Meniscectomy (Arthroscopic Partial or Total Meniscus Removal)

Overview

Meniscectomy may be used to remove a portion of a torn meniscus cartilage in the knee, and it can be performed arthroscopically through small incisions. The procedure is typically considered when a meniscus tear causes persistent pain, mechanical symptoms (such as catching or locking), or reduced function, particularly when non-surgical care has not provided adequate relief. The main goal generally involves reducing symptoms by trimming unstable torn tissue while preserving as much healthy meniscus as possible. Outcomes can vary based on tear type, cartilage wear, knee alignment, and activity demands, and longer-term knee arthritis risk may be influenced by the amount of meniscus removed.

Indications

This procedure may be considered when:

• •A symptomatic meniscus tear with persistent pain or swelling that may not improve with a span of conservative management such as activity modification and physical therapy.
• •Mechanical symptoms such as catching, locking, or recurrent joint-line pain that can suggest an unstable meniscal fragment.
• •Displaced tear patterns (such as bucket-handle tears) that may cause motion blockage, when repair is not feasible or tissue quality is limited.
• •Complex, degenerative, or frayed tears in older adults that may be less amenable to repair, particularly when symptoms correlate with the tear location.
• •Meniscus tears associated with loose fragments or loose bodies that can irritate the joint and contribute to episodic swelling.
• •Meniscus tears identified during evaluation of other knee pathology (such as ligament injury) when the tear appears unstable and symptomatic.
• •Failure of prior meniscus repair or recurrent tear in which trimming unstable tissue may be considered based on remaining meniscus integrity.

How It Works

The procedure typically involves several coordinated steps:

• •Portal placement is typically planned to optimize access to the medial and/or lateral compartments while minimizing risk to nearby neurovascular structures.
• •Arthroscopic fluid inflow can distend the joint, which may improve visualization of the meniscus, cartilage surfaces, and intercondylar notch.
• •A systematic diagnostic survey is generally performed, often including evaluation of the suprapatellar pouch, patellofemoral joint, medial compartment, intercondylar notch (ACL/PCL), and lateral compartment.
• •The tear is typically probed to assess stability, displacement, and the quality of the remaining meniscal rim; tear location relative to vascular zones (red-red, red-white, white-white) can influence whether repair versus resection is considered.
• •Partial meniscectomy generally involves resecting only the unstable torn portion while preserving a stable peripheral rim that can continue to distribute load and contribute to joint stability.
• •Resection can be performed using arthroscopic punches, biters, and shavers; the surgeon typically contours the remaining meniscus to a smooth, stable edge to reduce future mechanical irritation.
• •Care is often used to avoid excessive removal, as meniscal tissue contributes to shock absorption and load transmission; the amount removed may influence contact pressures on articular cartilage.
• •Hemostasis can be addressed with pressure, irrigation, or electrocautery when needed, particularly near the meniscocapsular junction.
• •The joint is typically irrigated to remove debris, and a final inspection can confirm absence of unstable fragments and adequate contouring.
• •Portal sites are closed, and compressive dressings are applied to help limit postoperative swelling; some protocols can include cryotherapy and early mobilization depending on surgeon preference and intraoperative findings.

Risks

As with any surgical procedure, potential risks include:

• •Infection (superficial portal infection or deeper septic arthritis) may occur, and it can require additional evaluation and treatment.
• •Bleeding or hemarthrosis (blood in the joint) can occur and may contribute to swelling and stiffness in the early postoperative period.
• •Deep vein thrombosis or pulmonary embolism can occur after lower-extremity surgery, with risk influenced by patient factors and mobility.
• •Nerve or blood vessel injury near portal sites may occur, potentially causing numbness, tingling, or vascular complications, though these are generally uncommon.
• •Persistent pain, recurrent swelling, or incomplete symptom relief can occur, particularly when symptoms are influenced by cartilage degeneration or osteoarthritis.
• •Knee stiffness or loss of range of motion can occur, sometimes related to swelling, scar formation, or limited early mobility.
• •Progression of cartilage wear or osteoarthritis may occur over time, and risk can be influenced by the amount of meniscus removed, knee alignment, and baseline cartilage status.
• •Re-tear or new meniscal tearing can occur in remaining tissue, especially with ongoing high-demand activity or degenerative tissue quality.
• •Anesthesia-related complications (such as nausea, sore throat with general anesthesia, or rare cardiopulmonary events) can occur and vary by health status and anesthesia type.
• •Fluid extravasation into surrounding soft tissues may occur during arthroscopy and can contribute to temporary swelling.

Recovery Expectations

Recovery follows a gradual progression:

• •Day of surgery to 1–2 days: Weight-bearing can often begin as tolerated after uncomplicated partial meniscectomy, with crutches used as needed based on pain and stability.
• •First week: Swelling and discomfort may gradually improve; gentle range-of-motion exercises and quadriceps activation can often begin early depending on surgeon protocol and intraoperative findings.
• •1–2 weeks: Portal sites typically heal over this span; follow-up may include wound assessment and review of activity progression.
• •2–6 weeks: Physical therapy or guided rehabilitation can focus on restoring range of motion, strength, and gait mechanics; many daily activities may become easier over this span.
• •4–8 weeks: Return to higher-impact activities can vary and may depend on pain, swelling, strength symmetry, and the presence of cartilage wear; some individuals may require a longer span.
• •6–12 weeks: Functional recovery for sports or physically demanding work can require this span for many patients, particularly when preoperative symptoms were prolonged or when cartilage degeneration is present.
• •Several months: Residual swelling after heavy activity can persist in some cases, and longer-term symptom patterns may relate to meniscus loss, alignment, and cartilage condition.

Alternatives

Depending on individual circumstances, alternatives may include:

• •Activity modification and structured physical therapy may be used to improve strength, mechanics, and symptom control for certain tear types.
• •Non-surgical pain management options (such as nonprescription or prescription anti-inflammatory medications) may be used when appropriate, based on clinician assessment and individual risk factors.
• •Intra-articular injections (such as corticosteroid injections) may be considered for symptom relief in selected patients, particularly when arthritis contributes to pain.
• •Meniscus repair (suturing the tear) may be considered for repairable tear patterns, especially in more vascular zones and in younger or more active individuals.
• •Observation with symptom-guided rehabilitation may be considered for stable tears or degenerative tears without significant mechanical symptoms.
• •Meniscus transplantation may be considered in selected patients with prior substantial meniscus loss and persistent compartment symptoms, typically in specialized centers.
• •Osteotomy or alignment procedures may be considered when malalignment contributes to compartment overload and symptoms, often in the setting of meniscus deficiency and cartilage wear.

Sources

• AAOS OrthoInfo - Meniscus Tears
• AAOS OrthoInfo - Knee Arthroscopy
• Mayo Clinic - Torn meniscus (Diagnosis and treatment overview)
• Cleveland Clinic - Meniscectomy
• MedlinePlus (NIH) - Knee arthroscopy