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The Meniscus They Used to Remove Whole
For most of the twentieth century, if you tore your meniscus, they removed the whole thing: it was believed to be a spare part. It was a historical mistake — and the bill arrived decades later. In this video: what the meniscus does for your knee, the study that followed patients for 21 years, and why today's golden rule is to save it.
Educational content prepared with official health sources. Professional medical review pending.
No personalized diagnoses: consult your doctor.
📅 Published November 1, 2026 · 2-minute video · Full transcript included
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The historical mistake: taking it all out
For most of the twentieth century, the answer to a torn meniscus was always the same: remove the whole thing. It was believed to be a spare part, a useless leftover, and that the knee worked just as well without it. It wasn't bad intent: it was what was known at the time. The problem is that the knee did miss it — it just took years to say so.
The knee's shock absorber
The meniscus is a crescent of cartilage that spreads the load between the femur and the tibia with every step. Without it, that load lands on one small point and the pressure on the cartilage shoots up: in classic measurements, removing the whole meniscus cut the contact area by ~75% and raised peak pressure by ~235% (Baratz et al., American Journal of Sports Medicine, 1986). It is, literally, your knee's shock absorber.
The bill: 48% versus 7%, 21 years later
The bill arrived decades later. One study followed people who had their whole meniscus removed for 21 years: 48% had advanced arthritis on X-rays, compared with only 7% in a similar group without that surgery (Roos et al., Arthritis & Rheumatism, 1998). Forty-eight versus seven. It wasn't bad luck: it was the price of walking 21 years without a shock absorber.
The way out: a tiny camera and a 1957 atlas
The way out began with a tiny camera… and a lot of practice on the knees of people who had already passed away. Japanese surgeon Masaki Watanabe learned that way to look inside the knee, and in 1957 he published the first atlas of arthroscopy. Seeing the inside changed the question: it was no longer how to remove the meniscus, but how to save it.
The second mistake: seeing it isn't operating
But be careful: seeing a tear on an MRI doesn't mean it has to be operated on, either. In a study of 991 adults, six out of ten people with a meniscus tear on their MRI had had no pain at all (Englund et al., NEJM, 2008). And in a rigorous trial with sham surgery, removing part of the meniscus for wear-and-tear tears gave the same result as removing nothing, one year later (Sihvonen et al., FIDELITY, NEJM, 2013). The image shows; it doesn't decide.
What is in your hands: two questions
First: is my tear from an injury or from wear? They are not treated the same. Second: can it be repaired instead of removed? Today the golden rule is to save the meniscus. And if it's from wear, exercise and strength are usually the first step, before the scalpel. Mind you: a knee that catches, locks, or swells suddenly after a blow should be checked soon. That's taking care of yourself, too.
Ask this at your next visit
"Doctor, can my meniscus be repaired, or is there an option before surgery?"
If you remember one thing, make it this: the meniscus is not spare; it's your knee's shock absorber, and what has no replacement deserves care.
Frequently asked questions
Is the meniscus useless, as they used to believe?
Far from it: it's the crescent of cartilage that spreads the load between the femur and the tibia with every step. Without it, pressure on the cartilage concentrates on one small point — in Baratz et al.'s measurements (1986), peak pressure rose ~235% after total removal. That's why today's golden rule is to save it, not remove it.
What happens long-term if the whole meniscus is removed?
The study by Roos et al. (Arthritis & Rheumatism, 1998) followed patients for 21 years: 48% had advanced arthritis on X-rays, versus 7% in a similar group without that surgery. That was the practice of another era — today only what's necessary is removed, or the meniscus is repaired — but the finding explains why the rule changed.
If an MRI shows a tear, does it need surgery?
Not necessarily. In Englund et al. (NEJM, 2008), 61% of tears seen on MRI had never caused pain. And for wear-and-tear tears, the FIDELITY trial (NEJM, 2013) found the same result with surgery as with sham surgery, one year later. The decision depends on the type of tear, the symptoms, and whether the knee locks — not on the image alone.
When should a knee be checked soon?
When the knee catches, locks, or swells suddenly after a blow. Those signs do deserve a prompt check. A wear-and-tear tear, without locking, usually starts with exercise and strength — but the concrete plan is set by your doctor, with your case in hand.
References
- Roos H, Laurén M, Adalberth T, Roos EM, Jonsson K, Lohmander LS. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis & Rheumatism 1998;41(4):687–693. doi:10.1002/1529-0131(199804)41:4<687::AID-ART16>3.0.CO;2-2 · PMID: 9550478 · 107 patients operated on in 1973, reviewed 21 years later: advanced radiographic changes in 48% of operated knees versus 7% in 68 matched controls (relative risk 14.0).
- Englund M, Guermazi A, Gale D, Hunter DJ, Aliabadi P, Clancy M, Felson DT. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. New England Journal of Medicine 2008;359(11):1108–1115. doi:10.1056/NEJMoa0800777 · PMID: 18784100 · 991 adults aged 50 to 90: 61% of those with a meniscus tear on MRI had had no pain, aching, or stiffness in the previous month.
- Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvelä T (FIDELITY). Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. New England Journal of Medicine 2013;369(26):2515–2524. doi:10.1056/NEJMoa1305189 · 146 patients with a degenerative tear: removing part of the meniscus gave the same result as sham surgery at 12 months.
- Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. American Journal of Sports Medicine 1986;14(4):270–275 · After total meniscus removal, the contact area fell ~75% and peak pressure on the cartilage rose ~235%.
- Watanabe M, Takeda S, Ikeuchi H. Atlas of Arthroscopy. Tokyo: Igaku Shoin, 1957 · The founding text of arthroscopy: Watanabe learned to look inside the knee by practicing with a tiny camera, and his atlas changed the question from "how to remove" to "how to save."
How to read these numbers: the Roos study followed patients from an era when removing the whole meniscus was the standard — it measures the long-term cost of that practice, not of today's partial and repair surgeries —; Englund shows that a tear on an image does not equal pain or a need for surgery; and FIDELITY compared surgery with a sham procedure only in wear-and-tear tears, without osteoarthritis: it does not apply to tears from a blow or to knees that lock. The honest reading is the one in the video: the meniscus is not spare, and the first question is no longer how to remove it, but whether it can be saved.
Full video transcript
For most of the twentieth century, if you tore your meniscus, they took the whole thing out. It was believed to be a spare part, a useless leftover in the body. It was a historical mistake… and many knees paid for it.
The meniscus is a crescent of cartilage that spreads the load between the femur and the tibia with every step. Without it, that load lands on one small point, and the pressure on the cartilage shoots up.
The bill arrived decades later. In one study, people who had their whole meniscus removed were followed for twenty-one years: forty-eight percent had advanced arthritis on X-rays, compared with only seven percent in a similar group without that surgery. Forty-eight versus seven.
The way out began with a tiny camera… and a lot of practice on the knees of people who had already passed away. Japanese surgeon Masaki Watanabe learned that way to look inside the knee, and in nineteen fifty-seven he published the first atlas of arthroscopy. Seeing the inside changed the question: it was no longer how to remove the meniscus, but how to save it.
But be careful: seeing a tear on an MRI doesn't mean it has to be operated on, either. In a study of almost a thousand adults, six out of ten people with a meniscus tear on their MRI had had no pain at all. And in a rigorous trial with sham surgery, removing part of the meniscus for wear-and-tear tears gave the same result as removing nothing, one year later.
What's in your hands? Walking into your appointment with two questions. First: is my tear from an injury or from wear? They are not treated the same. Second: can it be repaired instead of removed? Today the golden rule is to save the meniscus. And if it's from wear, exercise and strength are usually the first step, before the scalpel. Mind you: a knee that catches, locks, or swells suddenly after a blow should be checked soon. That's taking care of yourself, too.
If you remember one thing, make it this: the meniscus is not spare; it's your knee's shock absorber, and what has no replacement deserves care. And at your next visit, ask this: "Doctor, can my meniscus be repaired, or is there an option before surgery?" We're not doctors — this is information so you walk in prepared. See you tomorrow.
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