Meniscus Surgery: What to Expect from Knee Arthroscopy

What Is the Meniscus and Why Does It Need Surgery?

The meniscus is a C-shaped piece of cartilage in your knee that acts as a shock absorber between your thighbone (femur) and shinbone (tibia). Each knee has two menisci - the medial meniscus on the inner side and the lateral meniscus on the outer side. Surgery becomes necessary when tears cause persistent pain, locking, or catching that doesn't improve with conservative treatment.

The menisci play several crucial roles in knee function and health. They distribute weight evenly across the knee joint, reducing stress on the articular cartilage that covers the ends of the bones. They also help stabilize the knee during movement and provide lubrication to keep the joint moving smoothly. Without healthy menisci, the knee experiences increased friction and stress, which can lead to premature arthritis.

Meniscus tears are among the most common knee injuries, affecting people of all ages. In younger, active individuals, tears typically result from sudden twisting movements, often during sports like football, basketball, or tennis. The knee is usually bent and then twisted while the foot is planted on the ground. In older adults, degenerative tears can occur with minimal trauma as the meniscus weakens and becomes more brittle over time - sometimes a simple deep squat or awkward step can cause a tear.

Understanding the anatomy of the meniscus is important for comprehending why some tears heal on their own while others require surgery. The outer third of the meniscus (the "red zone") has a good blood supply and can often heal naturally. The inner two-thirds (the "white zone") lacks blood supply, making natural healing difficult or impossible. This is why the location of the tear significantly influences treatment decisions.

When Is Surgery Recommended?

Not all meniscus tears require surgical intervention. Many tears, particularly small ones in the outer portion of the meniscus, can heal with conservative treatment including rest, ice, compression, elevation (RICE protocol), physical therapy, and anti-inflammatory medications. Surgery is typically recommended when conservative treatment fails after 6-12 weeks, or when specific symptoms indicate a tear that won't heal on its own.

Your doctor may recommend surgery if you experience persistent mechanical symptoms such as locking (the knee getting stuck in a bent position), catching (a sensation of something catching inside the knee during movement), or giving way (the knee suddenly buckling). These symptoms suggest that a piece of torn meniscus is interfering with normal joint function. Surgery is also considered when there is significant pain and swelling that limits daily activities or when imaging studies reveal a large tear or a tear pattern that is unlikely to heal conservatively.

How Should You Prepare for Meniscus Surgery?

Preparation for meniscus surgery includes fasting for 8-12 hours before the procedure, stopping certain medications as directed by your surgeon, washing with antibacterial soap, and avoiding tobacco and alcohol for several weeks before and after surgery. Your surgeon will provide specific instructions based on your individual health situation.

Proper preparation for meniscus surgery begins weeks before the actual procedure and plays a significant role in both the success of the surgery and your recovery. The pre-operative period is your opportunity to optimize your health and ensure the best possible outcome. This includes both medical preparations and lifestyle modifications that can significantly impact healing.

In the weeks leading up to surgery, your surgeon may order blood tests, an electrocardiogram (ECG), or other tests to ensure you're healthy enough for the procedure. If you take blood-thinning medications such as aspirin, warfarin, or newer anticoagulants, you'll likely need to stop them several days before surgery to reduce bleeding risk. Always follow your surgeon's specific instructions about which medications to continue and which to stop.

The night before surgery, you'll typically need to stop eating and drinking at midnight. This fasting requirement exists because anesthesia can cause nausea, and having food or liquid in your stomach increases the risk of aspiration (breathing stomach contents into your lungs). You'll also be instructed to shower with a special antibacterial soap both the evening before and the morning of surgery to reduce the risk of infection.

The Importance of Stopping Tobacco and Alcohol

One of the most important things you can do to improve your surgical outcome is to completely avoid tobacco and alcohol for several weeks before and after surgery. This isn't just a recommendation - it can make a real difference in how well you heal. Smoking impairs blood circulation and oxygen delivery to tissues, which are essential for healing. Smokers have significantly higher rates of wound complications, infection, and poor bone and cartilage healing.

Alcohol consumption also affects healing in multiple ways. It can interfere with blood clotting, increase bleeding during and after surgery, and negatively interact with anesthesia and pain medications. Additionally, alcohol impairs immune function, increasing infection risk. If you need help quitting tobacco or alcohol, speak with your healthcare provider - there are effective resources and support systems available to help you through this process.

What Happens During Meniscus Surgery?

Meniscus surgery is performed arthroscopically through two small incisions on the front of the knee. The surgeon inserts a tiny camera (arthroscope) and surgical instruments to examine and treat the tear. Depending on the tear's location and pattern, the surgeon will either repair the meniscus with sutures or remove the damaged portion. The procedure typically takes 20-45 minutes.

Before the surgery begins, you'll meet with the surgeon and anesthesiologist to discuss the procedure and answer any final questions. The type of anesthesia used varies - most meniscus surgeries are performed under general anesthesia (you're completely asleep), but some may be done with regional anesthesia such as a spinal block or nerve block, sometimes with sedation to keep you relaxed. Your anesthesiologist will recommend the best option based on your health and the specific procedure planned.

Once anesthesia takes effect, the surgical team positions your leg and applies a tourniquet around your thigh. The tourniquet temporarily stops blood flow to provide a clear view inside the joint. The surgeon then makes two small incisions, typically less than one centimeter each, on either side of the patellar tendon (the tendon below your kneecap). Through one incision, the surgeon inserts the arthroscope - a thin tube with a camera and light that projects images onto a monitor. Through the other incision, surgical instruments are inserted.

The surgeon first examines the entire knee joint, including the cartilage surfaces, ligaments, and both menisci, to assess the full extent of any damage. The knee joint is filled with sterile fluid to expand the space and improve visibility. Based on what the surgeon finds, they will perform one of two main procedures:

Meniscus Repair

If the tear is in the outer portion of the meniscus where blood supply is adequate, and the tear pattern is suitable, the surgeon may be able to repair the meniscus by stitching the torn edges back together. Various suturing techniques can be used depending on the tear location and pattern. Meniscus repair preserves the natural cartilage and is associated with better long-term outcomes for joint health. However, the repaired tissue needs time to heal, so recovery is longer and weight-bearing is more restricted initially.

Partial Meniscectomy

When the tear is in the inner portion of the meniscus (where blood supply is poor and healing unlikely), when the meniscus tissue is too damaged to repair, or when the tear pattern doesn't lend itself to repair, the surgeon will perform a partial meniscectomy. This involves removing only the damaged portion of the meniscus while preserving as much healthy tissue as possible. Recovery from partial meniscectomy is faster because there's no repaired tissue that needs to heal together.

After completing the procedure, the surgical instruments and arthroscope are removed. The small incisions are closed with sutures or surgical tape and covered with sterile dressings. A compression bandage is wrapped around the knee to minimize swelling. The entire procedure typically takes between 20 and 45 minutes, though this can vary depending on what the surgeon finds and the complexity of the treatment required.

What Should You Expect During Recovery?

Recovery begins immediately after surgery with observation until anesthesia wears off. Most patients go home the same day. Initial recovery involves managing pain and swelling, protecting the surgical site, and beginning gentle exercises. Full recovery takes 4-6 weeks for partial meniscectomy and 3-6 months for meniscus repair, with physical therapy playing a crucial role throughout.

Immediately after surgery, you'll be taken to a recovery area where medical staff will monitor you as the anesthesia wears off. This typically takes one to two hours. During this time, they'll check your vital signs, manage any post-operative nausea, and ensure there's no unusual bleeding. You may feel groggy, and some temporary numbness in your leg is normal, especially if regional anesthesia was used.

Before you go home, you'll receive detailed instructions about wound care, medications, activity restrictions, and warning signs that require medical attention. You'll also learn how to use crutches if needed. It's essential that someone drives you home - you should not drive yourself due to the effects of anesthesia and the procedure itself. Having someone stay with you for the first 24 hours is also recommended.

The First Days After Surgery

The first few days after surgery are focused on controlling pain and swelling. You'll likely experience some discomfort, which is normal and can be managed with prescribed pain medications and over-the-counter anti-inflammatories as directed. Applying ice wrapped in a cloth for 20 minutes every 2-3 hours helps reduce swelling. Keep your leg elevated above the level of your heart when resting - this is one of the most effective ways to minimize swelling.

Keep the surgical dressing clean and dry. Your surgeon will tell you when you can shower and how to protect the incisions. Most surgeons use sutures or surgical strips that dissolve or fall off on their own, but some may require removal at a follow-up appointment. Watch for signs of infection including increasing redness, warmth, swelling, discharge from the incisions, or fever - contact your surgeon immediately if you notice any of these.

Returning to Daily Activities

How quickly you can return to activities depends on which procedure you had. After a partial meniscectomy, most patients can bear weight immediately with the assistance of crutches for comfort. Within one to two weeks, many can walk without crutches and resume light daily activities. Driving is usually possible within one to two weeks if you had surgery on your left knee (for automatic transmission) or when you can comfortably control the pedals for right knee surgery.

After meniscus repair, recovery is more gradual because the repaired tissue needs time to heal. You may need to use crutches for four to six weeks and wear a knee brace that limits movement. Weight-bearing is often restricted or limited during this period. Your surgeon will provide a specific timeline based on your repair and healing progress.

Most people can return to desk work within one to two weeks, though this varies based on individual recovery and the nature of the job. More physically demanding jobs may require four to eight weeks of recovery time. Discuss your specific work requirements with your surgeon to get personalized guidance.

Why Is Rehabilitation So Important After Meniscus Surgery?

Rehabilitation through physical therapy is essential for regaining full knee function after meniscus surgery. A structured exercise program restores range of motion, rebuilds strength in the muscles supporting the knee, and improves balance and coordination. Working with a physical therapist ensures proper progression and helps prevent re-injury.

The importance of rehabilitation after meniscus surgery cannot be overstated. Surgery addresses the structural problem - the torn meniscus - but it doesn't automatically restore full knee function. The muscles around your knee, particularly the quadriceps and hamstrings, weaken after injury and surgery. Joint stiffness can develop if movement is limited for too long. Proprioception - your body's sense of joint position and movement - may be impaired. All of these issues must be addressed through systematic rehabilitation.

Physical therapy typically begins within a few days of surgery, though the intensity and exercises vary depending on whether you had a meniscectomy or repair. Your physical therapist will design a program specifically for you, considering the type of procedure, your baseline fitness level, your goals, and how your body responds to treatment. The program evolves as you progress through different phases of healing.

Phases of Rehabilitation

Early rehabilitation focuses on reducing swelling, regaining range of motion, and activating the muscles around the knee. Gentle exercises like ankle pumps, heel slides, and straight leg raises begin almost immediately. These exercises maintain circulation, prevent stiffness, and keep the quadriceps from becoming too weak.

As healing progresses, the program advances to strengthening exercises. These include progressive resistance exercises for the quadriceps and hamstrings, balance and stability training, and eventually sport-specific exercises if you plan to return to athletics. The timeline for these progressions varies significantly between meniscectomy patients (who can progress faster) and meniscus repair patients (who must protect the healing repair).

Returning to sports or high-impact activities should only happen when cleared by both your surgeon and physical therapist. This decision is based on objective measures of strength, stability, and movement quality - not just the passage of time. Returning too soon increases the risk of re-injury or new injuries because the knee hasn't fully recovered.

What Are the Potential Complications of Meniscus Surgery?

Meniscus surgery is generally safe with low complication rates. Potential risks include infection (less than 1%), blood clots, nerve or vessel damage, stiffness, persistent pain, and failure of meniscus repair. Long-term, removing meniscus tissue may increase the risk of osteoarthritis. Most complications can be prevented or managed with proper care and following post-operative instructions.

While meniscus surgery is one of the safest orthopedic procedures, it's important to understand the potential risks so you can make an informed decision and know what warning signs to watch for after surgery. Being aware of complications doesn't mean they're likely to happen - most patients have uncomplicated recoveries - but knowing what to look for allows for prompt treatment if something does go wrong.

Infection is a concern with any surgery, though the risk with arthroscopic knee surgery is very low - typically less than 1%. Signs of infection include increasing redness around the incisions, warmth, swelling, drainage (especially if cloudy or foul-smelling), and fever. Infection requires prompt treatment with antibiotics and sometimes additional surgery to wash out the joint.

Blood clots (deep vein thrombosis or DVT) can form in the leg veins after knee surgery, particularly if mobility is limited. Symptoms include calf pain, swelling, warmth, and redness in the lower leg. A clot that travels to the lungs (pulmonary embolism) is a serious medical emergency. The risk of blood clots is reduced by moving your ankle and foot frequently, walking as soon as permitted, staying well-hydrated, and sometimes using blood-thinning medications as prescribed.

Other Potential Complications

Nerve damage, though rare, can cause numbness or tingling around the knee. This usually resolves over weeks to months but can occasionally be permanent. Blood vessel damage is extremely rare. Knee stiffness can develop, especially if rehabilitation exercises aren't performed consistently - this is why physical therapy is so important.

For meniscus repair specifically, the repair can fail to heal or can re-tear. The success rate of meniscus repair depends on many factors including tear location, tear pattern, patient age, and rehabilitation compliance. When repairs fail, another surgery may be needed to either re-repair or remove the damaged portion.

In the long term, any loss of meniscus tissue increases stress on the knee joint and may accelerate the development of osteoarthritis. This is why surgeons try to preserve as much meniscus as possible during meniscectomy and why repair is preferred over removal when feasible. However, even partial meniscectomy provides symptom relief and allows return to activities, and the progression to arthritis typically takes many years.

What If the Meniscus Is Injured Again?

Re-injury to the meniscus can occur, especially in people who return to high-impact sports or activities. If a repaired meniscus tears again, it may need another surgery. Since repeated repairs are sometimes not possible, the damaged tissue may need to be removed. Preventing re-injury through proper rehabilitation and activity modification is important.

Unfortunately, having one meniscus tear does put you at increased risk for future tears - either a re-tear of the same meniscus or a new tear. This risk is higher in people who return to activities that place significant stress on the knee, such as pivoting sports (soccer, basketball, tennis) or jobs requiring frequent squatting, kneeling, or heavy lifting.

If you experience a new injury or a re-tear, the evaluation and treatment process is similar to the first time. Your doctor will assess your symptoms, perform a physical examination, and likely order an MRI to see the new damage. Treatment options will depend on the type and location of the new tear and what meniscus tissue remains.

For re-tears after meniscus repair, a second repair attempt may be possible if enough healthy tissue remains and the tear is in a healable location. However, repeated repairs become more challenging, and at some point, removing the damaged portion (converting to a meniscectomy) may be the only practical option. This is one reason why protecting a repaired meniscus during the healing period is so important.

Preventing Re-injury

While you can't completely eliminate the risk of re-injury, you can reduce it through several strategies. Complete your rehabilitation program fully, including the strengthening and stability exercises, before returning to demanding activities. Maintain good leg strength through ongoing exercise - strong quadriceps and hamstrings help protect the knee. Consider activity modification, especially as you age - you may need to switch from high-impact sports to lower-impact activities like swimming or cycling. Use proper technique when exercising or playing sports, and wear appropriate footwear.

What Are the Long-Term Outcomes After Meniscus Surgery?

Most patients have good long-term outcomes after meniscus surgery, with significant improvement in pain and function. Success rates are highest for meniscus repair (80-90% when the tear is in a healable location) and for partial meniscectomy in patients without significant arthritis. Preserving meniscus tissue through repair is associated with better long-term joint health.

The long-term success of meniscus surgery depends on several factors including the type of procedure, the amount of meniscus preserved, the presence of other knee problems (such as ligament injuries or cartilage damage), and patient factors like age, weight, and activity level. Most patients experience significant improvement in their symptoms and can return to the activities they enjoy.

Meniscus repair, when successful, provides the best long-term outcome because it preserves the natural shock-absorbing function of the meniscus. Studies show that successful repairs maintain joint health better than meniscectomy over the long term. However, repairs require a longer recovery period and don't always heal completely.

Partial meniscectomy provides reliable short-term symptom relief - most patients have significantly less pain and improved function. However, removing meniscus tissue does increase stress on the knee and may contribute to osteoarthritis development over time, especially if a large portion is removed. The progression to arthritis is gradual and varies greatly between individuals.

Some patients eventually require additional treatments, ranging from injections (such as corticosteroids or hyaluronic acid) to manage symptoms, to eventually knee replacement if arthritis becomes severe. However, many patients do well for years or decades after meniscus surgery. Maintaining a healthy weight, staying active with appropriate exercises, and addressing any new symptoms promptly all help optimize long-term outcomes.