Meniscus Repair

Overview

Meniscus repair sutures a torn meniscus back together to preserve its shock-absorbing tissue, rather than trimming the torn portion away in a partial meniscectomy. Dr. Raffo, whose practice across Bethesda and Montgomery County includes a regular volume of meniscus surgery, repairs the meniscus whenever the tear pattern and tissue quality make it possible, because the long-term difference in arthritis and knee replacement risk between repair and removal is one of the largest effects in all of orthopedic sports medicine.

How Dr. Raffo Performs This Procedure

Meniscus repair is performed arthroscopically, most often using an all-inside technique with specialized suture devices passed through small portals, or an inside-out technique with sutures tied over the back of the knee through a small incision, depending on the tear's location. Root tears are repaired by anchoring the meniscus root back to its native footprint on the tibia, restoring the tension that keeps the meniscus functioning as a load-sharing structure rather than letting it extrude out of the joint. When repair is not feasible because of tear pattern or tissue quality, a partial meniscectomy trims only the torn, unstable fragment, preserving as much of the remaining meniscus as possible. If the tear is found at the time of ACL reconstruction, it is addressed in the same surgical setting.

Ramp Lesions

A ramp lesion is a tear at the back of the medial meniscus, where it attaches to the capsule — a tear pattern that is easy to miss because it sits behind the meniscus, out of the direct line of sight during standard arthroscopy. It is common: pooled data put the prevalence at 21.9% of ACL reconstructions, and it can be found in up to 55% of medial meniscus tears in ACL-injured knees, though a large multicenter registry found a somewhat lower rate of 15.3% across 5,359 patients (Siboni et al., Curr Rev Musculoskelet Med 2023; Lambrey et al., KSSTA 2024). MRI is not reliable for finding these tears, with pooled sensitivity of only 65–71%, which is why Dr. Raffo routinely inspects the posteromedial compartment directly during ACL reconstruction rather than relying on imaging alone (Siboni et al., Curr Rev Musculoskelet Med 2023).

Not every ramp lesion needs to be sutured. In a robotic cadaveric study, only lesions at least 3 centimeters long significantly increased anterior tibial translation and rotation in an ACL-deficient knee, and after simulated ACL reconstruction, ramp lesions of any size tested had no significant effect on knee kinematics (Deichsel et al., AJSM 2024). Randomized and comparative studies of stable ramp lesions treated with abrasion or trephination versus formal suture repair found no meaningful difference in outcomes, and even leaving small stable lesions untreated showed no difference in laxity, functional scores, or complications at a minimum of 3 years, though return to sport took somewhat longer (Siboni et al., Curr Rev Musculoskelet Med 2023). Dr. Raffo looks for ramp lesions in every ACL reconstruction and treats unstable ones, but does not automatically suture every stable lesion he finds.

Who Is This For?

• Patients with a repairable tear pattern — typically in the vascularized outer red-red or red-white zones — are candidates for repair, especially when the tear is diagnosed and treated within about 6 months of injury.
• Patients undergoing ACL reconstruction with a concurrent meniscus tear are strong repair candidates, since repairs performed alongside ACL reconstruction heal substantially better than repairs done in isolation.
• Patients with posterior meniscus root tears are candidates for root repair specifically, since the biomechanical consequence of an untreated root tear is essentially the same as removing the entire meniscus.
• Patients with a tear confined to the avascular inner white-white zone, longstanding degenerative tears in an already arthritic knee, or tissue too damaged to hold a suture are generally not repair candidates and are more realistically treated with partial meniscectomy or nonoperative care.
• Age alone is not a firm cutoff. Repair failure in patients 40 and older is 12%, not meaningfully different by age group (relative risk 0.73, P=.22) — tear location and whether the ACL is also reconstructed matter far more than age (Sedgwick et al., OJSM 2024; von Essen et al., KSSTA 2025).

Recovery & Rehabilitation

Recovery after meniscus repair is slower and more protected than after meniscectomy, because the repaired tissue needs time to heal rather than simply recovering from a trimming procedure. Return to play after meniscus surgery broadly ranges from 65% to 100% of patients returning at 4 to 7 months, and reported time off work is longer after repair (about 55 days) than after partial meniscectomy (about 37 days) (AAOS Acute Isolated Meniscal Pathology CPG, 2024).

• Weeks 0–4: Protected weightbearing, often with a brace limiting deep flexion, to protect the healing repair.
• Weeks 4–8: Progressive weightbearing and range of motion as the repair matures.
• Months 3–4: Gradual return to straight-line activity and strengthening.
• Months 4–7: Return to sport for most patients, once strength and functional criteria are met (AAOS Acute Isolated Meniscal Pathology CPG, 2024).
• Note for combined ACL and meniscus repair cases: Rehabilitation follows the more conservative of the two protocols, generally the meniscus repair timeline, to protect the healing meniscal tissue.