Meniscus Tear Surgery

Dr Chong Xue Ling
Dr Chong Xue Ling
Senior Consultant Orthopaedic Surgeon

Meniscus tear surgery is a procedure that addresses damage to the meniscus, a C-shaped cartilage pad that acts as a cushion between the femur (thigh bone) and tibia (shin bone) in the knee joint. The procedure aims to repair or remove damaged portions of the meniscus to restore knee function, reduce pain, and prevent further joint deterioration. This surgery is typically performed arthroscopically, using small incisions and specialised instruments to minimise tissue trauma and promote faster recovery.

Indications for Meniscus Tear Surgery

The following conditions may necessitate surgical intervention for a meniscus tear when conservative treatments do not provide adequate relief.

Persistent Pain

Ongoing knee pain that does not respond to non-surgical treatments such as rest, ice, compression, and elevation (RICE protocol) may require surgical intervention. The pain typically occurs along the joint line where the meniscus is located.

Restricted Range of Motion

Limited ability to fully extend or flex the knee can indicate a displaced meniscus tear. The torn piece may act as a physical block to normal joint movement.

Large or Displaced Tears

Tears that are significant in size or have displaced fragments often require surgical repair. These types of tears are less likely to heal on their own due to the poor blood supply to much of the meniscus.

Failed Conservative Treatment

When non-surgical approaches, including physical therapy, anti-inflammatory medications, and activity modification, have not improved symptoms after 6-12 weeks, surgery may be considered.

Benefits of Meniscus Tear Surgery

Meniscus tear surgery offers several advantages for patients dealing with this common knee injury, particularly when conservative management has not been successful.

Surgery removes or repairs the damaged portions of the meniscus that cause pain. This addresses the root cause of discomfort rather than simply managing symptoms.

Repairing or removing the torn meniscus restores smooth movement within the knee joint. Patients typically experience improved ability to walk, climb stairs, and participate in daily activities.

Untreated meniscus tears can lead to increased wear on the articular cartilage of the knee. Surgery helps prevent this progressive damage and reduces the risk of developing osteoarthritis.

Most patients can return to their previous level of activity following proper rehabilitation. Athletes and active individuals can often resume sports participation after complete recovery.

Arthroscopic techniques used for meniscus surgery require only small incisions, resulting in less pain, reduced risk of infection, and faster recovery compared to open surgery.

Surgical Techniques

Meniscus Repair

The torn edges of the meniscus are stitched together to promote healing. This is typically done for tears in the outer third (the “red zone”), where there is enough blood supply for recovery. Preserving the meniscus helps maintain its cushioning function and knee stability.

Partial Meniscectomy

If a tear cannot be repaired, the damaged portion is trimmed while preserving as much healthy tissue as possible. This is usually performed for tears in the inner two-thirds (the “white zone”), where healing is unlikely due to poor blood supply. The goal is to stabilise the remaining meniscus and reduce pain.

Meniscus Transplantation

For younger patients with a previously removed meniscus and persistent knee pain, a donor meniscus may be implanted. The donor tissue is carefully matched to the patient’s knee anatomy. This option is considered when significant meniscal loss has occurred but the knee joint remains otherwise healthy.

Preparing for Surgery

  • Medical Evaluation: A thorough assessment includes a physical examination, imaging studies, and laboratory tests. Your surgeon will review your medical history, current medications, and previous surgeries. Magnetic Resonance Imaging (MRI) provides detailed images of the meniscus tear pattern and location to help plan the surgical approach. Additional tests may be ordered to ensure you are fit for anaesthesia.
  • Medication Adjustments: Certain medications may need to be temporarily discontinued before surgery. Blood thinners such as aspirin, warfarin, or clopidogrel typically need to be stopped 5-7 days before the procedure to reduce bleeding risk. Anti-inflammatory drugs (NSAIDs) may also need to be paused.
  • Pre-operative Guidelines: Fasting is required for at least 8 hours before surgery to prevent complications from anaesthesia. You may take approved medications with a small sip of water.

Step-by-Step Procedure

The procedure begins with either general anaesthesia (which puts you completely unconscious) or regional anaesthesia (spinal or epidural), which numbs the lower body while allowing you to remain awake if preferred. The anaesthesiologist monitors vital signs throughout the surgery. The choice of anaesthesia depends on factors such as procedure complexity and duration.

The knee is cleaned with an antiseptic solution, and the leg is positioned, typically bent at 90 degrees, to allow optimal access. Sterile drapes are placed around the area, and the surgeon marks incision sites based on your anatomy and the location of the meniscus tear.

The surgeon makes 2–3 small incisions (5–10 mm each) around the knee. These serve as entry points for the arthroscope (a thin tube with a camera) and surgical instruments. The arthroscope provides a clear view of the joint on a monitor, while additional portals allow instrument access.

Sterile saline is introduced to expand the joint, improving visibility. The surgeon inspects the menisci, cruciate ligaments, and cartilage surfaces to confirm the diagnosis and check for additional issues. The size, location, and pattern of the meniscus tear are documented.

Depending on the findings, the surgeon proceeds with either meniscus repair or partial meniscectomy. In meniscus repair, sutures or fixation devices are used to secure the tear and promote healing. If repair is not feasible, a partial meniscectomy is performed, where specialised instruments remove the damaged portion while preserving as much healthy tissue as possible. The remaining meniscus is then contoured to minimise irritation and improve knee function.

Any loose fragments are removed, and the saline is drained before closing the small incisions with sutures or surgical tape. Sterile dressings are applied, and a compression bandage or brace may be used to reduce swelling and provide support during early recovery.

Post-Surgical Care and Recovery

Immediate Care: Pain and swelling are managed in the first 24–48 hours with elevation, icing, and prescribed medications. The leg should be elevated above heart level, and ice packs applied for 20 minutes every 2–3 hours. A compression dressing or brace helps stabilise the knee, with weight-bearing restrictions depending on the procedure.

Rehabilitation and Activity Progression: Recovery spans 3–6 months, starting with gentle range-of-motion exercises before progressing to strength training and functional activities. Physical therapy begins within days of surgery, with a structured exercise programme tailored to the procedure and individual goals. Return to activities follows a phased approach, gradually reintroducing complex movements and sport-specific training as healing allows.

Follow-up Appointments: Regular check-ups monitor healing and guide rehabilitation. The first visit occurs within 10–14 days to assess wound healing, followed by reviews at 6 weeks, 3 months, and 6 months to evaluate progress. Imaging may be used to confirm meniscus healing, and rehabilitation plans are adjusted as needed.

Potential Risks and Complications

While meniscus tear surgery is generally effective, there are some risks. Infection at the incision sites may require antibiotics or further treatment. Blood clots can develop, especially with limited mobility. Some patients experience persistent pain or stiffness despite successful repair. Nerve damage is rare but can cause numbness or weakness. In some cases, the repair may not heal properly, particularly in areas with limited blood supply. Anaesthesia complications, such as allergic reactions or breathing issues, are possible. Long-term arthritis risk remains, as the meniscus may not fully regain its pre-injury function. The likelihood of complications increases with complex tears, advanced age, or pre-existing conditions.

Dr Chong Xue Ling

Dr Chong Xue Ling

Senior Consultant Orthopaedic Surgeon

Dr Chong Xue Ling is a Swiss fellowship-trained orthopaedic surgeon specialising in foot and ankle, as well as shoulder and elbow surgery.

She is a member of the European Group for the Study and Research of Minimally Invasive Surgery of the Foot and Ankle. For shoulder and elbow surgery, she completed her fellowship at La Tour Hospital, an accredited Swiss Olympic Medical Centre and learnt innovative techniques in arthroplasty for earlier return to activity as well as the stabilising techniques, developed to have greater strength without extensive fixation.

  • MBBS (S’pore)
  • MRCS (Ireland)
  • MMed Orthopaedic (S’pore)
  • FRCS Orthopaedic (Edinburgh)

Through active involvement in research, she aims to constantly improve existing treatment in the pursuit of quality care for her patients.

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    Meniscus Tear Surgery

    Frequently Asked
    Questions

    Will I need a brace after meniscus surgery?

    Bracing requirements depend on the specific procedure. Partial meniscectomy patients may use a simple compression sleeve for comfort. Meniscus repair patients typically wear a hinged knee brace that limits range of motion for 4-6 weeks to protect the repair while it heals.

    When can I drive after meniscus surgery?

    You may resume driving when you have full control of your leg and are no longer taking narcotic pain medications. For surgery on the right knee, this typically takes 1-2 weeks for partial meniscectomy and 4-6 weeks for meniscus repairs. Surgery on the left knee generally allows an earlier return to driving with an automatic transmission.

    Can I prevent future meniscus tears?

    While no prevention strategy is guaranteed, several approaches may reduce risk. Maintaining strong thigh muscles helps stabilise the knee joint. Proper technique during sports and exercise, particularly with pivoting and squatting movements, reduces stress on the meniscus. Appropriate footwear provides needed support. Gradual progression of activity intensity allows tissues to adapt to increasing demands.