Meniscal Repair Techniques in Knee Surgery

Meniscal repair in knee surgery aims to restore the anatomy and function of the menisci, fibrocartilaginous structures that distribute load, absorb shock and stabilise the joint. Historically, meniscal tears were treated by partial or total meniscectomy, but this approach is now associated with accelerated cartilage degeneration and osteoarthritis. Preservation techniques have therefore advanced to include inside-out, outside-in and all-inside suture methods, each selected according to tear location, pattern and tissue quality. Posterior root tears, which interrupt circumferential “hoop” stresses crucial for load transmission, are treated with specialised pull-out repairs or suture anchors through tibial tunnels to re-establish native biomechanics. Biological augmentation strategies—such as platelet-rich plasma and tissue scaffolds—are under investigation to promote healing in areas of poor vascular supply. Biomechanical modelling has clarified the stress distribution implications of various tear and repair configurations, guiding surgical planning. Clinical series report success rates approaching 80–85% in optimally selected tears, and long-term data suggest lower rates of osteoarthritis progression and knee arthroplasty compared with tissue resection. Patient factors including age, body mass index and concomitant ligament injuries influence outcomes, and tailored rehabilitation protocols are essential. With rising sports participation and an ageing population, refining meniscal repair techniques remains key to preserving joint health and delaying degenerative change.

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Meniscal Repair Techniques in Knee Surgery publication trend

The graph below shows the total number of articles in meniscal repair techniques in knee surgery across all publications each year (not limited to Nature Index journals).

Technical terms

Meniscal repair: Surgical restoration of torn meniscus tissue aiming to preserve function and delay degeneration.

Partial meniscectomy: Resection of the damaged portion of the meniscus to relieve symptoms while reducing load-bearing tissue.

Transtibial pull-out repair: Technique employing sutures passed through tibial tunnels to reattach meniscal roots and restore hoop stresses.

Meniscal extrusion: Displacement of meniscal tissue beyond the tibial articular margin, compromising load distribution.

Hoop stress: Circumferential tension within the meniscus that maintains joint congruity under load.

References

1. Biomechanical effects of the medial meniscus horizontal tear and the resection strategy on the rabbit knee joint under resting state: finite element analysis. Frontiers in Bioengineering and Biotechnology (2023).
2. Meniscectomy is associated with a higher rate of osteoarthritis compared to meniscal repair following acute tears: a meta‐analysis. Knee Surgery, Sports Traumatology, Arthroscopy (2023).
3. Superior outcomes of pullout repairs for medial meniscus posterior root tears in partial tear compared to complete radial tear. Knee Surgery & Related Research (2024).
4. A Prospective, Randomized, Double‐Blind, Parallel‐Group, Placebo‐Controlled Study Evaluating Meniscal Healing, Clinical Outcomes, and Safety in Patients Undergoing Meniscal Repair of Unstable, Complete Vertical Meniscal Tears (Bucket Handle) Augmented with Platelet‐Rich Plasma. BioMed Research International (2018).