Meniscus Repair vs Meniscus Removal: Should You Save Your Knee’s Natural Cushion?A torn meniscus does not always mean surgery. And if surgery is needed, should we repair the tear or remove the damaged portion?If you’ve ever twisted your knee while playing badminton, cricket, football or simply getting up from a squatting position, you may have experienced a meniscus injury.But what exactly is the meniscus, and why is preserving it so important?First, what is the meniscus?Think of the meniscus as the natural shock absorber of your knee.* Each knee has two C-shaped pieces of cartilage called menisci.* They act as cushions between the thigh bone and shin bone.* They absorb shock, distribute body weight and improve knee stability.* They protect the joint cartilage from excessive wear and tear.Simply put: Your meniscus is your knee’s built-in shock absorber!What happens when the meniscus tears?A meniscus can tear due to:* Sudden twisting during sports.* Deep squatting or lifting heavy weights.* Sports injuries involving the ACL.* Age-related degeneration and gradual wear and tear.Common symptoms include knee pain, swelling, clicking, difficulty squatting and sometimes locking of the knee.Two surgical options: Repair or Remove?1. Meniscal Repair – Saving Your Natural CushionThe aim is to stitch the torn meniscus back together so that it can heal.* Preserves the natural meniscus.* Maintains its shock-absorbing function.* Helps protect the knee cartilage in the long term.* Requires a longer rehabilitation period.* Healing is not guaranteed, and occasionally the repair may fail.Example: Imagine a 22-year-old football player who twists his knee and sustains a repairable meniscal tear. If the tissue is healthy and the tear is suitable, stitching it back together is usually preferable to removing it.1. Meniscal Excision – Removing Only the Damaged PortionThis procedure is also called partial meniscectomy.* The torn and irreparable portion is removed using keyhole (arthroscopic) surgery.* The healthy meniscus is preserved as much as possible.* Recovery is generally faster than after repair.* Weight-bearing and return to routine activities are often earlier.* However, removing meniscal tissue reduces its cushioning capacity and may increase the risk of future arthritis.Example: Imagine a 45-year-old patient with a degenerative meniscal tear, where a small fragment is unstable and causing persistent mechanical symptoms despite appropriate conservative treatment. If the tissue cannot be repaired, removing only the unstable fragment may be appropriate.Repair vs Removal: What’s the Difference?FeatureMeniscal RepairPartial ExcisionAimSave the meniscusRemove damaged tissueTissue preservationMaximumSome tissue removedRecoveryLongerUsually fasterWeight-bearingMay be restrictedOften earlierHealingRequires biological healingNo repair healing requiredLong-term joint protectionBetter when successfulPotentially reducedCan Every Meniscus Tear Be Repaired?Unfortunately, no!The decision depends on:* Location: Tears near the outer blood-supplied zone have better healing potential.* Type of tear: Some patterns, such as longitudinal and certain root tears, may be repairable.* Age and tissue quality: Healthy tissue generally offers better healing potential.* Associated injuries: ACL injuries and other ligament problems may influence treatment.* Knee condition: Cartilage damage and arthritis also matter.Which option is better for your knee?My philosophy is simple:Preserve whenever possible. Remove only when necessary.A meniscus should not be removed just because it is torn. Many tears can be managed without surgery through physiotherapy, activity modification and appropriate treatment.When surgery is needed, saving the meniscus should be the priority whenever the tear is repairable.The Take-Home Message* Not every meniscus tear requires surgery.* Meniscal repair is generally preferred when a tear is suitable for healing.* Partial meniscectomy is reserved for tears that cannot be repaired or selected cases with persistent symptoms.* Preserving meniscal tissue is important for long-term knee health.Remember: Your meniscus is not a disposable part of your knee. Protecting it today may help protect your knee for years to come!For consultation regarding meniscus injuries, knee arthroscopy and meniscal preservation, consult Dr. Abhishek Vaish, Orthopaedic and Sports Surgeon, Indraprastha Apollo Hospitals, New Delhi.