Does Meniscus Removal Result in Bone-on-Bone Contact?
No, removing a torn meniscus does not immediately create bone-on-bone contact, but it significantly increases the risk of developing osteoarthritis over time by altering knee biomechanics and increasing cartilage contact pressures. 1, 2
Understanding Meniscal Function and What Happens After Removal
The meniscus is responsible for transmitting more than 50% of the load across the knee joint and increases joint congruity, which aids in protecting the articular cartilage. 1 When meniscal tissue is removed through partial meniscectomy, the knee loses its ability to dissipate hoop stresses effectively, resulting in altered biomechanics and increased contact pressures on the remaining articular cartilage. 2
Immediate vs. Long-Term Effects
- Immediately after meniscectomy: The articular cartilage on both the femur and tibia remains intact, so there is no bone-on-bone contact. 1
- Over time: The increased contact pressures and altered biomechanics accelerate cartilage degeneration, which can eventually lead to osteoarthritis where cartilage is progressively lost. 2, 3
- End-stage progression: Only in advanced osteoarthritis, after years of cartilage deterioration, does true bone-on-bone contact occur. 3
Clinical Evidence on Post-Meniscectomy Outcomes
Partial meniscectomy combined with ACL reconstruction increases the odds of developing structural osteoarthritis by 1.87 times compared to ACL reconstruction alone, and medial meniscectomy specifically increases these odds by 3.14 times. 4 This demonstrates that meniscal tissue removal is a significant risk factor for accelerated joint degeneration, though not an immediate cause of bone-on-bone contact. 4
Why Meniscal Repair is Preferred
- Meniscal repair should be the first-line surgical option whenever technically feasible because it preserves the protective load-bearing function of the meniscus. 5, 6
- Long-term follow-up studies demonstrate better clinical outcomes and less severe degenerative changes after meniscal repair compared to partial meniscectomy, despite higher reoperation rates. 5
- Even repeated meniscal repairs over multiple years can maintain minimal articular cartilage damage, whereas meniscectomy predictably leads to arthritis progression. 6
Important Clinical Caveats
For degenerative meniscal tears in the setting of existing osteoarthritis, arthroscopic surgery provides minimal benefit and should generally be avoided. 7, 8 The AAOS strongly recommends against arthroscopy with debridement for primary diagnosis of symptomatic knee osteoarthritis, as it subjects patients to surgical risks without addressing the underlying pathology. 4, 7
The only clear indication for arthroscopic intervention in degenerative knee disease is when patients have objective mechanical symptoms such as true locked knee (inability to fully extend). 8
Bottom Line
Meniscus removal does not leave bone-on-bone contact initially—the articular cartilage remains present. However, removing meniscal tissue fundamentally compromises the knee's biomechanics, placing the joint at substantially increased risk for developing osteoarthritis over subsequent years. 1, 2 This is why meniscal preservation through repair is strongly preferred whenever the tear pattern and location allow. 5