Meniscal injury remains one of the most frequent pathologies encountered in sports medicine, with approximately 61 per 100,000 people annually, corresponding to about 200,000 cases per year in the United States.1,2 A major concern with meniscal injuries is that they pose significant implications for joint biomechanics, cartilage health, and long-term knee osteoarthritis.3, 4, 5 Several animal and cadaveric model studies have shown that meniscal injury leads to increased tibiofemoral contact pressure, decreased contact area, and changes to articular cartilage visualized microscopically.6, 7, 8

Although they involve a single anatomic structure, these injuries encompass a wide variety of pathologies characterized by the tear pattern and location, the patients who suffer them, and the traumatic or atraumatic setting in which they developed, among other features.1,2,9,10 Nonoperative management has been suggested as a relatively successful first-line treatment with a 33% crossover rate to surgery for atraumatic meniscal tears in the middle-aged patient with mild to moderate osteoarthritis.11 A recent study even showed nonoperative treatment to have some success in younger patients with atraumatic tears.12 In the traumatic setting and when nonoperative measures have failed, arthroscopic partial meniscectomy has historically been the most common surgical intervention, although poor long-term outcomes and increased osteoarthritis risk13, 14, 15, 16, 17, 18 have stimulated increased research on and innovation for meniscal repair.

Meniscal repair has been shown to achieve good long-term outcomes and facilitate joint preservation. At 10 years, healed meniscal repairs show no chondral difference on MRI between the surgical knee and contralateral (control) knee in addition to no difference in short- or long-term patient-reported outcomes.19 When compared directly to arthroscopic partial meniscectomy in database studies, repair has a lower reoperation rate, lower progression to total knee arthroplasty, and lower progression rate towards osteoarthritis.20,21 When meniscal root repair is specifically examined, repair has been shown to provide a greater functional improvement and the smallest total knee arthroplasty risk compared to nonoperative care and partial meniscectomy.22,23

A multitude of innovations in our understanding of the meniscus and in technologies for repair, preservation, and restoration are facilitating joint preservation better than ever before. The objective of this article is to share major innovations in meniscal repair devices and implants relevant to preserving the knee joint, and we will discuss cutting-edge all-inside meniscal repair innovations, meniscal root repair developments, orthobiologics in meniscal repair, and meniscal replacement technologies.