Clinical success and evolving techniques in radial meniscal tear repair

As new data emerges, the orthopaedic community must update its protocols accordingly. In our recent international multicenter retrospective study, we sought to evaluate the clinical success rate and associated risk factors for failure of radial meniscus repairs over a minimum two-year follow-up.

Helito, Camilo Partezani et al. Clinical outcomes of repaired radial meniscal tears: A retrospective study with minimum 2-year follow-up The Knee, Volume 53, 285–292.

Clinical success in radial repairs: the latest evidence

Our recent multicenter study confirms that radial meniscal tears can be repaired with a high degree of clinical success, what many knee specialists have begun to observe anecdotally. The majority of patients in the study who underwent repair experienced sustained symptom relief and avoided reoperation or radiographic progression of joint degeneration over two years.

While radial tears present more complexity than longitudinal lesions, their successful repair brings outcomes on par with other well-established meniscal repair indications. This challenges outdated assumptions that radial tears—especially those in the body or posterior horn—should be managed conservatively or with partial meniscectomy.

How to apply the latest study findings in the operating room

Surgeons should consider the following clinical pearls when deciding whether and how to repair radial meniscal tears, selecting strategies that work for augmenting the repair, and for their patient-specific considerations.

1. Prioritize repair in young, active patients—especially for lateral tears

Radial tears of the lateral meniscus, particularly in young and athletic patients, respond well to repair. The lateral compartment’s more mobile anatomy and often better vascular environment may contribute to improved outcomes. These patients tend to be ideal candidates for preservation.

2. Medial meniscus repairs require caution but are still worthwhile

Repairs of medial meniscal radial tears are more prone to failure, especially when mild degenerative changes are present. This doesn’t mean such tears should be left untreated, but surgeons should weigh the risks carefully and consider adjunctive techniques to bolster healing potential.

3. Use transtibial tunnel techniques when possible

One of the most notable findings from our study was the lower failure rate in patients whose repairs included transtibial tunnel augmentation. This technique not only enhances the mechanical stability of the repair but also introduces bone marrow elements to the repair site, providing biological support for healing.

For surgeons comfortable with tunnel creation, this method can be a game-changer, particularly in tears that present a large gap between the fragments, the ones that cross the vascular zone or those at higher risk of non-healing. Even though it is a promising technique for radial tears repair, some concerns exist regarding meniscus mobility, especially in the lateral side, and this should be further studied.

4. Add biologic augmentation in isolated repairs

When ACL reconstruction is not performed concurrently, the meniscus loses out on the marrow-derived healing boost that comes from tunnel drilling. In these cases, biologic augmentation should be considered. Techniques such as bone marrow venting, bone marrow aspirate concentrate (BMAC), or fibrin clot application can compensate for the absence of intrinsic healing stimuli.

5. Age is a factor, but not a disqualifier

Although failure rates were higher in older patients in unadjusted analysis, age alone should not exclude a patient from meniscal repair. The healing potential must be weighed alongside functional demands. An active 45-year-old with a lateral radial tear and minimal degenerative change may benefit greatly from a repair.

6. Gender trends may reflect risk, not biology

Female patients showed a higher rate of failure in our initial analysis. However, existing literature does not consistently link biological sex with poorer meniscal vascularization or repair outcomes. These trends may reflect activity levels or other confounding factors, rather than intrinsic tissue differences.

Decision-making framework for surgeons

When evaluating a patient with a radial meniscal tear, surgeons should follow a stepwise approach.

1. Assess tear type and location

• Lateral > Medial in terms of healing predictability
• Posterior horn and body tears are good candidates

2. Evaluate patient profile

• Younger, active patients have higher healing potential
• Mild degenerative changes (Kellgren-Lawrence grade 1) are not a contraindication but warrant caution

3. Plan surgical technique

• Inside-out or all-inside repair depending on tear location and access
• Transtibial tunnel augmentation should be considered to improve anchorage and bring biology

4. Consider concurrent procedures always possible in the same surgical time

• ACL reconstruction boosts healing; if absent, augment biologically

5. Tailor rehabilitation protocols

• Standard: 6 weeks non-weight-bearing
• Range of motion limited to 90° in early phase
• Gradual return to sport after 4–6 months based on healing and functional recovery

Redefining the role of repair in radial meniscal tears

The collective evidence now supports an assertive approach to radial tear repair. For decades, these lesions were regarded as “unsalvageable.” Today, they represent a technical challenge, but one that can be overcome with thoughtful planning, biomechanical reinforcement, and appropriate biological support.

Surgeons should treat radial tears with the same commitment to preservation as they do for other meniscal injuries. When repairs are successful, as they so often are, the long-term benefits for joint health are substantial.

Summary: when to repair, and when to be cautious

Repair when:

• The tear involves the lateral meniscus in a young, active patient
• There is no or minimal pre-existing joint degeneration
• You have the surgical access and skill to perform an anatomically stable repair

Be cautious when:

• The tear is medial and the patient is older or has existing chondropathy
• There is a lack of biological support (i.e., no ACLR)
• Transtibial tunnel repair or biological augmentation is not feasible

Ultimately, radial meniscal tear repair should be viewed as a core competency in joint-preserving knee surgery. With growing evidence supporting its success, this strategy can be incorporated more broadly into surgical practice.