Post-operative osteoarthritis following meniscus repair versus meniscectomy: A systematic review and meta-analysis

Objectives: Meniscal tears are among the most common intra-articular knee injuries. Surgical management typically involves either meniscus repair or partial meniscectomy. While repair preserves meniscal tissue, it carries a higher risk of reoperation. Meniscectomy provides faster symptom relief but may predispose to early osteoarthritis (OA). The objective of the study is to systematically review and compare the long-term risk of postoperative OA between meniscus repair and meniscectomy. Methods: The primary electronic database search was restricted to studies published between 2000 and 2025. However, earlier landmark biomechanical and long-term cohort studies were retained where directly cited within eligible contemporary studies or considered essential for contextual interpretation. Eligible studies included randomized controlled trials and prospective cohort studies that reported the incidence of OA following meniscal surgery, with a minimum follow-up duration of 2 years. Two independent reviewers performed risk-of-bias assessments and data extraction using standardized protocols, with discrepancies resolved through consensus or adjudication by a third reviewer. Both narrative synthesis and quantitative meta-analysis were conducted to summarize pooled effect estimates and explore patterns across studies. Results: Thirty-two studies were included in the qualitative synthesis; of these, 10 provided extractable data for quantitative meta-analysis. Meniscus repair was associated with a pooled risk ratio of 0.52 (95% confidence interval 0.41–0.65), indicating ~50% lower incidence of radiographic and symptomatic OA compared with meniscectomy. Magnetic resonance imaging confirmed better cartilage preservation. Repair carried higher early reoperation rates (10–26% vs. 3–8%). Patient-reported outcomes were comparable in the short term but favored repair at ≥10 years. Conclusion: Meniscus repair reduces long-term OA risk and preserves joint function compared with meniscectomy, despite a higher early revision rate. The choice between procedures should be individualized, balancing short-term risks against long-term benefits.