Meniscus Injury

Anatomy of a meniscus injury

The meniscus is a crescent-shaped wedge of fibrocartilage located between the femur (thigh bone) and tibia (shin bone) in each knee joint. There are two menisci per knee, the medial meniscus (on the inside) and the lateral meniscus (on the outside). Together, they act as shock absorbers, distribute load during weight-bearing, enhance joint congruency, and contribute to knee stability, particularly in rotation and during dynamic cutting motions.

Each meniscus is shaped like a “C” and consists of three distinct zones:

• Red-red zone (outer third): Well vascularized, with higher healing potential.
• Red-white zone (middle third): Moderately vascularized, limited healing capacity.
• White-white zone (inner third): Avascular, poor to no healing potential.

Because only the outer 25–30% of the meniscus receives direct blood supply, the majority (approximately 70–75%) of the meniscus has limited ability to heal on its own.¹ This is why many meniscal tears, especially those located in the inner region, do not heal without surgical intervention. Conversely, tears in the outer (peripheral) zone may heal non-operatively, particularly in younger athletes or when the tear is small and longitudinal.

Biomechanically, the menisci convert compressive loads into circumferential (hoop) stress, reducing peak cartilage pressure and protecting against long-term joint degeneration. Damage to the meniscus, especially when combined with ligament injuries, significantly alters joint mechanics and increases risk for osteoarthritis over time.

Cause of a meniscus injury

The meniscus is often injured when the knee twists while bending simultaneously. The meniscus can be torn on its own or in combination with an ACL or MCL tear, especially during high-velocity pivoting injuries.¹ In football players, these tears are most commonly seen during a quick change of direction, planting, or cutting motion, often seen with skill position players.

Running backs are particularly vulnerable due to frequent inside-outside cuts, contact through traffic, and rapid deceleration demands. Wide receivers and tight ends are also at risk, but typically experience fewer high-load cuts in congested areas compared to backs.

There are several different types of meniscus tears, each with different implications for healing and treatment:

• Longitudinal (vertical) tear: Often occurs in younger athletes. If located in the red-red zone, this type can sometimes be repaired.
• Radial tear: A common type, cutting across the meniscus’ circumferential fibers. These often compromise the hoop stress function and are harder to repair.
• Horizontal (cleavage) tear: Splits the meniscus into top and bottom layers, often seen in older athletes or with degenerative changes.
• Complex tear: A combination of two or more patterns (e.g. radial + horizontal). Frequently degenerative and usually requires partial meniscectomy.
• Bucket-handle tear: A severe form of a longitudinal tear where a segment of the meniscus displaces into the joint space. These often lock the knee and may require urgent surgical repair.
• Flap Tear: A small fragment of the meniscus lifts away, creating a flap that can catch in the joint. May cause mechanical symptoms (clicking, catching).

Understanding the type and location of the tear is crucial when determining whether surgery is needed and how long recovery may take.

Surgical procedure for a meniscus injury

Meniscus surgery is typically performed arthroscopically, through small incisions using a camera and specialized tools. There are two primary types of surgery: a menisectomy (trim) and a full repair. The choice of procedure depends on the location, type, and severity of the tear, as well as the athlete’s age, sport, and desired return timeline.

Meniscectomy (Debridement or “Trim”)

In a partial meniscectomy, the surgeon removes the torn, unstable portion of the meniscus while preserving as much healthy tissue as possible. This is commonly referred to as a “clean-up” procedure. This approach is typically chosen when the tear is in the avascular (white-white) zone, where healing is unlikely even with sutures.² Return to play is relatively quick, typically 2 to 6 weeks, depending on the extent of tissue removed and sport demands.³ There are fewer post-op restrictions, and players often begin light loading within days.

However:

Long-term outcomes are less favorable, as removing meniscal tissue reduces shock absorption and increases the risk of early cartilage wear and osteoarthritis.²,⁵ In the NFL, this procedure is often used for in-season injuries, where a fast return is prioritized over joint preservation.⁶

Meniscus Repair

In a meniscus repair, the torn edges are sutured together to allow the tissue to heal naturally. This is typically done when the tear is located in the red-red or red-white zone, where vascularity is sufficient to support healing.² This procedure preserves meniscal function and reduces long-term joint degeneration, making it the better choice for athletes with longer playing windows or younger athletes prioritizing longevity.⁵,⁷ However, return-to-play timelines are significantly longer, often 4 to 6 months, and up to 9 months for full clearance in contact or pivot-heavy sports.⁶,⁸

Postoperative rehab involves:

Initial restricted weight-bearing and range of motion limits to protect the repair site.⁷. Gradual reintroduction of dynamic movement and sport-specific drills over several months.

In the NFL and college football, meniscus repairs are more commonly performed in the offseason, when athletes have time to recover without impacting the current season.⁶,⁸

Meniscus injury surgical outcomes

Outcomes following meniscus surgery vary significantly depending on whether an athlete undergoes a meniscectomy (debridement) or a meniscus repair.

Meniscectomy (Debridement or “Trim”) Surgical Outcomes

Outcomes following meniscus surgery vary significantly depending on whether an athlete undergoes a meniscectomy (debridement) or a meniscus repair.

In elite athletes, return-to-play rates after partial meniscectomy range from 75% to 90%, depending on the level of competition and sport demands.³ In NFL-specific cohorts, one study found that 61% of players returned to gameplay, and only 40% were still active 4.5 years after surgery.² While meniscectomy offers a quicker recovery, often within 2 to 6 weeks, it comes with a notable downside: removing meniscal tissue compromises shock absorption and increases joint stress. Athletes who undergo meniscectomy are 2 to 3 times more likely to develop cartilage damage in the medial femoral condyle or tibial plateau within 1 to 2 years,⁶ and long-term studies show a clear increase in knee osteoarthritis risk.⁵ Reoperation rates following meniscectomy hover around 10% to 15%, typically due to persistent pain, recurrent symptoms, or additional degenerative changes.⁵

Meniscus Repair Surgical Outcomes

Meniscus repair, by contrast, aims to preserve the structure and function of the meniscus, making it a more favorable long-term option when the tear is located in a vascular zone. Return-to-play rates following repair are typically around 80% to 85% in high-level athletes,³⁷ though the average recovery timeline is 5.5 to 6 months, depending on the player’s age, position, and tear type.³⁸ Re-tear rates after repair range from 15% to 25%,⁷⁹ with younger athletes and those with complex tears at greater risk. Roughly 25% to 28% of athletes require a second surgery within five years of repair, most often due to a new tear or irritation from surgical sutures or anchors.⁷ That said, repair significantly reduces the risk of long-term cartilage breakdown and arthritis compared to debridement,⁵ making it the better option for younger players or those prioritizing joint longevity.

In summary, meniscectomy offers a faster return but comes with higher long-term risk, while repair takes longer to recover from but better preserves joint health, especially in younger athletes. These differences are crucial when projecting both short-term fantasy impact and long-term durability.

Meniscus injury rehab process

Rehabilitation following meniscus surgery varies considerably based on the type of procedure performed, the location and severity of the tear, and the surgeon’s protocol. While meniscectomy allows for a rapid return to function, meniscus repair requires a longer, more conservative rehab timeline to protect the healing tissue.

Menisectomy (Debridement or “Trim”) Rehab Process

The rehab process after a partial meniscectomy is typically straightforward and fast. The primary goals in the early phase are to reduce swelling, restore range of motion (ROM), and begin reactivating the quadriceps.⁶ Most athletes use crutches for 1–3 days post-op, depending on pain and swelling, but can usually transition to full weight-bearing within the first week.⁶

Because no sutures are placed and the meniscus is not healing but rather trimmed, there’s no need to protect the structure with restricted motion or loading. Light activity, including stationary cycling and bodyweight strengthening, is usually allowed by Week 1.⁶

• Running often begins by Weeks 2–3 if swelling is controlled and strength is restored.
• Return to sport generally occurs between 3 and 6 weeks post-op, depending on the demands of the sport and the athlete’s functional progress.³⁶

That said, athletes who rush back too soon without regaining proper strength or neuromuscular control may be at greater risk for compensation injuries, especially in the knee, hip, or hamstring.

Meniscus Repair Rehab Process

Rehabilitation following meniscus repair is more complex and conservative due to the need for biological healing of the repaired tissue. Unlike meniscectomy, this procedure requires protecting the meniscus from shear and compressive forces in the early postoperative period.⁷⁹

Immediately after surgery, the athlete is typically placed in a knee brace locked in extension to limit flexion stress on the repair site.⁷. Weight-bearing is restricted to toe-touch or partial loading for the first 4 to 6 weeks, and knee flexion is often limited to 60–90 degrees during this same window to minimize mechanical strain on the sutures.⁷⁹ By Weeks 6–8, most athletes begin weaning off crutches and gradually increase ROM to full flexion as tolerated.⁷. Once the athlete regains at least 70–80% quadriceps strength and neuromuscular control, running may begin around Weeks 12–16, assuming there is no swelling or instability.⁷⁹ From Month 4 onward, athletes begin cutting, jumping, and sport-specific drills, typically progressing toward full clearance around 5–6 months, though this may extend to 8–9 months depending on the tear type, healing response, and position demands.³⁸

There is no universally accepted “best” rehab protocol for meniscus repairs; surgeon preferences, tear morphology (e.g., bucket-handle vs longitudinal), and concurrent procedures (like ACL reconstruction) all influence the timeline.⁷

References

1. Arnoczky SP, Warren RF. Microvasculature of the meniscus and its response to injury: An experimental study in the dog. Am J Sports Med. 1983.
2. Aune KT, Andrews JR, Dugas JR, Cain EL Jr. Return to Play After Partial Lateral Meniscectomy in National Football League Athletes. Am J Sports Med. 2014;42(8):1865-1872. doi:10.1177/0363546514535069
3. Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ. Return to sport after meniscectomy in elite athletes: A systematic review. Orthop J Sports Med. 2020;8(3):2325967120906825. doi:10.1177/2325967120906825
4. Logan CA, O’Brien LT, LaPrade RF. Meniscal repair versus partial meniscectomy: A systematic review and meta-analysis. Am J Sports Med. 2019;47(9):2183–2190.
5. Papalia R, Del Buono A, Osti L, Denaro V, Maffulli N. Meniscectomy as a risk factor for knee osteoarthritis: A systematic review. Br Med Bull. 2011;99(1):89–106.
6. Bhan K. Meniscal Tears: Current Understanding, Diagnosis, and Management. Cureus. 2020;12(6):e8590. Published 2020 Jun 13. doi:10.7759/cureus.8590
7. Beaufils P, Becker R, Kopf S, et al. Current concepts for meniscal repair: State of the art. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):335–346. doi:10.1007/s00167-016-4247-z
8. Nelson TJ, Parikh SN, Latt LD, et al. Return-to-play timelines after meniscal repair versus meniscectomy in professional athletes. Orthop J Sports Med. 2021;9(5):23259671211003382. doi:10.1177/23259671211003382
9. Spang III RC, Nasr MC, Mohamadi A, DeAngelis JP, Nazarian A, Ramappa AJ. Rehabilitation following meniscal repair: A systematic review. BMJ Open Sport Exerc Med. 2018;4(1):e000212. doi:10.1136/bmjsem-2016-000212