Arthroscopy · meniscal preservation

Meniscal reconstruction

Meniscal reconstruction is not a single operation. It describes a spectrum of techniques intended to preserve or restore meniscal function when simple resection would sacrifice too much protective tissue.

Consultation and assessment All procedures

Principle

Why meniscal preservation matters

The meniscus distributes load, contributes to stability and protects articular cartilage. A complete radial tear or root tear can disrupt circumferential fibres and markedly reduce meniscal function.

Planning considers tear pattern, vascularity, tissue quality, extrusion, limb alignment, ligament stability and cartilage status. Chronological age alone does not determine whether a tear is repairable.

Preservation techniques

What reconstruction may involve

concurrent correction of instability or malalignment when either would overload the repair.

longitudinal sutures for vertical or bucket-handle tears
converging or transosseous sutures for complete radial tears
anatomical root reattachment with a transtibial pull-out construct or anchor when appropriately indicated
stabilisation of complex tears and, selectively, centralisation when extrusion is clinically relevant

After meniscal loss

Scaffolds and meniscal allograft transplantation

Meniscal allograft transplantation may be considered for a symptomatic, usually younger or active patient with subtotal or total meniscal deficiency, reasonably preserved cartilage, correctable alignment and a stable knee. Partial scaffolds have narrower indications and do not replace a completely absent meniscus.

The aim is to reduce symptoms and improve function. These procedures cannot guarantee cartilage regeneration and are not routine solutions for advanced osteoarthritis.

Selection

When repair is not realistic

Very friable tissue, a non-viable fragment, advanced osteoarthritis or a geometry that cannot be fixed securely may make repair unsuitable. When resection is required, it should remain as selective as possible and the dominant source of pain must still be identified.

A degenerative signal on MRI is not, by itself, an indication for arthroscopy or reconstruction.

Rehabilitation

Protection follows the construct

Progression after a stable longitudinal repair may be faster than after repair of a complete radial tear or a meniscal root. The latter commonly require stricter weight-bearing and flexion restrictions during the early weeks.

Return to running and pivoting is guided by healing, absence of effusion, range of movement, strength and control—not by the calendar alone.

Partial, segmental or subtotal meniscal deficiency

Meniscal reconstruction with an autologous tendon graft

When a clinically important portion of meniscus is absent or the remaining tissue cannot be repaired, yet the patient remains symptomatic and the joint is still reconstructable, arthroscopic reconstruction using the patient's own tendon may be discussed. Semitendinosus is the most frequently described option; patellar tendon and peroneus longus grafts have also been reported.

What it aims to restore

The graft is shaped and secured to the meniscal remnants, capsule and/or root attachments to recreate peripheral continuity and interposed load-bearing tissue. Root reconstruction with a tendon graft is a different indication from replacing an absent meniscal segment.

Who may be assessed

Usually a younger or active patient with compartment-specific pain after partial or subtotal meniscal loss, no advanced diffuse cartilage loss, a stable or stabilisable knee and neutral or correctable alignment. Relevant instability, varus/valgus or excessive posterior tibial slope must be addressed at the same sitting or in stages.

Important limitations

This remains an emerging technique. Clinical evidence is limited, it does not prove cartilage regeneration and it cannot promise prevention of osteoarthritis. Meniscal allograft transplantation remains the more established benchmark for subtotal or total deficiency; choice also depends on availability, sizing, defect morphology and associated procedures.

What recent evidence shows

A Level III prospective cohort of 60 patients reported encouraging two-year results for tendon autografts versus allografts in selected outcome domains, without proving definitive superiority. A much older, very small series in patients with severe arthritis and malalignment performed poorly—supporting strict selection rather than routine use.

Editorial responsibility

Medically reviewed content

Dr Răzvan Anițaș · Consultant orthopaedic and trauma surgeon, PhD · Last updated: 26 August 2026

Clinical reference sources

First step

Assessment, diagnosis and an individual plan

This information is educational and does not replace a consultation. The indication, restrictions and pace of rehabilitation depend on the examination, imaging and the exact procedure performed.

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