Lim Y, Lim WB, Bonner T, Wood L, Volpin A. Rethinking meniscal repair in patients over 40: Extending the boundaries of joint preservation. World J Methodol 2026; 16(1): 113664 [DOI: 10.5662/wjm.v16.i1.113664]
Corresponding Author of This Article
Andrea Volpin, MD, Consultant, Department of Trauma and Orthopedics, James Cook Hospital, Marton Road, Middlesbrough TS4 3BW, Redcar and Cleveland, United Kingdom. andrea.volpin1@nhs.net
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Orthopedics
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Field of Vision
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Mar 20, 2026 (publication date) through Feb 10, 2026
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World Journal of Methodology
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2222-0682
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Lim Y, Lim WB, Bonner T, Wood L, Volpin A. Rethinking meniscal repair in patients over 40: Extending the boundaries of joint preservation. World J Methodol 2026; 16(1): 113664 [DOI: 10.5662/wjm.v16.i1.113664]
World J Methodol. Mar 20, 2026; 16(1): 113664 Published online Mar 20, 2026. doi: 10.5662/wjm.v16.i1.113664
Rethinking meniscal repair in patients over 40: Extending the boundaries of joint preservation
Yizhe Lim, Wei Boon Lim, Tim Bonner, Lisa Wood, Andrea Volpin
Yizhe Lim, Wei Boon Lim, Tim Bonner, Lisa Wood, Andrea Volpin, Department of Trauma and Orthopedics, James Cook Hospital, Middlesbrough TS4 3BW, Redcar and Cleveland, United Kingdom
Author contributions: Lim Y and Volpin A conceived and designed the study; Lim Y conducted the literature review and prepared the initial manuscript draft; Lim WB, Bonner T, and Wood L contributed to data presentation and critically revised the manuscript. All authors reviewed and approved the final version of the manuscript and declare no conflicts of interest.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrea Volpin, MD, Consultant, Department of Trauma and Orthopedics, James Cook Hospital, Marton Road, Middlesbrough TS4 3BW, Redcar and Cleveland, United Kingdom. andrea.volpin1@nhs.net
Received: September 1, 2025 Revised: October 10, 2025 Accepted: December 3, 2025 Published online: March 20, 2026 Processing time: 163 Days and 12.2 Hours
Abstract
This article provides a comprehensive overview of current perspectives on meniscal repair, with a particular focus on the evolving situation for patients over 40. In the past, meniscectomy was the most common treatment for meniscal tears in this group due to presumptions about its poor capacity for healing. The paradigm has shifted in favor of meniscal preservation, thanks to recent developments in arthroscopic procedures, a deeper understanding of meniscal biology, and the crucial recognition of the role that meniscal tissue plays in long-term knee health. Results from important primary studies, meta-analyses, and recent systematic reviews are summarized in this article. We address the advantages of meniscal repair over meniscectomy in terms of long-term results and functional preservation, considering conflicting data and the significance of a patient’s unique evaluation. In addition to the substantial influence of biologic augmentation methods like platelet-rich plasma and bone marrow aspirate concentrate in accelerating healing rates, the role of conservative management for degenerative tears is examined. Additionally, we compare all-inside and inside-out repair methods and look at the crucial elements of patient and tear selection, surgical methods, and technological advancements. Future research directions are paved by highlighting unresolved issues, such as the standardization of terminology and outcome definitions. Overall, the findings indicate that meniscal repair is no longer strictly contraindicated based solely on age, with careful patient selection and the strategic application of innovative techniques providing older patients with improved long-term outcomes and significant chondroprotective benefits.
Core Tip: Age alone should not preclude meniscal repair in patients over 40. Careful tear selection and modern arthroscopic techniques can yield outcomes comparable to younger cohorts while preserving chondroprotection and potentially slowing osteoarthritis progression. Emerging biologic augmentation, such as platelet-rich plasma and bone marrow aspirate concentrate, and structured rehabilitation broaden indications. This review synthesizes current evidence, clarifies patient and tear selection, outlines repair tactics and augmentation, and highlights unresolved risks and research priorities shaping joint-preserving care in the middle-aged knee.
