Meniscus Repair

Meniscus repair is a surgical procedure that stitches a torn meniscus — the C-shaped pad of cartilage (tough, rubbery tissue) that cushions and stabilises the knee joint — back together so it can heal.

The knee has two menisci, one on the inner side and one on the outer side. When one tears, it can cause pain, swelling, and a catching or locking sensation in the knee. During the repair, a surgeon uses a thin camera called an arthroscope (a small telescope inserted through a tiny cut) to see inside the joint, then passes sutures (stitches) through the torn edges to hold them in place while the tissue heals over the following months.

Meniscus repair is considered when a torn meniscus causes significant symptoms that do not improve with rest, physiotherapy (exercise-based treatment), or pain management. The goal is to save as much of the natural meniscus as possible, because keeping the meniscus reduces the long-term risk of osteoarthritis (wear-and-tear joint damage).

• A tear in the outer zone of the meniscus, where blood supply is good enough to support healing after stitching.
• A sports injury — for example, a sudden twist or pivot that tears the meniscus, common in football, basketball, or badminton players.
• A traumatic knee injury, often occurring alongside an ACL (anterior cruciate ligament — the main stabilising cord inside the knee) tear.
• A bucket-handle tear (a large, displaced flap of cartilage that causes the knee to lock and cannot straighten fully).
• Younger, active patients whose tissue quality makes healing more likely.

Not every meniscus tear is suitable for repair. In the following situations, the surgeon may instead trim away the damaged portion — a procedure called a partial meniscectomy — rather than repair it.

• Tears in the inner zone of the meniscus, where there is little or no blood supply to support healing.
• Degenerative tears (gradual wear-related damage) in older patients with pre-existing knee arthritis.
• Very small, stable tears that are not causing symptoms.
• Tissue that is too damaged or frayed to hold stitches reliably.
• Patients who are unlikely to follow the extended recovery needed after repair.

Meniscus repair is generally considered safe, but like all surgical procedures it carries recognised risks that your surgical team will discuss with you beforehand.

• Failure of the repair to heal — the stitched tissue does not fully knit together, which may require further surgery.
• Knee stiffness or reduced range of motion, particularly if rehabilitation exercises are not started at the right time.
• Infection inside the joint (septic arthritis — a serious joint infection), which may require antibiotics or further washout of the joint.
• Blood clot in the leg veins (deep vein thrombosis, or DVT), which can cause leg swelling and pain; rarely, a clot can travel to the lungs.
• Damage to nerves or blood vessels near the repair site, causing temporary or, rarely, lasting numbness or tingling around the knee.
• Swelling and fluid build-up in the joint (knee effusion) after surgery, usually settling with rest and physiotherapy.
• Anaesthesia-related reactions, which the anaesthetic team monitors carefully.
• Re-tear of the repaired meniscus if the knee is stressed too early or returns to high-impact sport before full healing.

Preparation for meniscus repair involves several steps before the day of surgery, on the day itself, and during the procedure. Your care team will give you instructions tailored to your specific health situation.

Before the procedure, patients are usually asked to fast — meaning no food or drink (including water) — for a set number of hours beforehand, as determined by the anaesthetic team. Blood thinners and certain anti-inflammatory medications are typically paused for a period before surgery because they increase bleeding risk; your doctor will advise on timing. Smoking reduces the body's ability to heal tissue, so patients who smoke are usually strongly encouraged to stop in the weeks before the operation. Alcohol is also best avoided in the days leading up to surgery.

Standard pre-operative (pre-surgery) tests are usually arranged. These commonly include:

• MRI of the knee — to confirm the location, type, and size of the tear and to plan the repair.
• Blood tests — to check general health, clotting ability, and blood group.
• An ECG (electrocardiogram — a recording of heart electrical activity) if heart monitoring is needed.
• A chest X-ray if there are breathing or heart concerns.
• A physical assessment by the anaesthetist (the doctor who manages sedation or general anaesthetic) to choose the safest type of anaesthesia.

On the day of surgery, the procedure itself typically follows these steps:

• 1. The patient changes into a hospital gown and an intravenous (IV) line is placed in the arm to deliver fluids and medications.
• 2. Anaesthesia is given — this is usually either a spinal block (numbing from the waist down) or general anaesthesia (fully asleep), depending on the surgical team's assessment.
• 3. The knee is cleaned and draped with sterile covers. A tourniquet (a cuff that temporarily slows blood flow) is usually placed around the upper thigh to keep the surgical field clear.
• 4. The surgeon makes two or three small cuts (portals) around the knee, each roughly the size of a buttonhole.
• 5. The arthroscope is inserted through one portal, projecting a clear video image of the inside of the joint onto a screen.
• 6. Saline (sterile salt water) is pumped into the joint to expand the space and improve visibility.
• 7. The surgeon locates the tear and assesses it through the camera to confirm it is suitable for repair.
• 8. Sutures or small fixation devices are passed through the tear to bring the torn edges together precisely.
• 9. The instruments are removed, the saline is drained, and the small cuts are closed with sutures or adhesive strips.
• 10. A sterile dressing is applied and, in many cases, a knee brace is fitted before the patient goes to the recovery area.

Recovery after meniscus repair is longer than recovery from a simple meniscus trim, because the stitched tissue needs time to heal. Most patients go home the same day or the day after surgery, but the full recovery process — including a return to sport — typically takes several months. Your orthopaedic surgeon and physiotherapist will guide the pace based on how your knee is healing.

• Monitoring: After surgery you will be observed in a recovery area until the anaesthesia has worn off and your vital signs are stable. Nursing staff will check your pain level, sensation, and circulation in the leg.
• Weight-bearing: In many cases, crutches are needed for several weeks after surgery, and the amount of weight allowed on the repaired leg is gradually increased on a schedule set by the surgeon.
• Knee brace: A brace is often prescribed to protect the repair and limit certain movements while healing takes place. How long it is worn varies by the type of tear and the surgeon's protocol.
• Pain and swelling control: Keeping the leg elevated and applying ice wrapped in a cloth (not directly on the skin) to the knee helps manage swelling in the early days. The care team will advise on suitable pain relief.
• Physiotherapy: A structured rehabilitation programme (physiotherapy) usually begins soon after surgery, starting with gentle range-of-motion exercises and progressing to strengthening and balance training as healing allows.
• Wound care: The small portal wounds should be kept clean and dry until the surgeon confirms they have closed. Signs of infection — increasing redness, warmth, discharge, or fever — should be reported promptly.
• Blood clot prevention: Compression stockings or prescribed blood thinners may be used in the early recovery period to reduce the risk of DVT.
• Follow-up appointments: Clinic reviews are usually scheduled at regular intervals after surgery to check healing, review the physiotherapy programme, and decide when activities can be safely expanded.
• Return to driving and work: Timing depends on which leg was operated on, the type of work involved, and progress in rehabilitation; your surgeon will advise when it is safe.
• Return to sport: High-impact sports such as football or running are usually not permitted until the surgeon and physiotherapist are satisfied that the repaired meniscus is strong enough — this commonly takes many months and requires passing specific strength and movement tests.
• Lifestyle: Maintaining a healthy body weight reduces ongoing stress on the knee joint. Smoking should be avoided during the healing period as it impairs tissue repair.