Meniscus Injuries Surgical Treatment

Surgery is considered when mechanical symptoms persist, when nonoperative treatment has not provided adequate relief after a reasonable trial, or when the tear pattern is one that benefits from early intervention. Certain injuries move to the front of the line:

• A locked knee from a displaced bucket-handle tear
• A repairable tear in a young or active patient
• A meniscus root tear
• A tear occurring alongside an ACL injury, where both can be addressed in a single procedure

In these situations, timing matters, because a repairable tear left untreated may no longer be repairable months later, and a root tear left untreated can lead to rapid cartilage loss.

Meniscus surgery is performed arthroscopically, through a few small incisions using a camera that provides a magnified view inside the joint. This allows Dr. Rynecki Baker to examine the entire knee, confirm the tear pattern and blood supply, and treat the meniscus and any associated injuries. These procedures are performed on an outpatient basis, and most patients go home the same day.

Meniscus Repair

Meniscus repair brings the torn edges back together with sutures so the tissue can heal in place. Depending on where the tear sits, Dr. Rynecki Baker uses an all-inside, inside-out, or outside-in technique. Repair is favored for vertical and bucket-handle tears in the outer portion of the meniscus, and in younger patients it is increasingly extended to tears once considered unrepairable. To support healing, the repair site may be stimulated and bone marrow cells released into the joint, which can enhance the healing environment.

Meniscus Root Repair

Root tears are repaired by securing the meniscus back to its attachment on the bone, typically with sutures passed through a small tunnel in the tibia. Restoring the root allows the meniscus to bear load again and helps protect the cartilage from the rapid wear that follows an untreated root tear.

Ramp Lesion Repair

A ramp lesion, a tear at the back of the medial meniscus where it attaches to the capsule, is commonly seen with ACL tears. Dr. Rynecki Baker specifically evaluates for this injury during ACL surgery and repairs it when present, as leaving it untreated can contribute to ongoing instability.

Partial Meniscectomy

Partial meniscectomy is used when a tear sits in the inner portion of the meniscus that has limited blood supply and cannot heal. Only the damaged fragment is trimmed, leaving as much stable tissue as possible, because every millimeter of preserved meniscus continues to protect the cartilage beneath it.

Meniscal Allograft Transplantation

Meniscal transplantation is an option for a specific group of patients, typically younger individuals who have previously had a meniscus removed and now have pain in that compartment without advanced arthritis. Donor tissue is sized to the patient’s anatomy and secured in the joint to restore cushioning and load distribution. When malalignment is present, an osteotomy may be performed at the same time to protect the new meniscus.

Additional Procedures

Meniscus surgery is often part of a broader plan to protect the knee:

• ACL reconstruction: When a meniscus tear occurs with an ACL tear, both are addressed in the same procedure. Restoring knee stability protects the meniscus repair and prevents further damage.
• Osteotomy: A bowlegged or knock-kneed limb places excess load on one compartment. Correcting alignment can protect a meniscus repair, root repair, or transplant in that compartment.
• Cartilage procedures: When cartilage damage is present, it may be addressed at the same time to protect the joint surface.

Recovery depends on which procedure was performed. After a partial meniscectomy, patients bear weight immediately and return to most activities within four to six weeks.

After a repair, the timeline is considerably longer, because sutured tissue must be protected from load and rotation while it heals. Patients can expect a brace and crutches early on, restrictions on deep bending and pivoting for several months, and a return to sport around four to five months. Root repairs, complex repairs, and transplantation are protected longer still.

Every patient receives a written protocol specific to the procedure performed, and progression is guided by motion, strength, and movement quality rather than the calendar alone.