Overview
Meniscus repair stitches a torn meniscus back together so it heals, instead of removing the torn piece. The meniscus spreads load across the knee, and every bit of it that is removed raises the long-term risk of arthritis. When a tear sits in tissue with a blood supply and the pattern allows it, Dr. O'Donnell repairs it, accepting a longer recovery in exchange for a meniscus that keeps protecting the knee for decades.
The operation is arthroscopic, takes under an hour, and is done as an outpatient at Bayside Surgery Center. Most repairs heal, and the patient returns to sport at about 5 to 6 months.
Who It's For
Repair suits a meniscus tear that can heal: a longitudinal, radial or bucket-handle tear in the outer third of the meniscus, where blood vessels reach, in healthy tissue. That describes most traumatic tears in patients under about 40 and many tears found alongside an ACL tear, which are repaired during the ACL reconstruction because the healing environment of a reconstructed knee is favorable. Root tears, where the meniscus has pulled off its bony anchor, are generally repaired regardless of age when the cartilage is still healthy, because losing the root is the same as losing the whole meniscus.
Degenerative, complex or horizontal tears in the inner, avascular third do not heal when stitched, and are treated with rehabilitation first or, when they catch and lock, by partial meniscectomy. The decision is often confirmed at arthroscopy when the tear is probed directly, so patients consent to both.
A meniscus tear on MRI is not by itself a reason for surgery; tears are common on scans of knees that do not hurt, especially after 40. Dr. O'Donnell recommends repair when the joint-line tenderness and McMurray test match the tear on MRI, the symptoms fit, and the tear pattern and location are ones that can heal. The meniscus tear page explains how a finding is weighed against the exam.
What the Procedure Involves
Under a nerve block plus general anesthesia, the arthroscope is placed through two small portals at the front of the knee. The tear is probed to confirm its pattern, location and tissue quality. The torn edges are rasped to a bleeding surface, and a bucket-handle fragment is reduced back into place. Sutures are then passed across the tear. For tears in the back of the meniscus, Dr. O'Donnell uses all-inside devices that deliver a suture with a small anchor through the arthroscope; for tears further forward, an inside-out technique passes sutures through the tear and ties them outside the capsule through a small accessory incision, which gives the strongest fixation. Sutures are placed every 4 to 5 millimeters until the edges sit together without a gap. Any other injury is treated at the same sitting, and the knee goes into a brace locked in extension for walking.
Risks & How They Are Minimized
The repair may fail to heal, particularly in tears further from the rim, in older tissue, and in patients who squat or twist too early. Dr. O'Donnell repairs only tears with a realistic chance of healing, uses the strongest fixation the location allows, and holds loaded flexion to 90° for the first 4 to 6 weeks with no pivoting for about 4 months. Nerve irritation is the risk specific to inside-out repair: the saphenous nerve on the inner side and the peroneal nerve on the outer side run near where sutures are tied, so a small incision is made to see and protect them. Stiffness is prevented by unrestricted passive extension and early flexion within the limit. Infection is uncommon after arthroscopy and is guarded against with a pre-incision antibiotic; deep-vein thrombosis is addressed with early walking and aspirin in patients with risk factors.
Recovery & Rehabilitation
Unlike a meniscectomy, a repaired meniscus must be protected while it heals. Deep knee flexion under load and pivoting stress the repair most, so both are restricted early, while full passive extension is encouraged from the first day.
| Phase | Timing | What happens |
|---|---|---|
| Protection | Weeks 0–6 | Brace in extension for walking and sleeping; flexion limited to 90°; no loaded flexion or squatting. Quad sets and straight-leg raises in the brace, patellar mobilizations, heel slides to 90°, prone hangs for extension. Advance with full extension, a good quad set and controlled swelling. |
| Motion & strength | Weeks 6–12 | Flexion progressed gradually to full; brace and crutches weaned. Closed-chain strengthening from 0–60° then deeper, stationary bike, balance work, hip and core strengthening. Still no deep loaded flexion or pivoting. Advance with full motion, normal gait and good quad control. |
| Strengthening | Weeks 12–16 | Progressive resistive strengthening into deeper ranges as cleared, single-leg strength and balance, low-impact conditioning. Controlled running late in the phase if criteria are met. Advance at 80% strength of the opposite side. |
| Return to sport | Months 4–6 | Running and plyometric progression, agility and cutting drills, sport-specific training. Return to sport typically at 5 to 6 months on symmetric strength and hop testing. |
Desk work is possible within about a week. Driving resumes once out of the brace and off crutches with good quad control, about 4 to 6 weeks for a right knee. Running begins late in the fourth month at the earliest; cutting and pivoting not before about 4 months; sport at 5 to 6 months.
Protocol summary
Precautions: brace locked in extension for walking, with weight bearing as tolerated in extension and limited flexion under load; knee flexion limited to about 90° for the first 4 to 6 weeks with no weight bearing in deep flexion; no deep squatting, twisting or pivoting for about 4 months; full passive extension allowed and encouraged throughout.
Criteria: the protection phase ends with full extension, a good quad set and controlled swelling; strengthening begins with full motion and a normal gait; running begins at 80% strength with no swelling; return to sport requires symmetric strength and hop testing, typically at 5 to 6 months.
Physical Therapy Protocol
Meniscal Repair PDF ↗Frequently Asked Questions
How long does it take for a meniscus repair to heal?
The stitched tissue takes about 3 to 4 months to heal enough to tolerate twisting and deep loaded bending, which is why pivoting is held until about 4 months. The brace and 90° flexion limit protect it for the first 4 to 6 weeks, and full return to sport is typically 5 to 6 months.
Meniscus repair or meniscectomy: which is better?
Repair, whenever the tear can heal. A trimmed meniscus works immediately but leaves less tissue to spread load, and the arthritis risk rises with the amount removed. A repaired meniscus takes months longer to rehabilitate and does not heal in every case, but when it does the knee keeps its full meniscus.
How long are you on crutches after meniscus repair?
Weight bearing is allowed from the first day with the brace locked in extension, so crutches are for balance and gait rather than protection. Most patients wean them over 2 to 4 weeks as quad control returns, while the brace stays on for walking until about 6 weeks.
When can I bend my knee after meniscus repair?
Passive bending to 90° begins right away with heel slides, and full straightening is encouraged from day one. Bending past 90° is added gradually from about 6 weeks, and bending under load, such as squatting or kneeling, is avoided until the strengthening phase around 3 months. Deep squats and twisting wait until about 4 months.
Can a meniscus repair fail?
Yes. Tears further from the vascular rim, older degenerate tissue, and early squatting or pivoting all lower the healing rate. A repair that has not healed usually shows itself as recurrent catching or joint-line pain some months later, and is treated by arthroscopic trimming of the failed portion. Repairs done alongside an ACL reconstruction heal at the highest rates.
This page is for general education and is not a substitute for a medical evaluation. The right procedure depends on your individual diagnosis, anatomy, and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.