Overview
Arthroscopic partial meniscectomy removes an irreparable, unstable fragment while retaining as much functional meniscus as possible. The endpoint is a stable, balanced peripheral rim with smooth transitions, rather than removal of all abnormal-looking tissue. Meniscal preservation or repair is preferred whenever the tear and the patient's knee make healing realistic (Campbell, Chapters 50 and 56).
Even partial resection increases joint loading and can be followed by cartilage degeneration. The amount of degeneration generally increases with the amount of tissue removed; partial lateral meniscectomy has less favorable long-term behavior than partial medial meniscectomy (Campbell, Chapters 50 and 56).
Assessment and Indications
Correlate joint-line symptoms, examination and imaging. Clicking, giving way or a meniscal abnormality on MRI alone does not establish the source of symptoms (Campbell, Chapter 50).
Consider resection for a symptomatic tear with an unstable component that cannot be repaired because of tissue damage, fixed deformation or an unfavorable tear configuration. Discuss possible repair as well as partial meniscectomy before surgery (Campbell, Chapters 50 and 56).
Degenerative tears: Chapter 50 describes nonoperative treatment as the initial strategy. Studies in patients older than 40 found no advantage for debridement as first-line treatment. Persistent symptoms after rehabilitation require reassessment of the meniscus, cartilage and other causes of pain.
Locked bucket-handle tear: arrange prompt assessment and treatment to preserve the opportunity for repair. Avoid repeated forceful reduction attempts. A repairable displaced fragment should not be resected merely because it is displaced (Campbell, Chapters 50 and 56).
Small, stable peripheral tears may be suitable for observation or healing stimulation in selected knees. Complete radial tears and root tears require a separate preservation-oriented assessment because they can abolish meniscal hoop function (Campbell, Chapters 50 and 56).
Preoperative Planning
Review MRI for the location and extent of the tear, displaced fragments and a communicating meniscal cyst.
Assess ligament stability, alignment and articular cartilage. Instability and chondral damage influence both the treatment choice and prognosis.
Explain that the final decision between repair and resection follows arthroscopic assessment of tissue quality, reducibility and tear stability. Their rehabilitation requirements differ.
Prepare a probe, straight and angled basket forceps, graspers and a motorized shaver; ensure that equipment for repair is available when preservation may be possible.
(Campbell, Chapters 50 and 56.)
Positioning and Portals
Position supine with a padded lateral post or thigh holder that permits controlled valgus stress and adequate flexion.
Use anterolateral and anteromedial portals located to reach the intended tear. Confirm working trajectories with a spinal needle rather than forcing a poorly aligned instrument.
For a medial tear, the contralateral anterior portal commonly provides the view and the ipsilateral portal admits the probe or basket.
For lateral meniscal work, a figure-four position opens the lateral compartment. Hip flexion, abduction and external rotation and appropriate knee flexion facilitate access; this position may collapse the suprapatellar pouch and impair fluid flow.
(Campbell, Chapter 56.)
Surgical Technique
Diagnostic Survey and Final Treatment Decision
Complete a systematic arthroscopic examination before focusing on the tear. Examine the cartilage, cruciate ligaments and both menisci.
Probe the superior and inferior surfaces to define the anterior and posterior extent, stability and tissue quality. A flap can be folded beneath an apparently normal meniscal segment or displaced behind a condyle.
Reduce a displaced fragment gently with a probe or blunt instrument. Assess whether it can be repaired before committing to resection.
Plan the smallest resection that removes the unstable, irreparable tissue while preserving a functional rim.
(Campbell, Chapter 56.)
Posterior Horn and Flap Tears
View from the contralateral portal and bring the working instrument through the ipsilateral portal when this provides the safest trajectory.
For posterior horn resection, Campbell describes a low-profile, 15-degree up-biting basket. Take controlled bites until the unstable tissue is removed.
For flap or complex tears, repeatedly probe between resections. Look beneath the residual meniscus and behind the femoral condyle for an overlooked displaced flap.
Use the shaver to smooth transitions and remove small loose fragments. Keep the cutting window visible and preserve healthy tissue.
Reprobe the remaining rim. The goal is stability and balanced contour, not an unnecessarily wide or uniform resection.
(Campbell, Chapter 56, Techniques 56.2–56.3.)
Irreparable Bucket-Handle Tear
Reduce the fragment to its anatomic position and establish the full extent of both attachments under direct vision.
Partially release the posterior attachment, leaving a small bridge so that the fragment does not float into the posterior compartment after anterior release.
Release the anterior attachment flush with the retained meniscal rim. Change portals or add appropriate access if visualization or the cutting trajectory is inadequate.
Grasp the fragment near its remaining attachment and retrieve it under direct vision using the controlled release described in Technique 56.1. If release is incomplete, complete it with instruments under vision rather than pulling blindly.
Enlarge the portal sufficiently if the fragment cannot pass through the skin and capsule. Confirm that it has been removed completely.
Smooth the rim, inspect for further tears and examine the posterior compartment before finishing.
(Campbell, Chapter 56, Technique 56.1.)
Associated Meniscal Cyst
If MRI demonstrates a communicating cyst, identify the horizontal cleft and decompress it into the joint with careful probing, a small curved curette or suction. External palpation or a spinal needle can assist localization. If it decompresses during meniscal treatment, a separate open excision is not routinely needed (Campbell, Chapter 56).
Final Checks
A stable peripheral rim remains, with no loose flap hidden on its undersurface.
Anterior and posterior transitions are smooth, without a retained unstable stump.
Loose morselized fragments have been removed and the posterior recesses inspected when indicated.
The operative record documents tear configuration, tissue removed, remaining meniscal stability and associated chondral or ligament findings.
(Campbell, Chapters 54 and 56.)
Postoperative Care
For the isolated resection in Technique 56.1, Campbell permits partial weight bearing with crutches for the first 48 hours until comfortable. Straight-leg raises, ankle pumps and range-of-motion exercises start in recovery; wall sets begin after 3–4 days. Cycling and progressive low-impact strengthening begin when swelling has resolved. The chapter describes return to sport around 3–4 weeks after an uncomplicated isolated procedure; this schedule does not apply to a concomitant repair, ligament reconstruction or cartilage procedure (Campbell, Chapter 56).
Complications and Outcomes
Potential problems include residual unstable tissue, iatrogenic cartilage injury, hemarthrosis, infection, venous thromboembolism and persistent symptoms from associated disease.
Long-term degeneration remains possible despite early symptom relief. Cartilage damage, degenerative tissue, lateral resection and removal of the peripheral rim are associated with poorer outcomes.
Partial meniscectomy preserves more function than total meniscectomy, but repair should be favored when feasible. Early recovery should not be confused with protection against later osteoarthritis.
(Campbell, Chapters 50 and 56.)
References
Bernholt DL, Azar FM. Knee injuries. In: Azar FM, Sawyer JR, Throckmorton TW, eds. Campbell's Operative Orthopaedics. 15th ed. Elsevier; 2026. Chapter 50, pp. 2003–2006.
Bernholt DL, Mihalko MJ. Arthroscopy of the lower extremity. In: Azar FM, Sawyer JR, Throckmorton TW, eds. Campbell's Operative Orthopaedics. 15th ed. Elsevier; 2026. Chapter 56, pp. 2336–2345, Techniques 56.1–56.3.
Bernholt DL. General principles of arthroscopy. In: Campbell's Operative Orthopaedics. 15th ed. Elsevier; 2026. Chapter 54, documentation and instrument safety.