Skip to main content

Surgical interventions for meniscal tears: a closer look at the evidence



The aim of the present study was to compare the outcomes of various surgical treatments for meniscal injuries including (1) total and partial meniscectomy; (2) meniscectomy and meniscal repair; (3) meniscectomy and meniscal transplantation; (4) open and arthroscopic meniscectomy and (5) various different repair techniques.

Materials and methods

The Bone, Joint and Muscle Trauma Group Register, Cochrane Database, MEDLINE, EMBASE and CINAHL were searched for all (quasi) randomized controlled clinical trials comparing various surgical techniques for meniscal injuries. Primary outcomes of interest included patient-reported outcomes scores, return to pre-injury activity level, level of sports participation and persistence of pain using the visual analogue score. Where possible, data were pooled and a meta-analysis was performed.


A total of nine studies were included, involving a combined 904 subjects, 330 patients underwent a meniscal repair, 402 meniscectomy and 160 a collagen meniscal implant. The only surgical treatments that were compared in homogeneous fashion across more than one study were the arrow and inside-out technique, which showed no difference for re-tear or complication rate. Strong evidence-based recommendations regarding the other surgical treatments that were compared could not be made.


This meta-analysis illustrates the lack of level I evidence to guide the surgical management of meniscal tears.

Level of evidence

Level I meta-analysis.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. 1.

    Clayton RA, Court-Brown CM (2008) The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury 39(12):1338–1344. doi:10.1016/j.injury.2008.06.021

    Article  PubMed  Google Scholar 

  2. 2.

    Cullen KA, Hall MJ, Golosinskiy A (2009) Ambulatory surgery in the United States, 2006. Natl Health Stat Rep 11:1–25

    Google Scholar 

  3. 3.

    Kim S, Bosque J, Meehan JP, Jamali A, Marder R (2011) Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 93(11):994–1000. doi:10.2106/JBJS.I.01618

    Article  PubMed  Google Scholar 

  4. 4.

    Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ (2013) Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med 41(10):2333–2339. doi:10.1177/0363546513495641

    Article  PubMed  Google Scholar 

  5. 5.

    Mb D, Sadoghi P, Wimmer MD, Vavken P, Pagenstert GI, Valderrabano V, Rosso C (2015) Meta-analysis on biomechanical properties of meniscus repairs: are devices better than sutures? Knee Surg Sports Traumatol Arthrosc 23(1):83–89. doi:10.1007/s00167-014-2966-9

    Article  Google Scholar 

  6. 6.

    Kim JG, Lee YS, Bae TS, Ha JK, Lee DH, Kim YJ, Ra HJ (2013) Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation. Knee Surg Sports Traumatol Arthrosc 21(9):2121–2125. doi:10.1007/s00167-012-2182-4

    Article  PubMed  Google Scholar 

  7. 7.

    Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Bonanzinga T, Nitri M, Raggi F, Ravazzolo G, Marcacci M (2014) MRI evaluation of a collagen meniscus implant: a systematic review. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3155-6

    Google Scholar 

  8. 8.

    Stone KR, Ayala G, Goldstein J, Hurst R, Walgenbach A, Galili U (1998) Porcine cartilage transplants in the cynomolgus monkey. III. Transplantation of alpha-galactosidase-treated porcine cartilage. Transplantation 65(12):1577–1583

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Jiang D, Zhao LH, Tian M, Zhang JY, Yu JK (2012) Meniscus transplantation using treated xenogeneic meniscal tissue: viability and chondroprotection study in rabbits. Arthroscopy 28(8):1147–1159. doi:10.1016/j.arthro.2012.01.001

    Article  PubMed  Google Scholar 

  10. 10.

    Thorlund JB, Juhl CB, Roos EM, Lohmander LS (2015) Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ 350:h2747. doi:10.1136/bmj.h2747

    PubMed Central  Article  CAS  PubMed  Google Scholar 

  11. 11.

    Khan M, Evaniew N, Bedi A, Ayeni OR, Bhandari M (2014) Arthroscopic surgery for degenerative tears of the meniscus: a systematic review and meta-analysis. CMAJ Can Med Assoc J 186(14):1057–1064. doi:10.1503/cmaj.140433

    Article  Google Scholar 

  12. 12.

    Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JP, Straus S, Thorlund K, Jansen JP, Mulrow C, Catala-Lopez F, Gotzsche PC, Dickersin K, Boutron I, Altman DG, Moher D (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162(11):777–784. doi:10.7326/M14-2385

    Article  PubMed  Google Scholar 

  13. 13.

  14. 14.

    Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10(3):150–154

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  16. 16.

    Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD (1998) Knee Injury and Osteoarthritis Outcome Score (KOOS)—development of a self-administered outcome measure. J Orthop Sports Phys Ther 28(2):88–96. doi:10.2519/jospt.1998.28.2.88

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29(5):600–613

    CAS  PubMed  Google Scholar 

  18. 18.

    Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. doi:10.1002/sim.1186

    Article  PubMed  Google Scholar 

  19. 19.

    Albrecht-Olsen P, Kristensen G, Burgaard P, Joergensen U, Toerholm C (1999) The arrow versus horizontal suture in arthroscopic meniscus repair. A prospective randomized study with arthroscopic evaluation. Knee Surg Sports Traumatol Arthrosc 7(5):268–273

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Biedert RM (2000) Treatment of intrasubstance meniscal lesions: a randomized prospective study of four different methods. Knee Surg Sports Traumatol Arthrosc 8(2):104–108. doi:10.1007/s001670050195

    Article  CAS  PubMed  Google Scholar 

  21. 21.

    Bryant D, Dill J, Litchfield R, Amendola A, Giffin R, Fowler P, Kirkley A (2007) Effectiveness of bioabsorbable arrows compared with inside-out suturing for vertical, reparable meniscal lesions: a randomized clinical trial. Am J Sports Med 35(6):889–896. doi:10.1177/0363546506298582

    Article  PubMed  Google Scholar 

  22. 22.

    Hamberg P, Gillquist J, Lysholm J (1984) A comparison between arthroscopic meniscectomy and modified open meniscectomy. A prospective randomised study with emphasis on postoperative rehabilitation. J Bone Joint Surg Br 66(2):189–192

    CAS  PubMed  Google Scholar 

  23. 23.

    Hantes ME, Zachos VC, Varitimidis SE, Dailiana ZH, Karachalios T, Malizos KN (2006) Arthroscopic meniscal repair: a comparative study between three different surgical techniques. Knee Surg Sports Traumatol Arthrosc 14(12):1232–1237. doi:10.1007/s00167-006-0094-x

    Article  PubMed  Google Scholar 

  24. 24.

    Hede A, Hejgaard N, Larsen E (1986) Partial or total open meniscectomy? A prospective, randomized study. Int Orthop 10(2):105–108

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Jarvela S, Sihvonen R, Sirkeoja H, Jarvela T (2010) All-inside meniscal repair with bioabsorbable meniscal screws or with bioabsorbable meniscus arrows: a prospective, randomized clinical study with 2-year results. Am J Sports Med 38(11):2211–2217. doi:10.1177/0363546510374592

    Article  PubMed  Google Scholar 

  26. 26.

    Kise NJ, Drogset JO, Ekeland A, Sivertsen EA, Heir S (2015) All-inside suture device is superior to meniscal arrows in meniscal repair: a prospective randomized multicenter clinical trial with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 23(1):211–218. doi:10.1007/s00167-014-3423-5

    PubMed Central  Article  PubMed  Google Scholar 

  27. 27.

    Rodkey WG, DeHaven KE, Montgomery WH 3rd, Baker CL Jr, Beck CL Jr, Hormel SE, Steadman JR, Cole BJ, Briggs KK (2008) Comparison of the collagen meniscus implant with partial meniscectomy. A prospective randomized trial. J Bone Joint Surg Am 90(7):1413–1426. doi:10.2106/JBJS.G.00656

    Article  PubMed  Google Scholar 

  28. 28.

    Xu C, Zhao J (2015) A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? Knee Surg Sports Traumatol Arthrosc 23(1):164–170. doi:10.1007/s00167-013-2528-6

    Article  PubMed  Google Scholar 

  29. 29.

    Paxton ES, Stock MV, Brophy RH (2011) Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy 27(9):1275–1288. doi:10.1016/j.arthro.2011.03.088

    Article  PubMed  Google Scholar 

  30. 30.

    Ayeni O, Peterson D, Chan K, Javidan A, Gandhi R (2012) Suture repair versus arrow repair for symptomatic meniscus tears of the knee: a systematic review. J Knee Surg 25(5):397–402. doi:10.1055/s-0032-1313752

    Article  PubMed  Google Scholar 

  31. 31.

    Grant JA, Wilde J, Miller BS, Bedi A (2012) Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: a systematic review. Am J Sports Med 40(2):459–468. doi:10.1177/0363546511411701

    Article  PubMed  Google Scholar 

  32. 32.

    Lozano J, Ma CB, Cannon WD (2007) All-inside meniscus repair: a systematic review. Clin Orthop Relat Res 455:134–141. doi:10.1097/BLO.0b013e31802ff806

    Article  PubMed  Google Scholar 

  33. 33.

    Myers P, Tudor F (2015) Meniscal allograft transplantation: how should we be doing it? A systematic review. Arthroscopy 31(5):911–925. doi:10.1016/j.arthro.2014.11.020

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Carola F. van Eck.

Ethics declarations

Conflict of interest

The authors did not receive any outside funding or grants directly related to the research presented in this manuscript. The authors state that this manuscript is an original work only submitted to this book. The authors hold the rights to all the material presented in this manuscript. All authors contributed to the preparation of this work. Author Job Doornberg has received a research grant from the Marti-Keuning-Eckhardt Foundation for his post-doctoral research. The remaining authors declare that they have no conflict of interest.



See Tables 2 and 3.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mutsaerts, E.L.A.R., van Eck, C.F., van de Graaf, V.A. et al. Surgical interventions for meniscal tears: a closer look at the evidence. Arch Orthop Trauma Surg 136, 361–370 (2016).

Download citation


  • Meniscus
  • Meniscectomy
  • Meniscal repair
  • Meniscal transplant
  • Meta-analysis
  • Clinical outcomes