THE END OF PARTIAL MENISCECTOMY: FROM THE ABSENCE OF SPECIFIC CLINICAL BENEFIT TO IRREVERSIBLE LOSS OF MENISCAL FUNCTION

Abstract

Arthroscopic partial meniscectomy has historically been regarded as a less destructive alternative to total meniscectomy and became one of the most frequently performed procedures for symptomatic meniscal tears. However, advances in meniscal biomechanics, randomized clinical trials, long-term follow-up studies, and modern preservation techniques have progressively challenged the therapeutic rationale of tissue resection. This integrative literature review aimed to critically examine whether contemporary evidence supports arthroscopic partial meniscectomy as a definitive treatment for meniscal tears, including isolated lesions and lesions associated with other knee conditions, when structured nonoperative treatment, meniscal repair, functional restoration, reconstruction, or treatment of associated pathology constitutes a clinically applicable alternative. The evidence was analyzed across complementary domains encompassing the biomechanical consequences of meniscal tissue loss, comparative clinical effectiveness, structural joint outcomes, the contribution of the meniscus to knee stability, and the expanding concept of meniscal reparability. Randomized trials in degenerative meniscal lesions consistently demonstrated no clinically relevant superiority of partial meniscectomy over exercise-based therapy, physical therapy, or placebo surgery, with findings maintained during mid- and long-term follow-up. Evidence from younger patients with isolated traumatic tears likewise failed to demonstrate clear superiority of early partial meniscectomy over an initial strategy of structured rehabilitation, although these findings should not be extrapolated to all traumatic tear patterns. Biomechanical evidence demonstrates that meniscal tissue loss reduces contact area, increases articular contact stresses, disrupts circumferential load transmission, and may compromise the meniscus contribution to joint stability. Evidence from posterior medial meniscal root tears further demonstrates unfavorable outcomes after partial meniscectomy and more favorable structural and arthroplasty-related outcomes with repair in appropriately selected patients. At the same time, contemporary evidence indicates that chronological age and extension into regions historically considered to have limited vascularity should not, in isolation, be regarded as absolute determinants of irreparability. Advances in meniscal repair, root reinsertion, radial tear restoration, stabilization, biological augmentation, and reconstructive strategies have progressively expanded the possibilities for meniscal preservation, although the evidence supporting biological augmentation remains heterogeneous. Collectively, the available evidence challenges partial meniscectomy as a function-restoring definitive treatment when viable nonoperative or meniscus-preserving alternatives exist. Contemporary decision-making should prioritize structured nonoperative management when surgery is unnecessary and meniscal repair, reinsertion, stabilization, functional restoration, or reconstruction when intervention is required and preservation is technically and biologically feasible. Arthroscopic partial meniscectomy should therefore not remain the standard definitive treatment for meniscal tears when clinically applicable strategies capable of preserving or restoring meniscal function are available.