Knee Arthroscopy and Meniscal Surgery

Indications

Meniscal Injuries, mri of a meniscal tear
MRI of a meniscal tear. Image by Ciernik M, Wikimedia Commons, CC BY-SA 4.0.
  • Mechanical symptoms from a displaced meniscal tear or loose body
  • Meniscal repair for peripheral longitudinal tears in the red zone, above all in young patients and with ACL reconstruction
  • Partial meniscectomy for degenerative tears is no better than sham surgery (FIDELITY, NEJM 2013)
  • Meniscal repair for peripheral vertical tears in the red zone, especially with ACL reconstruction

Position

  • Supine with lateral post or leg holder, tourniquet available
  • Lateral post or leg holder for valgus stress

Operative Steps

  1. Anterolateral portal in the soft spot beside the patellar tendon, about 1 cm above the joint line
  2. Anteromedial portal placed under vision with a needle
  3. Systematic inspection of suprapatellar pouch, patellofemoral joint, gutters, medial compartment, notch and lateral compartment in figure of four
  4. Partial meniscectomy back to a stable rim
  5. Repair with all inside devices, or inside out sutures
  6. Inside out repair needs a posteromedial incision protecting the saphenous nerve or a posterolateral incision anterior to biceps protecting the peroneal nerve

Postoperative Care

  • Meniscectomy, weight bear as tolerated
  • Repair, brace and restricted flexion for about 6 weeks
  • Weight bearing as tolerated after meniscectomy

Complications

  • Infection and VTE
  • Iatrogenic cartilage damage
  • Saphenous and peroneal nerve injury
  • Failure of repair
  • Saphenous nerve injury with medial repair

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.