent pain in the knee
  • Little to no osteoarthritis of the knee
  • Healthy weight
  • Knee is otherwise healthy

It's rare for a patient to meet all these requirements. Usually, if a person is missing a significant portion of the meniscus and has severe enough knee pain to justify another operation, they already have too much osteoarthritis to be eligible for a transplant. The procedure is sometimes performed in young people with serious knee injuries to prevent osteoarthritis from developing early.

In addition to the patient meeting these strict requirements, the surgeon also needs to locate a donor meniscus of the appropriate size to be a good fit for the patient, which further narrows the possibility of a transplant. The operation has a fairly high failure rate, but can be hugely beneficial to the right candidate when it's successful.

Recently, medical science has pursued synthetic meniscal implants that may be a good alternative to meniscectomy or meniscus transplant. However, these products are relatively new, and studies are still underway to determine whether they are a viable long-term solution.

There are three grades of meniscus tears, depending on severity. Not all three grades of meniscus tear need surgery. Mild tears (Grades 1 and 2) may heal on their own if given time, rest, and certain conservative therapies. However, if a doctor diagnoses your meniscus tear as Grade 3, it's likely that you'll need meniscus surgery to fix it.

Meniscus surgery cost

Surgery costs are a major concern for many patients. Fortunately, meniscus surgeries aren't as expensive as some procedures. The average cost of an arthroscopic partial meniscectomy is about $3,800 and is covered by many insurance plans, including Medicare and Medicaid, when it's medically necessary.

What happens before meniscus surgery

Before meniscus surgery, you'll need to get some medical imaging done. For instance, an MRI can show the surgeon the torn meniscus in great detail and give them information about what kind of tear it is and how severe it is.

You'll also meet with an anesthesiologist to determine what kind of anesthetic to use for the procedure. Usually, general anesthetic is the preferred choice for this procedure, but some doctors may use regional or local anesthetic instead.

Finally, you'll meet with your care team to get final instructions for your operation. They'll tell you when to stop eating and drinking before the procedure, give you prescriptions for pain management and other medications you'll need after the surgery, and may give you other specific instructions.

What happens during meniscus surgery

When it's time for your meniscus surgery, you'll go to the hospital with someone who can take you home after the procedure. You'll check in, the anesthetic will be administered, and the surgeon will perform the operation. Whichever procedure you get—meniscus repair, partial meniscectomy, or total meniscectomy—the surgeon will usually use minimally invasive arthroscopic techniques.

The operation begins with the surgeon making several small cuts in precise locations around your knee. Then, they fill the knee with sterile fluid to keep the joint clear while they work and insert a camera into the knee. Depending on the nature of the tear, they'll either repair or remove the meniscus, and then close the incisions with stitches.

How long does meniscus surgery take?

Arthroscopic meniscus surgery usually takes less than an hour.

What to expect after meniscus surgery

Meniscus surgery is an outpatient procedure, so you'll go home the same day after the anesthetic wears off. You’ll remain at the hospital for a while after you wake up. Your care team will likely give you instructions about taking care of the stitches and other aspects of post-surgical care.

Depending on the procedure, you may also need to wear a leg brace or special compression sock. The hospital staff may show you how to put these devices on before discharging you.

Meniscus removal side effects

Meniscus surgery is generally a very safe procedure. The operation itself carries the same sorts of risks as all surgery, such as infection, blood loss, and complications from anesthetic. The risk of these complications is very low.

However, a torn meniscus can have side effects that are not necessarily alleviated by a meniscectomy. Because a meniscectomy takes out part of the shock absorber in your knee, it can lead to knee osteoarthritis later in life. A meniscus tear, even with a partial meniscectomy, raises your chances of developing osteoarthritis earlier than you might have without the injury. Additionally, you may have persistent joint pain and swelling in the knee after meniscus removal. Meniscus repair, on the other hand, can restore the function of the torn meniscus and decrease the risk of future arthritis.

Recovery from meniscus surgery

The recovery time and rehab process depend on whether you had a meniscus repair or removal.

Following a meniscus repair, you'll need to immobilize the knee for around six weeks. This gives the slow-healing cartilage time to grow back together. During this healing period, you may have gentle physical therapy sessions to help prevent muscle loss and regain range of motion.

The physical therapist may manipulate your leg, massage the muscles, or give you exercises to perform that don't involve putting any weight on the leg. Once your meniscus has healed enough to bear weight, you'll gradually stop using your crutches and start doing physical therapy to rebuild strength, mobility, and coordination in the leg.

It may take as long as six months to finish rehabilitation and physical therapy for a meniscus repair.

The recovery time after a meniscectomy is shorter than for a meniscus repair. In general, it will take about six weeks to recover. Depending on the location and severity of the tear, you may be able to start putting weight on your knee almost immediately. Your surgeon will provide guidelines about how long to use crutches. You'll also meet with a physical therapist. Many people return to their athletic and training activities after a month or two.

FAQs about meniscus surgery

The recovery timeline for meniscus tear surgery is relatively fixed. It takes about 6-8 weeks to recover from a meniscectomy and about three months to recover from a meniscus repair surgery. The best thing you can do to recover quickly is to follow your physical therapy program closely, get plenty of rest, eat a balanced diet, and don't smoke or take recreational drugs while you recover.

A torn meniscus is usually repaired through arthroscopy. The surgeon makes several small cuts around the knee, inserts a camera to show the inside of the joint, and then uses tiny tools to sew the edges of the torn meniscus back together.

It depends on the tear. Minor tears may heal on their own with time, rest, and conservative treatments, but severe tears will not.

In either case, waiting to have meniscus surgery doesn't have a hard "time limit," but the longer you wait, the less likely a surgeon will be able to repair the damage and the more likely that you'll need a meniscectomy.

Once your care team determines that surgery is the right choice, it's better to get the operation as soon as you can. Acting quickly can prevent the meniscus from becoming degenerative and worsening over time.

No. Some mild tears may be able to heal with rest and conservative treatments. Severe or more complex tears generally require surgery to heal.

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